Wellbeing issues facing psychological professionals

A charter has been launched to support the wellbeing and resilience of mental health professionals after a survey revealed rising levels of depression, stress, burnout and bullying in the field. The British Psychological Society and New Savoy Partnership research showed levels of depression rose from 40 per cent to 46 per cent from 2014 to 2015, while the number of respondents feeling like a failure rose from 42 per cent to almost 50 per cent.

The survey, of more than a thousand people who work in mental health and psychology, also found qualitative data to suggest that targets, stress and burnout were major concerns for many. It revealed one quarter of respondents considered themselves to have a long-term, chronic condition, and 70 per cent said they were finding their jobs stressful. Reported stress at work also went up by 12 per cent over the survey period, while incidents of bullying and harassment had more than doubled.

This led to the Psychological Professionals Wellbeing and Resilience Charter being launched at the New Savoy Conference in February 2016, with support from the BPS, NHS England, Mind, Rethink and other key organisations. The Charter states: 'We commit to promoting effective services through models of good staff wellbeing at work. We will do this by engaging in reflective and generative discussions with colleagues, other leaders, and frontline staff to co-create compassionate workplaces and sustainable services.'

Concerns have been raised that, while the Improving Access to Psychological Therapies programme has been important in making therapy more easily accessible, it may have an impact on the wellbeing of staff. Following a stakeholders' consultation event, the Society is aiming to establish a collaborative learning network to reset this balance.

Consultant Clinical Psychologist Dr Amra Rao and Jeremy Clarke, chair of the New Savoy Conference, spoke to BPS President Jamie Hacker Hughes and President Elect Professor Peter Kinderman for their views on the charter, staff wellbeing and the formation of a collaborative wellbeing network. (Their full interview can be found below). Professor Hacker Hughes explained how individual therapists could use the charter: 'The Charter actually provides a new opportunity for people working in psychological therapy services to raise the issue of the stress involved in this sort of work, the consequence of this work and the effects on work life balance, simply by referring to it in meetings and promoting it in the bottom-up way to their organisations, through the chains of leadership up to their Trusts or other employing organisations… to say that a Charter which refers to the work of psychological therapists now exists, that it is very important to us, are you aware of it, and have you signed up to it?'.

Professor Hacker Hughes also said the development of a network should not be limited to health professionals themselves: '[The network] will, of course, involve not only psychological therapists ourselves, the organisations which we work for, and the organisations that train and accredit us, but also policy makers. As the network progresses, there needs to be a development of a way of forming clear links with policy makers so that psychological wellbeing of staff is something that is always at the forefront of their minds when making policy that might affect staff working in psychological therapies services.'

Professor Peter Kinderman said he saw the Charter as central to the work of the NHS: 'Policy makers are increasingly seeing as a central aim the improvement of the quality of life and to do that we need to develop measures of what matters to people in terms of genuine factors that contribute to their wellbeing. I see the Charter as saying the same thing: this is something important that matters to us and it is from this – finding better ways of maintaining good staff psychological wellbeing – that everything to do with compassionate, effective services will follow. Psychologists should be at the leading edge of this work'.

The Learning Collaborative Network is due to be lunched on 21 June 2016.

In conversation with BPS President Professor Jamie Hacker Hughes & President-Elect Professor Peter Kinderman

Interviewers: Dr Amra Rao & Jeremy Clarke

Background: The Leadership & Management Faculty of the British Psychological Society's Division of Clinical Psychology (DCP) in partnership with the New Savoy Conference is involved in raising the importance of wellbeing in the workplace. Psychological professionals play a pivotal role in enhancing the mental health of the general population. The profession has made tremendous and wide-ranging contributions in recent years to the national drive to increase the access to psychological therapies successfully. However, recent staff surveys have highlighted a concerning increase in the stress levels of psychological professionals, which is bound to reflect on the quality of care provided and the client/patient experience.

The British Psychological Society (BPS) has been engaged with the National Savoy conference in conducting annual wellbeing surveys and setting out stakeholders' consultations. The Psychological Professionals Wellbeing and Resilience Charter was launched at the New Savoy Conference in February 2016, with the support of the BPS, NHS England and other key organisations. The Society is currently engaged in establishing a learning collaborative network to reset the balance between staff wellbeing and the drive to increase access to psychological therapies. Given the significant concerns emerging about staff morale and stress, BPS President Professor Jamie Hacker Hughes & President-Elect Professor Peter Kinderman were invited to give their views on how they see the Society responding to and supporting the Charter.

Amra: Why is the Charter for Psychological Staff Wellbeing important?

Jamie: The New Savoy Conference and the BPS Staff Wellbeing Charter is extremely important because for the first time it actually puts the problems facing our psychological therapies workforce on the map and begins the process of asking those organisations who employ psychological therapists to take into account staff wellbeing and to treat it as importantly as all other aspects of their work.

Peter: For me there is a fundamental principle to do with the commonality between what we are trying to achieve in our work in mental health services and the importance of psychological wellbeing to everyone's quality of life, including our own as professionals. The two concepts are indivisible. So what is at the heart of what the Charter seeks to achieve is nothing other than what we are trying to achieve also for our patients.

Jeremy: Could you say a little about how you think this links with your work with the ONS (Office for National Statistics), Peter?

Peter: Yes. As you know I'm on the technical advisory group for the ONS work on measuring national wellbeing. This is an initiative that derives from the work of economists such as Joseph Stiglitz and Amartya Sen and has been picked up by the World Bank and the OECD (Organisation for Economic Cooperation and Development). Essentially, we are saying that policy makers should have as a central aim the improvement of the quality of life and to do that we need to develop measures of what matters to people in terms of genuine factors that contribute to their wellbeing. In a way, I see the Charter as saying the same thing: this is what matters and it is from this – finding better ways of maintaining good staff wellbeing – that everything to do with compassionate, effective services will follow. Psychologists should be at the leading edge of this work.

Amra: There are other initiatives in the BPS for professional development & support. Why do we need a Charter for Wellbeing?

Jamie: What sets this Charter apart from other initiatives is that it is intended to be a Charter adopted by several organisations. It is not just confined to the BPS but will also involve several other organisations who either employ psychological therapists or through whom psychological therapists are trained and accredited.

Peter: For me there is this broader point in relation to employers, to help them understand an approach to wellbeing as opposed to an approach to managing staff sickness. When I saw you were launching this Charter that was the reason I felt straightaway this is something we definitely need to sign up to ourselves.

Jeremy: What would you like to see happening with the wellbeing survey?

Jamie: The BPS has supported an annual staff wellbeing survey and the results were made known at the New Savoy Annual Conference. I think that it is very important that the results of this survey are made widely known in as much detail as possible so that: firstly, people working in psychological therapies can be aware of the fact that they are not alone and that many other people are sharing the same experiences as them and that, secondly, the results need to be shared with as many employee organisations, policy makers and accrediting and training organisations as possible so that they can actually take the results into account.

Peter: What the survey is showing is that there is a clear risk of staff burnout for a significant number of the respondents. This is going to lead to the kinds of problems that the Francis Report identified: a loss of compassion in our work if we don't do something about it. So I think the survey is very important in shining the spotlight on the state of staff wellbeing in psychological services as a key indicator for whether those services are sustainable. It also has a very practical purpose. It tells us that some of our services and organisations have clearly got to start to take some steps to address how to improve their staff wellbeing. So I think it's a tool in a very practical sense that organisations can begin to use for that.

Jamie: As far as the national survey is concerned it needs to be supported to be done on an annual basis, with the results being made known and publicised and shared as widely as possible with psychological therapists and employing and accrediting organisations. These annual surveys will generate a number of publications in the psychological literature and this will be another important way of disseminating the results and encouraging further engagement. 

Amra: Following the roundtable discussion, which you were a part of at the conference, Jamie, what do you want to see happening regarding the wellbeing collaborative network development? How do you hope this new network will be developed?

Jamie: There were two key things that came out of the roundtable: (a) the tool being developed should be made widely available and used in as many settings as possible so that the results may be replicated, and (b) the network should develop into a real active network of people sharing their experiences with their issues, sharing their experiences with the tool, sharing their views of the results that have been obtained by the tool and sharing the vision for the way forward.

This will of course involve not only psychological therapists ourselves, the organisations which we work for, and the organisations that train and accredit us but also policy makers. As the network progresses, there needs to be a development of a way of forming clear links with policy makers so that psychological wellbeing of staff is something that is always at the forefront of their minds when making policy that might affect staff working in psychological therapies services. 

Amra: We are keen to address abdication of responsibility and to facilitate conditions to foster shared responsibility and partnership. This will inevitably require engaging with all stakeholders including training bodies, employee organisations, policy makers as well as professionals themselves. What are your thoughts on engaging professionals to work with us as, with all good intention, we simply cannot, and should not, do it all on their behalf.

Peter: I think this is a very important point, Amra. One of the tasks for your new network will be to try to clarify these areas of responsibility. If I think about myself, for example, I have involvement with the BPS and with Liverpool University. Its clear to me that both those organisations have a responsibility and an interest in maintaining good wellbeing for their own employees, and that is something I can probably help influence. I also have a role within Mersey Care NHS Trust, which is a big provider of mental health services, where we have the same duty to look after the wellbeing of our staff as well as the core task of improving wellbeing for our patients. The great advantage of a network is that it brings together different organisations and stakeholders whose collective influence goes wider than any one constituency interest because for me this is an issue that goes wider than the BPS, wider than employers and the NHS, its an issue for society as a whole.

Jamie: Talking about psychological therapists and people working in psychological therapies, we have to be a part of the network as well as having official representation of our body. So in the case of BPS, for example, I would imagine that you could have people who are speaking as psychologists or as psychological therapists and just speaking from that view rather than speaking from the view of the organisation such as a Society president or a chair of one of the Society's divisions. There must be a way of engaging therapists as well as the organisations which we work in. We all need to work on this together.

Peter: Yes, I would think that all BPS members, for example, are interested in promoting wellbeing and that this is a common aim across all of them. Like Jamie I think that building an alliance around this Charter with other organisations will be extremely useful for achieving that common aim. But the three of you have already been closely involved with getting this off the ground, so really I'm excited to be joining this discussion and looking forward to working with you. I'd like to listen a bit to what each of you thinks are the ways forward with this.

Jeremy: There is a range of people asking for help; there are individuals who are at the front line delivering treatments, there are people who are trying to be the clinical leads and the managers of those services who have got challenging targets to meet and the staff team to keep the morale up, so maybe whilst keeping a common aim we could also start talking about differentiating between those groups and what they need.

Jamie: One way of doing that is that in the network meetings between the annual conferences – the network focuses on different groups and tries to engage with clinical leads or service leads or individual therapists. This will allow a focus on different roles and needs but of course a lot of people have duel roles that can bring rich contributions.

Amra: We are keen to avoid instilling fear in our own workforce. People who are leaders and managers are employees themselves and are part of the system. We have noticed some anxiety emerging in the system following the survey results as if we are criticising the services. This project is about supporting staff wellbeing, which includes managers and leaders as well as frontline staff as we are all in it together. Whilst meeting the service needs, we also need to reflect on own experiences to consider the impact of our work on us and, in turn, on the service quality. It is really important that we listen to experiences at all levels to avoid risk of isolating people, as this would come in the way of mobilising the system to improve wellbeing for all.

Jamie: Absolutely. A good thing to do at a very early stage would be to have an early meeting with people in the front line rather than just having meetings with the Directors of Trusts, just to get that emphasis right. 

Amra: How do individual therapists use the Charter to reset the balance?

Jamie: I think the answer is that the Charter actually provides a new opportunity for people working in psychological therapy services to raise the issue of the stress involved in this sort of work, the consequence of this work and the effects on work life balance, simply by referring to it in meetings and promoting it in the bottom-up way to their organisations, through the chains of leadership up to their Trusts or other employing organisations to say that a Charter which refers to the work of psychological therapists now exists, that it is very important to us, are you aware of it, and have you signed up to it?

Individual therapists also have a role to play in helping organisations to address this area or, in some cases, to draw their leadership's attention to the fact that actually their organisation has signed up to it or to say that they are a member of an accrediting group, to flag that up, for example: "I am a member of X and as such my organisation has signed up to the charter so what are you going to do about it?".

There are two levels:

Firstly it is a way of saying: "Look. This Charter applies to my work and me so it is really important so it is something that I need to think about."

Secondly, to say that this is something that the whole leadership in the  organisation needs to think about. If they haven't signed up to it then they need to think about signing up to it and if they have signed up to it then they need to enact it and engage with it.

Jeremy: That's useful but I think there is a stage further to that that we have discussed but we didn't really resolve in our earlier meetings about this project, which goes into the sort of territory of whistleblowing. Is there any mechanism in how we are going to develop this project where we could anonymously collect feedback in such a way that the identities of those people are protected so that they feel that they can do what you just said, that they don't feel they are in a position to draw attention to the existence of the Charter because the atmosphere in the service is just too difficult for that?

Jamie: There would have to be some central reporting mechanisms so that people could file an anonymous message about their concerns. I am totally for supporting whistleblowing and publicly did it at the beginning of my Presidency.

Jeremy: There is one way we could do it for the time being by having a feedback form on the New Savoy website, plus a link to the BPS website alongside the Charter, whereby we allow people to submit a written form, but without them requiring to identify themselves or, if they wish to identify themselves, to give them a confidential email or telephone number to follow-up with that.

Jamie: We would encourage people to raise the existence of the Charter with their leadership, organisation and Trusts but if for any reason they feel unable to do that there is a mechanism where people could confidentially raise concerns through the New Savoy and BPS websites.

Amra: As part of preparation of the Charter, I spoke with a whistle-blowing service. They highlighted the need to manage whistleblowing robustly while meeting expectations and setting out standards of confidentiality. Whistleblowing is a stressful process for all involved. We would need to think more and carefully about the framework, standards and appropriate resources. 

Jamie: That's right. It is important to investigate the mechanisms and to consider the options and resources necessary to set it up.

Jeremy: Well, then we can set up a feedback form as a way of consulting people. A question on the form could be: "At this stage we are not in a position to provide a helpline but how do you think that the  BPS and NSP could best provide support for people in your situations?" and get some suggestions from people themselves.

Jamie: I hope that the Charter network can become a force for change and a voice so that we can speak to policy makers and  we can then seek to have meeting with individual Trusts if it really takes off.

Amra: The NHS staff survey results for  Allied Health Professionals are not very encouraging. We need to link up with relevant monitoring bodies to have a joined up approach on improving staff morale. How do you see that happening?

Jamie: The link with the Chief Allied Health Professionals Officer (CAHPO), equivalent to the CMO or Chief Medical Officer would be important.

Jeremy: I have another question related to individual therapists. So obviously we know that some of these are BPS members and registrants but some of them would be outside the BPS. Have you got any thoughts on how we can provide support for people outside the BPS?

Jamie: Well, yes. Most psychological services fall outside the BPS because our clinical division is 10,000'ish and then we have counselling psychologist and health psychologists and others which boost it up to 15,000 or 20,000. But then if you go to organisations such as the BACP, their therapist membership is 30,000 to 40,000 and then there are the charities and then the people who are working independently, so I think that if we have a Charter saying  'If the wellbeing of therapists is really important than that applies right across the board' and they can refer to that and they can engage in dialogue and discussion to raise this issue with their organisation whether it be UKCP or BACP or BPC or whatever. 

Jeremy: How would we liaise with those organisations?

Jamie: We would try to bring them into the network. We haven't yet managed to bring the BACP in the network or UKCP or BPC. But the BPS have just entered into talks into increased collaborations with BACP, UKCP and the BPC, so I think it is just a question of bringing them into the network at some stage.

Amra: Do you think that your collaboration with these bodies would facilitate this as we have come across a few barriers, which we need to understand to build bridges and forge mutually helpful partnerships?

Jamie: Absolutely.

Amra: How do you see IAPT taking staff wellbeing seriously given other priorities such as their performance targets?

Jamie: I think the bottom line is that we want the psychological wellbeing of staff to be taken extremely seriously right across the system so anyone working in psychological therapy services as well as in NHS secondary care, IAPT, early intervention, psychosis or early intervention services - whatever psychological services - the psychological wellbeing of staff needs to be important as highlighted by the Charter. We believe that it is important and we need to ask whether they have signed up to it. We are going to work together to improve it to the benefit of our staff and IAPT is no exception.

How many people work in IAPT services?

Jeremy: Around 7,000 all together, we should get an update from the recent workforce census shortly.

Jamie: That's a lot of people and we were saying at the conference and at the roundtable that staff wellbeing and how services look after staff wellbeing should be a matrix, that employers should be measuring staff wellbeing and that when CCGs are giving contracts they should be looking at what measures organisations are taking to look after their staff wellbeing as a factor which determines whether or not they get the contract, and that would apply to IAPT as much as anybody else. It's a matter of bringing people like this into the network. 

Amra: Would you be thinking of setting out standards for staff wellbeing?

Jamie: Yes. We do need to develop them but they need to be across the board. I remain committed to the project, as it requires support all across the board.

Peter: And I would like to thank the three of you really for the hard work you have put in to getting this started. This is something I will definitely be supporting. The BPS have already signed up to the Charter. It has been fascinating for me listening to this conversation because I think you know that both as a clinician and a researcher the subject of wellbeing has been central to my work. Indeed, I have an ESRC grant for a Cabinet Office supported study that will be looking into what works for creating wellbeing in communities. I just want to say that I see this being at the heart of what we are trying to do as psychologists and as core to our professional role. I'm looking forward to working with you, therefore, on taking the Charter forwards and making sure that it has a real impact in the way you have been saying.