Why did we stop clapping? With the decision to stop the weekly clapping we seemingly have done what we always do with mental health concerns and that is to put them out of sight and out of mind. Frontline health and social care staff have faced the brunt of the coronavirus pandemic and will continue to do so. They will also disproportionately face the burden of mental health problems long after the pandemic has passed. Throughout the height of the crisis, staff have been in coping mode but, as things slow down, the real difficulties will arise with many of these workers needing months, possibly years of mental health care after things settle down.

Health workers are extremely resilient and, though used to dealing with difficult and often traumatic situations, the COVID-19 crisis has presented particular risk factors which are impacting their mental health. Frontline healthcare workers are at increased risk of developing symptoms of posttraumatic stress disorder (PTSD), depression and anxiety, with many struggling with insomnia.

While providing the care communities need, many frontline staff have made the extremely difficult decision of choosing self-imposed isolation around fear of spreading the virus, making them much more susceptible to developing serious mental health problems associated with the pandemic. 

Moral injury causing trauma for staff

Frontline staff have been faced with what is termed moral injury, where they have been asked to make decisions that conflict with their moral code around who should live or who should die. The term was developed in trying to describe what has happened to soldiers faced with similar war zone decisions, soldiers who were deciding to kill someone. This element, the moral injury, is particularly pernicious in terms of developing effective help for staff with the trauma they carry as shame profoundly interferes with a successful outcome in therapy. 

Previous research and experience with pandemics/infections have shown that a higher risk of trauma responses are seen in:

• Newly qualified and inexperienced
• Women
• Those socially isolated
• Those dealing with the virus and death directly on the frontline

The NHS recalled many people who had been away from the frontline to cover the frontline and also fast-tracked doctors and nurses in the final year of training to cover wards. The health and care sector is predominantly female at 79% of the workforce.

Risk factors for BAME communities

Additional risk factors exist for those from BAME communities working in healthcare in terms of mortality and, sadly, a high proportion of the staff who have died are from these communities. One in five NHS staff are BAME with a high percentage of those in medical roles. Study after study has shown that BAME community members are more likely to experience significant mental ill-health problems for a range of reasons that are psycho-social in origin including racism, for example.

Another group mostly overlooked are the porters and other support staff who have been dealing with the sharp end of the pandemic in dealing with the huge number of bodies. They are generally the least well trained and supported and are at significant risk.

All these higher risk factors indicate there is a significant risk for our health and social care workforce as they come out of the first wave with worries about a second in the winter. Additionally, the major symptoms don’t arise while still in the situation as we still are. We are likely to see the major symptoms emerge over the next two months. It’s crucial to be monitoring this now and proactively working with staff to help them identify symptoms and seek help. Most medical staff and most support staff outside of mental health have little or no knowledge of how anxiety, depression, and trauma manifest. Any many still fear stigma in asking for help.

It’s already known that pandemics put health and social care staff at risk (and what the mitigation factors are), but the reality is our mental health services were struggling to cope prior to the pandemic with the mental health needs of the general population let alone adding into the mix the additional burden of health workers with complex trauma and grief responses.

Noel McDermott is a psychotherapist with over 25 years’ experience in health, social care, and education.