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Greater focus needed on mental health of NHS staff

Trusts are failing to protect the mental health of nurses and other key staff, according to research that shows many do not have a mental wellbeing policy in place.

A study by the Health and Work Development Unit at the Royal College of Physicians found just 57% of health service trusts in England had a functioning mental wellbeing policy to support employees.

This is despite mounting evidence that the physical and emotional health of staff is crucial to patient welfare and the fact mental health issues are one of the biggest causes of long-term sickness absence among NHS workers.

The report also found less than a quarter of trusts – 24% – were monitoring the mental wellbeing of staff.

The findings were greeted with dismay by nursing leaders and other healthcare bodies.

Peter Carter, general secretary and chief executive of the Royal College of Nursing, said: “These are disappointing figures and we are greatly concerned by the implications for patient care as well as the welfare of nursing staff.”

The findings follow a recent RCN report that found more than half of nurses had been made unwell by stress in the past year.

The Faculty of Public Health said it was in the interests of employers to have effective health policies for staff, especially around mental wellbeing.

Professor Sarah Stewart-Brown, co-chair of the faculty’s mental health committee, said: “Without mental wellbeing it is difficult to have the compassionate and caring professionals the NHS needs.”

Nearly three quarters of NHS trusts took part in the audit, which looked at how well they were doing when it came to implementing official public health guidance for workplaces.

The research, carried out last summer, found only 28% of trusts had a plan to tackle staff obesity. While 76% of organisations offered healthy food in their restaurants, only 27% made similar healthy options available to nursing staff and others on night shifts.

However, the study revealed an overall improvement since a similar audit in 2010. Previously less than half of trusts – 48% – had a mental wellbeing policy while the proportion with obesity plans had more than doubled from 13% to 28%.

Dean Royles

Dean Royles, chief executive of NHS Employers, said:  “At least 300,000 more staff are covered by comprehensive policies compared to three years ago and sick leave has fallen over the same period among nurses and other major staff groups.”

However, he agreed “across-the-board improvements” were needed.

 

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Readers' comments (13)

  • Physical and mental health of staff is irrelevant for most senior managers. We're not important enough to them to justify any kind of care system.

    If a punitive attitude to individuals taking sick leave is adequate to prevent leave rates getting out of hand, who would they bother with anything more complicated or costly?

    It's not like they think of us as people, after all.

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  • michael stone

    Not that I want HCPs to have personal mental health problems - I would prefer nobody to have those problems - it was only after I myself 'became depressed' that I 'got the idea' about depression. Even then, I still only have a reasonable handle on my own experience - it is to an extent 'projection' to think 'so now I understand depression in other people'.

    But if more HCPs themselves suffer from mental health issues, presumably more HCPs will understand mental health issues, which might be a plus point for the wider public ?

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  • tinkerbell

    after being seriously assaulted many years ago in a ward round (patient angry with consultant I was sat closest to the assailant) smashed their coffee mug over my head left partially deaf with permanent tinnitus following the assault it was only my fellow colleagues who offered me support, not even a debrief was offered by management, I carried on working after a week off sick with concussion not realizing I was concussed.

    Nurses look after yourself and each other cos' only very good managers will notice.

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  • At time of writing I am feeling like I am close to losing the plot. I have worked as a nurse for 15 years. I never felt like this before becoming a nurse. Maybe nursing is bad for my health? I thought it was just the menopause!

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  • Response to Michael Stone. "But if more HCPs themselves suffer from mental health issues, presumably more HCPs will understand mental health issues, which might be a plus point for the wider public?"
    Having worked in Mental Health for 19 years I'm unsure why you think health professionals need to experience it to understand it. Should all oncology staff get cancer to understand their patients better?
    More staff with mental health problems reduces efficiency and effectiveness, increases time off, putting pressure on resources thus impacting negatively on patient care. How exactly can that be a plus point for the wider public? Are you saying that the other posters are better able to help patients who have depression/been assaulted?
    More resources being put into mental health care and support for NHS staff may benefit the wider public though surely.

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  • I think Michael has a point in that personal experience can help in the understanding of another's. However to assume it is the 'same as' is a mistake. If you have no experience of another's situation or feeling then you must rely on imagination of what it might be like and careful enquiry and listening.
    The current business model of organisation and funding in the healthcare industry does not welcome resource input, only product output. If we want a better system we must vote for it and stand up for what is kind, moral and humane.

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  • tinkerbell

    If in order to empathise with a patients condition you also had to experience it then I would be a manic depressive, schizophrenic, drug/alcohol addict, with puerperal psychosis, eating and personality disorder, with a polymorphic adjustment disorder & dementia.

    As above imagination of how that must feel is a great asset.

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  • michael stone

    David Wilcox | 30-Jan-2014 6:26 pm

    David, as I wrote in an e-mail to someone last November:

    ‘…although I did end up notably depressed for a couple of years: a new and 'academically interesting' experience, but I wouldn't recommend it to anyone as a learning exercise’.

    So I’m NOT recommending mental illness as an option.

    But observation (even years of observation) is not the same as experiencing something, and one person’s experience of something is not necessarily similar to another person’s experience of ‘the same [clinical] condition’. And even the same person’s sequential experiences [of something with the same ‘clinical label’] might vary, because ‘history’ can affect your next experience (as indeed, in theory, could ‘random variables’).

    So unless having a mental condition also interferes with one’s ability to learn from observing mental illnesses (I suspect that depression wouldn’t – some other conditions, perhaps would), I would expect that an HCP who has also experienced a mental illness first-hand, would ‘have a better handle on it’.

    I used to have an aunt who suffered from depression, and I definitely couldn’t ‘understand’ that, at the time. However, the way depression affected me, was to leave the ‘analytical’ capacity of my brain unaffected, but it TOTALLY removed my ability to enjoy anything at all, or indeed to ‘look forward to enjoying something in the future’. The world ‘turns grey’. I think most people who have had depression, probably understand ‘I can’t be bothered’ in a way most other people don’t ?

    Weirdly, the first sign that this ‘depression’ was lifting, was that I discovered I could be ‘amused’ by certain things again – I’m not sure that I would have assumed that ‘being able to laugh’ would have returned first, but that is how it worked for me.

    I also had a flick through a couple of books about depression – some things fitted my own experience, others didn’t (apparently many depressed people ‘blame themselves for their depression’ – I was very clear about who/what I was blaming, and it wasn’t myself).

    Also, I’m not very ‘empathic’ and what happened to cause my depression also angered me ‘analytically’ – I’m guessing, that other people don’t necessarily have that combination: other people, will have their own ‘variations’ on a ‘theme’.

    But, ‘mental health’ does keep intruding on my own end-of-life issues: notably confusion and conflation between mental capacity and mental health (and confusion between the Mental Capacity Act and the Mental Health Act), and I also have a major issue about the mental health of live-with relatives being damaged (trauma memory creation) because of a distinct lack of balance within, and attention paid to, post-mortem behaviour for EoL home deaths, as I touched on at:


    http://www.bmj.com/content/347/bmj.f4085/rr/654490

    tinkerbell | 30-Jan-2014 7:50 pm

    Tink, imagination is indeed a great asset, unless you imagine something which differs from the reality. I'm very concerned with people 'trying to get inside someone else's head' because having thought about this a lot, one thing I'm certain of is that nobody should be trying to 'get inside the head of the just-bereaved', and that is something that confused 999 Service personel clearly attempt to do, after home end-of-life deaths which are 'confused'. They shouldn't even try - people's brains are so weird in so many different ways just after someone you loved died, that 'trying to get inside their heads' is sheer madness, and people definitely shouldn't be trying to do that.



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  • tinkerbell

    Definitely not claiming to be psychic just saying one can use their imagination to try and understand how distressed someone might be by their condition. Experience is a great teacher and this is why user support groups are the greatest help once someone is stable enough to access them.

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  • michael stone

    tinkerbell | 1-Feb-2014 1:42 pm

    Tink, it was 'try(ing) and(to) understand how distressed someone might be by their condition.' that caused me a problem with the 999 Services when my mum died.

    My mum had been terminally comatose at home for 4 days before she happened to die at 8-15am. I knew she 'had wanted to die' anyway (I'd effectively asked her when she refused to take some prescribed medication) and my arrangement with her GP was 'Call me at the Surgery, or tell the cover GP it was an expected death - there will be no police'.

    Now, I wasn't sure if the GP arrived for work before 9am, so I did what was perfectly 'sane' for me: went to buy my newspaper, returned and checked my mum's skin was getting cold, then phoned the DNs to tell them not to bother to call that day, then at about 8-55am phoned the Surgery to ask for the GP to come out and certify the death. The GP had taken the Friday off as the start of a long-weekend in Europe, the surgery was busy, the receptionist told me to call 999 so I did. I told the 999 operator that I didn't consider this to be an emergency, and that the Surgery had told me to call 999 - she sent an AS crew, but without anybody telling that crew, what I had told the operator.

    So I got a 999 Ambulance screaming up, a paramedic who promptly told me 'the death must be sudden because we were called', he almost immediately called the police in and we then had:

    1) Paramedic wanted some evidence of 'expected death' in the medical notes. There was none - the GP didn't do that, and Coventry did not have a formal Community CPR/VoD policy: but WMAS also covered Sandwell, where a policy would have required such notes, and I suspect this paramedic was 'used to Sandwell, not Coventry'.

    2) Neither this guy, nor any of the police, could apparently grasp that the death at the end of a 4-day peacefully-terminal coma does NOT require any 'immediate action' from a live-with carer (I'm not saying many people would not do something immediately {it seems that most would - or, RATHER, they say that they would, if they have never actually watched a dying comatose relative at home for 4 days} - I'm saying, it depends on the carer: that turns out to be both complex and interesting, but too lengthy to discuss here) - I couldn't work out why they felt such a death DOES require 'immediate action'.

    3) The DNs turned up about 10 minutes after the paramedic and police, and the paramedic did ask the lead DN 'Was it an exected death': I think she answered 'Yes, but not necessarily today' although she 'thinks' she said 'Yes it was an expected death' (we don't actually know - the PCT, which supposedly investigated this fiasco, asked her but when I asked 'and what does the paramedic say she said ?' the PCT had not asked him - by the time I was talking to WMAS, the paramedic had left WMAS and couldn't be asked). 'Yes but not necessarily today' proves, if that is what the lead DN said, that our DNs didn't understand 'expected death'.

    4) My subsequent investigations, reveal that the police were 'using their imagination' by comparing coma deaths of patients in a hospital, to coma deaths at home, and concluding that these 2 things are similar - they are VERY different.

    Etc.

    Anyway, the police bothered me for 7 hours, dragged me off to a police station, finally returning me home to discover that they had attempted to search the house and had removed 2 of my computers, and left me incandescent with fury over the following weekend, and most of this stems from:

    a) using 'imagination' to try and apply 'the wrong past experience' to a situation;

    b) ticking boxes and backside covering 'when professionals are confused';

    c) the wrong protocols [being currently present] for EoL home deaths anyway;


    'Imagination' can be VERY unhelpful !

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  • tinkerbell

    Mike, sorry you had such an ordeal.

    Think you and I have a different understanding of imagination.

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  • Another piece of report by press release without asking any harder questions.

    I note that Dean Royle is let off the hook, and yet again is allowed to make bland statements which do not reflect the reality of how these "policies" are actually put into action.

    An alternative view:
    http://mentalhealthuncovered.blogspot.co.uk

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  • michael stone

    tinkerbell | 2-Feb-2014 6:29 pm

    It wasn't what happened to me - but it is very bad for that to happen - but rather that the protocols and 'mindsets' currently out there, for EoL death at home, mean it would happen again to other people who are, through no fault of their own, entangled in 'confused home deaths'.

    But I am nagging an awful lot of people about this - that doesn't mean it will change, but it might.

    'Patient centred' should not just involve looking at the patient - it should also involve looking through the patient's eyes, and for EoL at home, through the eyes of relatives.

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