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Tips for mental health professionals: Caring for people affected by COVID-19

Posted by: Neil Greenberg - Posted on:

Tips for mental health professionals

Caring for people affected by COVID-19

Neil Greenberg [00:00:00] In very broad terms, mental health professionals do have a role in trying to help frontline health care workers who are currently providing care to people affected by COVID 19. It’s important to think about it in three ways. Firstly, how do you prevent staff from developing mental health difficulties?

Neil Greenberg [00:00:19] How do you find out really early on in order that you can provide simple interventions? And then how do you provide treatment for people who unfortunately do go on and develop mental health difficulties?

Neil Greenberg [00:00:30] So in terms of preventing mental health problems, we know there’s a number of things that make a big difference. The most important of these is making sure that the team in which someone works is really supportive. And that means making sure that you get on really well with your colleagues and really importantly that your supervisor or your team leader knows what to look out for in terms of if you’re developing any difficulties. We also know that preparing staff really well for the task at hand also makes a difference. So people who have the right equipment and the right training are much more likely to be psychologically robust than people who don’t. There is a role for mental health professionals in helping supervisors to understand what their staff are going through in order to have a psychologically savvy conversation. And there may also be a role for mental health professionals to help supervisors and team leaders and prepare a brief to talk to their staff about the challenges ahead. Now, it’s likely in the current crisis that many staff will encounter situations which they’re just not used to dealing with. So it might be that there’s too many patients. There’s not enough staff. There may be insufficient equipment. And there may be lots of uncertainties about whether they themselves might get infected or whether their situation at work is something that they wouldn’t be able to cope with. So having a good preparatory brief, which openly and frankly discusses what the challenges of the job ahead is likely to be, can be really helpful. And sometimes supervisors may value a conversation with a mental health professional in order to try and understand how to deliver that brief in an effective way, as well as trying to prevent people from developing mental health difficulties, it’s really important to identify staff who develop distress symptoms really early on.

Neil Greenberg [00:02:27] So it’s really important that trusts and hospitals can really encourage all members of staff to feel confident to put their hand up and say, you know what? I’m finding this really tough. Because if you can adopt a nip it in the bud approach and provide simple interventions early on, then actually in many cases you will prevent people from going on to develop more serious difficulties. And that’s, developing that sort of strategy is something that mental health professionals may have a role in because they can talk to senior managers and help them and understand what the barriers to seeking care are and also help them come up with messaging to try and encourage staff to feel confident and safe to come forward and talk about their difficulties. It’s really important, though, that mental health professionals are not brought in to carry out psychological debriefing or trauma counselling to staff who are going about their job. The evidence from NICE, the National Institute for Health and Care Excellence, is really clear in that psychological debriefing is not helpful. And in fact, can cause additional harm.

Neil Greenberg [00:03:38] So, mental health professionals, even if they want to help their colleagues, really should make sure that they stand back and do everything they can to support the team and the system to look after their staff properly. But the role of a mental health professional can be to support the system to do that, and also to be available to carry out an early assessment, a triage assessment if people are not able to be held within the team and supported there. So if mental health professionals do carry out an early triage assessment, they need to make sure that they keep in mind that the main outcome needs to be return to duty. So to put that all together, mental health professionals absolutely can help assist the system in looking after staff, but they should be doing so in an advisory way and only really provide face to face services if the system can’t look after people themselves. Now, other staff members who don’t feel comfortable in speaking to colleagues or to supervisors might also find that there are other avenues of support that they might want to use.

Neil Greenberg [00:04:50] And that might include speaking to help lines that have specifically been set up in order to deal with the psychological difficulties in the current situation. Or it might involve going online to find resources that makes sense to them and which they find can support their mental health.

If you’re a mental health professional helping frontline health care workers who are providing care to people affected by COVID 19, Professor Neil Greenberg, from Kings College London, offers 3 important things to think about:

  1. How do you prevent staff from developing mental health difficulties?

There are a number of things that make a big difference when trying to prevent mental health difficulties:

  • Ensuring a supportive team environment: making sure that you get on really well with your colleagues and that your supervisor or your team leader knows what to look out for if you’re developing any difficulties
  • Preparation: well-prepared staff are much more likely to be psychologically robust than those who are not well prepared. This includes ensuring people have the right equipment and the right training
  • Preparing supervisors for having psychologically savvy conversations: In the current crisis, many staff will encounter situations which they’re just not used to dealing with such as:
    • too many patients
    • not enough staff
    • insufficient equipment
    • uncertainties about whether they themselves might get infected
    • their situation at work is something that they wouldn’t be able to cope with

Supervisors may value a conversation with a mental health professional in order to try and understand how to have an effective, open and frank conversation to help identify staff who develop distress symptoms early on and to try to prevent people from developing mental health difficulties.

  1. How do you find out really early on in order that you can provide simple interventions?

Mental health professionals may have a role in helping trusts and hospitals develop a strategy to encourage all members of staff to feel confident and safe to put their hand up and say: I’m finding this really tough, by:

  • Helping senior managers understand what the barriers are to seeking care
  • Adopting a ‘nip it in the bud’ approach
  • Providing simple interventions early on
  • Standing back and support the team and the system to look after their staff properly

It’s really important that mental health professionals are not brought in to carry out psychological debriefing or trauma counselling to staff who are going about their job. The evidence from the National Institute for Health and Care Excellence (NICE) is really clear in that psychological debriefing is not helpful and in fact, can cause additional harm.

  1. How do you provide treatment for people who unfortunately do go on and develop mental health difficulties?

Mental health professionals can help assist the system in looking after staff in an advisory way and also be available to carry out an early triage assessment if people are not able to be held within the team and supported there.

If mental health professionals do carry out an early triage assessment:

  • provide face to face services only if the system can’t look after people themselves
  • make sure to keep in mind the main outcome needs to be return to duty

The confidential staff support line or text service, might also be an option for staff not wanting to talk with colleagues or supervisors.

Professor Neil Greenberg is an academic psychiatrist based at King’s College London UK and is a consultant occupational and forensic psychiatrist. Neil served in the United Kingdom Armed Forces for more than 23 years. He is a past president of the UK Psychological Trauma Society and he chairs the Royal College of Psychiatrists (RCP) Special Interest Group in Occupational Psychiatry. Neil has published more than 250 scientific papers and book chapters related to the psychological health of the UK Armed Forces, organisational management of traumatic stress and occupational mental health.