Providing mental health support to frontline medics during the pandemic

By Samantha White

Finding ways to help frontline clinicians cope with the psychological impact of the COVID-19 pandemic was a priority for Dr Sandy Mather and her team at the Intensive Care Society from the outset.

In her role as CEO, Sandy was well aware of the pressures members would face. In 2019, the Society had published research which found that around 30% of intensive care staff experience burnout as a result of working in an ICU. That being the case in ‘normal’ times, Sandy and her team knew the need for support would increase significantly. Conversations with clinicians underlined the urgency of that need.

“I remember distinctly a meeting we had with Italian colleagues on about March 4, 2020, and the president of the Italian society, it seemed to me, was virtually in tears. He said, ‘The standards that you have, you can’t meet, because there are too many patients coming in. We can’t intubate them fast enough.’ ”

By March 18, clinicians in the UK were describing a similar influx of COVID patients who needed to be intubated and ventilated, noting that they weren’t responding to treatment in the expected way.

Intensive care practitioners are experienced in, and take great pride in, treating and supporting patients who are critically ill, explains Sandy. “But listening to their experiences in that first wave, when they didn’t know how to treat COVID, there was a cognitive dissonance for them.” In addition, they were witnessing a far higher number of deaths: around 50% of COVID patients in intensive care were dying, compared to around 20% of patients under normal circumstances.

“Round about May, I remember one of the clinicians said he couldn’t tell more than five families per day that their loved one was going to die, or had died. He said it was too much to take - just emotionally draining. He was used to having that conversation with maybe two families a week.”

To help members working under these conditions cope with what was happening, Sandy and her team created a comprehensive ‘Wellbeing And Resilience through Education’ project. Given differing attitudes to mental health and wellbeing in ICU, the team strove to offer as many ways to access support as possible. In addition, it was the Society’s intention to provide as much education as possible for free, since many nursing and allied health professionals working in intensive care do not receive funding for their CPD.

At the beginning of the pandemic, the Society had just eight staff members. “We’re not a rich charity, we’re very small, so we had to go out to the public and ask them to fundraise and support us by donations.”

Psychological support
Once the plans were approved by trustees, a Consultant Clinical Psychologist was appointed to lead the project. This new Wellbeing Director then recruited 15 practitioner psychologists to provide one-to-one support to Intensive Care staff.

Clinicians were offered six one-hour sessions, and to encourage as many people as possible to participate, the application was based on self-referral. “People didn’t have to ask their NHS Trust, or disclose the request to anyone. They didn’t have to be a member of the Society either – this was open to everyone. We also developed a baseline business case so that units could tailor it for their hospital and apply for funding locally to appoint a dedicated Practitioner Psychologist for their site.”

Sandy was astounded to find that just 70 individuals applied for the sessions, from a membership of over 3,000. The lower-than-expected uptake of talking therapy underlined the importance of providing clinicians with a wide range of ways to access help.

Peer support
Another strand of the wellbeing project was funded by the COVID-19 Healthcare Support Appeal (CHSA). To date, 144 intensive care staff (including doctors, nurses, physiotherapists and speech and language therapists) around the country have received training to identify when one of their colleagues needs to talk to someone, and assist those who may be struggling.

Participants were grateful for the opportunity to be involved and looked forward to implementing what they had learnt in a combination of theory and practical sessions. One clinician commented: ‘I found the explanations of stressors, moral injury and distress very helpful and it was easy to then understand how thoughts and feelings experienced in the unit have their place in a wider context’.

Education programme
There have been a range of written resources, podcasts and webinars run through the WARE project to help intensive care staff reflect upon and make sense of their experiences. Psychoeducation, also funded through the CHSA, offered group learning and a reflective space. The virtual sessions gave participants an opportunity to talk about what they had experienced, and provided coping techniques and advice on how to sustain yourself and your team in the long term. To date, a total of 516 people have benefitted from the Society’s psychoeducation programme.

Participants particularly welcomed the opportunity to explore their feelings about what they had been through, and found listening to others who shared similar feelings comforting. Clinicians commented that they had acquired practical advice that they could use to help themselves and others.

To extend the programme’s reach, the Society offered webinars and podcasts which explored how to build greater resilience and thrive, and underlined the extraordinary nature of the pandemic. “Our focus was that this is a systems issue in a terrible situation. It’s not that lots of people are experiencing mental health issues, they’re working in an extraordinary situation that no human would be able to cope with.” These initiatives were well received by the intensive care community. Webinars on wellbeing were attended by 654 people. The Society’s ‘Journey to Work’ podcast, a series of interviews with healthcare staff about their experiences during the pandemic, mental health and wellbeing, had garnered 10,970 listens by January 2022.

Clinical trial
Another option open to those reluctant to access talking therapies involves a clinical trial to explore the potential benefits of a software tool as a means of intervention for intrusive memories. Participants can use the software in their own time.

“People sometimes have unwanted memories that just come into their head. For those working in intensive care, perhaps even just looking at a phone could trigger memories of difficult conversations that you’ve had with families to tell them that a loved one has died. When these memories come back, they bring you back to the feelings of distress you had at the time,” explains Sandy. The trial is in its first stage, and the Society has recruited around 100 participants so far.

Beyond the crisis
After the trauma experienced over the last two years, many senior intensive care professionals are leaving the sector, retiring early or moving careers. In response to this situation, the Society has launched a new programme to develop future leaders, starting in April 2022, with 18 participants across the UK. This was also funded by the Covid Healthcare Support Appeal.  “We’re looking at those leaders from difficult-to-access groups who may not normally go into leadership positions, people who are new to leadership. Leaders have such an impact on the people that they manage, it should have quite a broad reach,” concludes Sandy.

To find out more about how the Society established an international network to share vital knowledge about the behaviour and treatment of Covid-19, click here.