It was World Mental Health Day in October 2018. As the day went by, I saw my Twitter feed filling in very quickly with hashtags including #worldmentalhealthday and #itsoknottobeok.
My mind went immediately to the staggering figures of NHS nurses’ mental health sickness absence. Some reports highlighted that mental health is now the primary cause for sickness absence among NHS staff, with a recent study drawing on data from more than 11,000 NHS workers confirming that mental health conditions – depression specifically – accounted for the most working days’ absence.
The costs and consequences of high sickness absence rates are well known. In 2017, NHS staff took a combined 16.4 million days off sick, costing the health service an estimated £2.4bn.
“When nurses’ sickness absence rates are higher, patients are less satisfied with the care they receive”
When nurses’ sickness absence rates are higher, patients are less satisfied with the care they receive, and could experience worse quality of care. Reducing sickness absence is thus high on the agenda of policy makers and NHS managers.
Simon Stevens, chief executive of NHS England, announced a £5 million initiative to improve the health and wellbeing of NHS staff.
Part of the solution put forward includes serving healthier food at NHS workplaces and promoting physical activity; offering yoga and Zumba classes – implying that staff have to take personal responsibility for their wellbeing.
While such initiatives are described as “evidence-based”, we have no evidence of the extent to which they can tackle causes of sickness absence in the NHS.
The research evidence on nurses’ sickness absence points to the importance of work environments; low staffing levels, long shifts and high workloads are associated with higher levels of sickness absence.
How can we ask nurses to be responsible for their wellbeing if a combination of positive work characteristics – which are key to nurses’ wellbeing and performance – are not in place?
On World Mental Health Day I was in Sweden, at the Karolinska Institutet, working with researchers in psychology. With funding from Public Health Sweden, Dr Ann Rudman and her team have surveyed cohorts of nurses every year for five years, starting in their final year as students to monitor their work life experiences.
When I asked how they had pitched this study to the funder, she replied that Public Health Sweden themselves had instigated this area of work. They were concerned by the increasing levels of sickness absence related to mental health issues found among nurses, and responded by commissioning research to better understand the issues to tackle them.
They sought research evidence from experts in the field to develop interventions that target the causes of the problem.
So why the different approach to tackling mental health-related sickness absence among nurses
“We need to be developing and using research evidence to create ‘healthy’ workplaces in the NHS”
One could argue that this was Sweden. This was 2002, long before the global economic crisis and subsequent austerity, but given that workforce shortages are the top challenge facing the NHS, surely the solution should go beyond the recommendation to take up yoga.
Time to be more Swedish: fund research that helps to tackle the causes of nurses’ sickness absence, and understand the pressures that have resulted in more nurses leaving the profession in the UK last year than joined it.
In my view, we need to be developing and using research evidence to create ‘healthy’ workplaces in the NHS. Only then can we expect that nurses’ own efforts to eat more fruit and do yoga will have any significant impact on their wellbeing.
Chiara Dall’Ora is research fellow in nursing workforce, University of Southampton