‘You need it more than I do’

Working within the Clinical Psychology department at an acute hospital during the Covid-19 crisis has revealed some unexpected outcomes. The initial mystery we faced was the minimal uptake of the staff support service, openly available to all hospital staff to help manage this difficult time. After several meetings and discussions as to why this might be, I decided a useful course of action would be to find out from the horse's mouth, why our medical colleagues were not making use of the support we were offering. Exploring this has left me with more questions than answers. 

Unsurprisingly I came up against a barrier in trying to pin down intensive care staff to hear their perspectives. After all, it would be naïve to think that those who are extremely busy caring for Covid positive patients would have the time to discuss a service which they do not appear to have time to access in the first place. This seems to be the case across most hospitals in the UK; reports have raised concerns that those working on the frontline are completely consumed by the task at hand and will only begin to show signs of psychological distress once things begin to settle (e.g. BBC News in April and May). With the media focus on frontline staff, I was curious as to how the hospital staff in other wards were coping. Were they not coming forward for help because they really didn't need it?

I interviewed Nurses and Consultant Anaesthetists whose roles require them to visit all areas of the hospital, across all specialities (babies, children, adults and end of life care) to review patients following surgery. This means that they have no permanent base within the hospital, and in working across wards they have a real flavour of working at the hospital during the Covid crisis.

I began to get a sense from the interviews that the staff did not see themselves as the ones who needed support, despite sharing their worries rather openly with me. There was a theme of anticipatory anxiety, fearing what could or might happen, with this being fuelled by the media, in particular the coverage of Northern Italy's outbreak. Exacerbating this anticipation was the fact that should there be a surge of Covid cases, the Anaesthetists would be responsible for intubating patients, and the Nurses potentially redeployed into intensive care, resulting in feeling hypervigilant and on constant standby. On the flip side, they almost seemed to disregard these anxieties as unwarranted, when referring to 'not being in the thick of it' and therefore the staff working in other wards 'must be' having a much more difficult time than them. In other words, it appears that the hospital staff are so busy considering others' emotions that they do not take the time to focus on their own and do not seem to recognise that their own anxieties are no less valid than their colleagues' on the frontline.

In addition, guilt has become much more prominent in those not working on the frontline over the past few weeks. Ward Sisters have expressed their concerns to the Psychology department that their team feel they could and should be doing more. Staff who have had to work from home to shield themselves have shared their worries that they are not contributing enough, whilst their colleagues hold the workload alone. Many of us have experienced 'imposter syndrome' when being named as 'heroes' by the rest of the nation, and feel undeserving of the praise we are receiving. The staff members I spoke to individually carried all of these uncomfortable emotions on top of fear and anxiety, but there was disconnect between knowing this, and at the same time not accessing the psychological support to discuss these difficulties. 

Is it the guilt itself that stands in the way? Some people I spoke to described feeling that they would be burdening the psychologists with matters which (from their perspective) seemed trivial compared to difficulties they imagined others were enduring on the frontline. Does the media's focus on frontline staff further reinforce the idea that non-frontline hospital staff should be okay and therefore add to this feeling of guilt when not okay? Reading between the lines, there was a collective idea that the psychology service would be great for others who were really struggling, but that it wouldn't be appropriate for 'me' to use. However, the support service is for all staff, with no anxiety too small to discuss. When reflecting on this, I found it difficult to see why others did not think they could use the psychology support. I realised this may be part of the problem. As psychologists, considering our mental health is second nature, but perhaps for others, speaking to a Clinical Psychologist may seem like something you only do when day-to-day living is near impossible. Despite society's growing awareness of mental health issues, it seems we still have a long way to go, particularly within physical health settings. These are very real emotional difficulties that hospital staff are experiencing, but if they are unable to justify accessing support then they may go under the radar and suffer in silence. In a world where we preach 'it's okay not to be okay', why do we find it difficult to apply this to ourselves? Should we instead be saying 'it's okay not to be okay, no matter your situation'? 

Perhaps having more of a presence throughout the hospital would encourage staff to feel confident to seek psychology support when it is really needed. In being familiar with the psychologists and the types of intervention that they provide, psychology would be viewed as 'the norm' within a hospital setting, rather than something only introduced during a crisis or following a major trauma. Interestingly, the staff I spoke to seemed to echo this idea, in identifying a need for face-to-face accessible psychology support within the hospital at all times, not just in the middle of a crisis. One Nurse summarised this with 'psychologists can be very good at keeping us sane, as opposed to managing us once we're insane'. 

If this is a service worth pursuing, then something needs to change within physical health settings. Certainly the Clinical Psychologists want to provide the necessary support for their colleagues, but are faced with the dilemma of not having the time or funding to do this once we resume regular clinical work. Further to this, we anticipate that some hospital staff could develop post-traumatic stress symptoms in the coming weeks and months. It is vital then that people feel able to come forward for help and when they do, the appropriate services are available in order to manage psychological distress in hospital staff. In looking after them today, they can look after us tomorrow.

- Olivia Sutton, Assistant Psychologist, Pain Management, Norfolk and Norwich University Hospital NHS Foundation Trust