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Mental Health Support: Frontline Staff

Volume 681: debated on Thursday 8 October 2020

I beg to move,

That this House has considered mental health support for frontline staff.

It is an honour to move the motion with you in the Chair, Mr Paisley, now that Westminster Hall is once again available for our purposes. In this unique time of pandemic, the mental health of frontline and key workers should be fully supported. I declare an interest as a former psychologist in the NHS for 20-plus years—I am showing my age—before I came to this House, and as chair of the all-party parliamentary health group and the all-party parliamentary group on psychology.

No one should underestimate the severity of the mental health crisis that engulfs us all as a direct result of the advent and ongoing havoc wreaked by covid-19 across the UK, and indeed worldwide. I thank the organisations that have been involved on the frontline, supporting mental health strategy and the delivery of services, including: the child mental health charter and, in particular, Helen Clark, a former Member of this House; the British Psychological Society; the British Medical Association; the Royal College of Psychiatrists; Mind; the Centre for Mental Health; and EveryDoctor—that is to name but a few. I thank all the other parliamentarians who have taken the time on a Thursday afternoon to speak on this vital issue.

On 5 October, Dr Tedros Ghebreyesus of the World Health Organisation introduced the first global dataset on covid-19 access to mental health services. He said:

“COVID-19 has interrupted essential mental health services around the world just when they’re needed most.”

There were some devastating findings. Before the pandemic, countries were spending less than 2% of their national health budgets on mental health. More than 120 countries —93%—reported that mental health services had been stopped or disrupted during the pandemic, 72% said that mental health services to children and adolescents had been disrupted, and 75% had seen a disruption to mental health services in the workplace. Despite the fact that 89% of the countries surveyed said that mental health and psychosocial supports were included in their national coronavirus response plans, only a shocking 17% had full additional funding to cover the cost of those services. Together, those figures show that there is likely to be an international tsunami of mental health morbidity like no other seen in our time.

The Centre for Mental Health, a UK charity, estimates that in England alone up to 10 million people may need mental health support—including long-term support—for the foreseeable future as a result of covid-19, and that 1.5 million children may require support. Those numbers are a stark warning that the impact of the pandemic will have severe long-term repercussions for the mental health of the UK as a whole.

Those affected will need support for depression, anxiety, post-traumatic stress disorder and other mental health difficulties in the coming months and years. Of course, some groups are disproportionately affected, including those with disabilities, those from minority ethnic communities and those with pre-existing mental health conditions who have experienced increased morbidity during the pandemic. Responding to increased mental health needs must therefore be a priority when a recovery plan is drawn up for both NHS and social care sectors for the future of our public health and in fiscal planning across Governments.

On the impact on frontline staff, the national forecast for adults is that more than 200,000 NHS workers may need treatment for post-traumatic stress disorder, psychological distress and burnout. Although less data has been collected, it is likely that a similar pattern will affect those who work across social care settings such as nursing homes. Research is badly needed. Those staff must not be excluded from or let down by the data collection and resourcing that is required. I would be grateful if the Minister looked specifically at the resourcing of data on the psychological impact of covid-19 in the community, nursing and social care sectors.

The International Council of Nurses reminds us that the effects of covid-19 on the mental health of nurses and the wider health social care workforce is a ticking time bomb. Every Thursday, across the UK, we were glad to show our support for key workers on the frontline, who risk themselves daily as they confront the pandemic on our behalf, but we owe them much more than weekly applause, and Governments across the UK owe them that duty of care.

Data from previous pandemics analysed by the British Medical Journal shows that post pandemic, healthcare workers are at high risk of both psychological illnesses and physical outcomes. For frontline staff, decisions made during the pandemic have regularly determined who to prioritise for care, but they have also felt a lack of control, especially when patients are care home residents who are dying and no treatment has been available for them. Emotionally and physically, having to be there day in, day out for patients as well as their families, who often could not visit relatives in their time of need, has been unduly toiling. That has come alongside the use of personal protective equipment for long periods; times when PPE has not been provided to the extent that it should have been; and long periods of excess working hours, stress and exhaustion.

A study by Kisley and colleagues has identified risk factors for psychological distress for staff in the time of covid-19. Personal care and socioeconomic stressors included personal childcare needs, having an infected family member at one point during the pandemic, and having a lower household income, with fewer choices in how to cope. Trauma is triggered when trusted bodies act in a way that can harm their safety at work, such as the failure to obtain correct or sufficient PPE, or by the breakdown or absence of testing and systems. The study also identified enforced redeployment to care for covid-19 patients, a failure to screen and triage healthcare workers for mental health needs prior to the pandemic, and a reliance on crisis intervention when symptoms develop.

Prior to the pandemic, the British Medical Association set out in a 2019 NHS staff survey that 40.3% of healthcare staff reported feeling unwell due to work-related stress. With the onset of covid-19, the workload for healthcare workers has increased radically. Four in 10 psychiatrists have reported an increase in people requiring emergency healthcare, including new patients, in the aftermath of lockdown. NHS and social care jobs obviously involve exposure to a huge range of potential stressors, including competing demands, interpersonal conflict, complex and life-changing decision making, moral injury, shift work and long hours. Added to that in the past six months is the pausing of the working time directive, the limited scope for time off or holiday periods, the increasing morbidity of patients, and losing colleagues. As someone who has worked in the NHS for many years, I have to say that the loss of colleagues is a terrible shock, and not something that people expect in their day-to-day working lives. That is something that frontline staff have had to cope with in addition to their care roles.

People join the caring professions to make a difference and make others better, but coronavirus has created an overwhelming feeling of helplessness in the midst of this trauma. It should be noted that previous coping strategies that those on the frontline utilised may play out differently if they have to cope with a second or third wave. The adrenaline with which they coped in those vital months so that they could be there to support those in need may be replaced by the dread of going through it all again and the fear of being retraumatised.

I have referred to some of the facts and figures impacting the mental health of care workers, but here are some voices from the frontline, expressed in letters sent to The Guardian and the nationwide EveryDoctor organisation, which has been in touch. One said: “The mental health exhaustion that comes from changing everything about the way you work on a weekly or sometimes daily basis for months is immense. All the while, you can see a light at the end of the tunnel, but then you are bracing yourself for the next disaster: a second wave or winter crisis, alongside mass staff absence.”

Another said: “There is the effect of not only seeing patients die, but losing colleagues. Everyone is struggling with this pandemic, but doctors are responsible for the decision making clinically. We can see that this is not going away. There is no respite in sight.”

Another said:

“I am employed on mental health wards as a support worker, helping people recover from acute problems… Covid-19 has not only affected general hospitals but has also had a huge impact on mental health facilities, which are more often run by a skeleton staff… On top of this we are also dealing with mental health patients infected with Covid-19… As we are not considered to be on the frontline, we are not equipped with proper personal protective equipment. We get a basic face mask, gloves and a flimsy apron.”

It should not be forgotten that school staff are also on the frontline, as they have to deal with the effects of the pandemic on children in their care. The mental health issues incurred by lockdown in the children they teach everyday are present upon return to schools. Anxiety and stress among a large group of pupils, alongside the experience of bereavement and a lack of community adolescent mental health services for those with acute problems, has been a feature of the recent past. That is alongside reduced assessment and diagnosis possibilities, due to staff having to change their working patterns, often from face-to-face to virtual sessions, after a period during which sessions were not offered.

Innovation will be key in ensuring that we can address the needs not only in the population but among the frontline staff who desperately need support. Using technology and ensuring that there is the capacity and technical knowledge to support the transition to other methods of care will be fundamental. Meeting the mental health needs that arise from coronavirus is a huge challenge, but it is not optional. Just as responding to the threat of the virus itself has tested our resources and resilience, so too will addressing the psychological and emotional consequences.

I am extremely grateful to the British Psychological Society, which has provided specialist guidance. I know that it has also been working with the Scientific Advisory Group for Emergencies and with the Minister’s office. It wants to see the planning of psychological support and resourcing of the psychological workforce to meet demands in the NHS and care homes and also in schools and the community. It also wants to see increased access to an in-house employee wellbeing service, which it believes will be critical, particularly if unemployment issues face the population in the coming months. It wants to see the employment of psychologists to focus specifically on staff. It tells me that it is not feasible, in the long term, to ask psychologists to work with patients in their work time and then to work with NHS staff in their spare time to meet psychological needs. The society would like to see more use of psychologists not just in supporting patients, but in a strategy to support staff over the long term.

My hon. Friend the Member for Midlothian (Owen Thompson) will be covering in depth the work of the Scottish Government in relation to mental health strategies during the pandemic, so I will focus on the issues that have been raised with me in my capacity as chair of the all-party parliamentary health group and the all-party parliamentary group on psychology.

These are some of the questions that I have been asked to raise with the Minister. What steps is the Department of Health and Social Care taking to model and plan for demand for mental health support as a result of coronavirus and the consequent impact on the economy and employment? What additional funding will be made available to mental health providers to ensure that services are covid-19 safe and that they can meet increased demand for support and deliver on existing pledges in the NHS long-term plan for mental health? What resources will be made available for local initiatives that provide early mental health support in our communities, especially for those people who have been bereaved? What proportion of schoolchildren will benefit from the wellbeing for education return funding? How will children’s mental health be supported moving forward?

What resources will be made available to support health and care staff in the NHS, social care and voluntary sectors who are experiencing post-traumatic stress disorder, high levels of psychological distress or burnout? What specialist support will be made available? What resources will be made available to ensure that research and funding are provided for those working in social care settings so that we adequately address their mental health needs alongside the NHS staff population?

What plans are being put in place to protect NHS staff from a potential onslaught of claims against them because of the pressures that they have worked under during the pandemic? That may give rise to a number of negligence suits in the future. That issue has particularly been raised by the Medical Defence Union, which is concerned that staff have often been placed on the frontline with a lack of resources and with a lack of support medically or clinically themselves.

Now is the time when I feel that I and other hon. Members should be responding in the main Chamber to a detailed statement from the Government about their proposals for mental health directly arising from the devastating impact and ongoing effect of covid-19. Such a statement could include ways in which the Government propose to protect and sustain the mental health and wellbeing of key workers and that will be distinctly and separately resourced, rather than relying on any money from pots designed for other purposes. I look forward to the Minister’s reply today. I hope, on behalf of the key workers for whom I have been given the privilege to speak, that she will tell us that the Government have set a date for the announcement of a properly and realistically resourced mental health strategy that will be both integral and central to the overall covid-19 recovery plan.

I thought I was going to be calling Jim Shannon to speak today, but he is not here, as we know, so I call Owen Thompson.

It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing the debate. It is important to focus on mental health, and today we have a great opportunity to do that. I know that my hon. Friend brings a wealth of invaluable professional experience to the topic, which I cannot begin to understand.

In mental health, as with other aspects of health, time needs to be dedicated to caring for and looking after people, to reduce the chances of someone becoming seriously unwell. If we relentlessly push our bodies every day we soon pick up physical ailments, stresses and strains, and they can develop into something more serious if they are not given time to recover. Our bodies will send signals telling us to stop before we collapse, and the same goes for our minds. Downtime is not a luxury. It is essential, and we all need to be able to read the signs before reaching breaking point. The brain is an unbelievably complex organ, and is constantly processing something even more complex—human experiences and emotions. I am amazed that it does not go down, and that something does not go wrong with it, more often.

On the frontline, our carers and health staff have faced the brunt of the pandemic response. We may moan about working from home, or not being able to go to the pub or to see friends, but they see people scared, alone and in pain, gasping for breath. They see families unable to get close enough to offer their loved ones the most basic human comfort—a hug. Dealing with that every day takes its toll.

[Siobhain McDonagh in the Chair]

The World Health Organisation reported a recent review of healthcare professionals finding that one in four was suffering from depression and anxiety and one in three had insomnia during the coronavirus outbreak. There was also an appalling rise in verbal harassment and discrimination and physical violence. No wonder they are battle-scarred.

Switching off from work is made even harder by the fear of being a spreader, which leads to increased isolation when what we need is social comfort and community. Like all of us, frontline staff cannot access the habitual escape routes that we used to take for granted, whether that might be going out for a drink with friends, to the theatre or to live music, or experiencing the warmth and excitement of the crowd at a football match. Those things just are not possible just now. With NHS resources cut by years of austerity, staff were already working at or beyond capacity before the pandemic, so they had to find a whole new superhuman reserve of energy when the crisis struck. Sheer willpower, determination and dedication keep the staff going and I cannot thank them enough for that, but after eight months with no end in sight more and more of our critical staff are getting to breaking point, traumatised, running on empty, and mentally as well as physically exhausted.

In those serious circumstances it is essentially the responsibility of Government to make sure that there are adequate levels of professional mental health support in place. We need more than a website, an app and a few choicely worded paragraphs in a staff handbook, although all sources of information are very welcome. Any port in a storm, I suppose we could say. We need more trained psychologists and counsellors available to provide tailored support—human faces with experience and expertise in their field. We need to make sure that people are able to talk and share experiences with others, to be listened to, get a bit of breathing space, and be guided to get more help and treatment whenever they cannot cope.

I know that NHS England, like the Scottish Government, brought in helplines to help staff dealing with covid-19. I welcome those efforts. The Scottish Government also established the national wellbeing hub in May for health and social care staff, which takes a psychological first-aid approach, with resources on self-care and 1,000 hours of coaching for staff to maintain health, wellbeing and resilience. I believe that it is the first of its kind in the UK and I know from the feedback that I have had that it has been a welcome move.

I am pleased to see that the national wellbeing hub includes a section for unpaid carers, because the Carers Trust found that 68% of young adult carers in Scotland said their mental health was worse as a result of coronavirus, and 85% were worried about their own future. Those 12 to 17-year-olds, who already have responsibilities beyond their years, are living in an age of anxiety unimaginable when all of us in the Chamber were their age. I recently hosted a virtual meeting with young people in Midlothian to talk about their lockdown experiences and concerns, and it was deeply worrying to hear how many issues they raised, including those related to their mental health, and how little they felt listened to by many of those in power.

Health & Safety Matters reports that a survey

“into the mental health of frontline staff and healthcare professionals has revealed that over 90% believe there is not enough mental health support available for the general public to deal with the aftermath of the pandemic and 66% felt there is not enough workplace support for healthcare professionals and frontline staff.”

We rightly call our frontline workers heroes, and we admire their courage and dedication, but those in Government need to look after them and not just praise them.

It is good to see carers, who have insultingly been called “low-skilled” by some in the Government, getting the recognition they deserve, but most key workers do not have a choice but to keep going. They would rather not risk their mental or physical health for a care badge or a clap. They should be proud of their jobs, but pride does not pay the bills or keep them and their loved ones safe. I suggest the best thing the Government could do is to find an appropriate way of honouring those heroes in our NHS, care sector and essential services who work tirelessly day after day to defeat coronavirus and look after all the rest of us.

It is indeed a pleasure to speak for the Opposition with you in the Chair, Ms McDonagh. I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing this extremely important debate and other hon. Members for their thoughtful contributions. I pay tribute to all staff on the frontline, far too many of whom have made the ultimate sacrifice while trying to keep us safe and well. Their unwavering courage in standing up to the virus, knowing full well the risks to themselves and their families, has been inspirational and truly deserving of the gratitude of Members across the House.

From the very beginning of the pandemic, health and care staff have made immense sacrifices. When we were asked to stay home to avoid the virus, they were going to work and facing it head-on anyway. They were sadly left unprepared, with PPE problems and no access to testing that lasted for months. Ahead of World Mental Health Day on Saturday, this is a fitting time to acknowledge that frontline staff have a unique need. Everyone across the country has had their life disrupted, but our frontline health and care staff have had to deal with patients, colleagues and friends dying on their watch. As the hon. Member for East Kilbride, Strathaven and Lesmahagow said, nothing prepares you for losing a colleague, particularly when you think it could have been avoided. Frontline staff are trained to deal with high-pressure scenarios, but even then, they were not trained to tell people that their loved ones had died via phone calls. Covid-19 has stripped the humanity out of grieving.

The additional pressure has undoubtedly had a significant impact on the emotional wellbeing of frontline health and care staff. They have had no break, no support and no relief from the Government. Fatigue and burn-out are setting in on an already exhausted workforce, who are in desperate need of respite. We need only look at the latest NHS staff absence figures to grasp the true magnitude of the hidden crisis. Over half a million sick days were taken by NHS staff in England because of mental ill health in May alone—one month. Half a million days in just one month.

For context, those absences account for almost a third of all NHS absences for the month of May. In comparison, 200,000 fewer sick days were taken for covid-related illness during the same time period. Let us remember that it was around that time that the virus was causing the most damage to our country, when hospital admissions were still high and transmission was rampant. Even then, for NHS staff, mental ill health still accounted for more time away from the frontline than any other reason. A survey conducted by NHS Providers of its membership at the tail end of June showed that 92% of NHS trusts were concerned about staff wellbeing, stress and burn-out following the pandemic.

The evidence is clear. If we are to expect NHS and care staff to deal effectively with an impending second spike in addition to the care backlog while approaching winter flu season, they must receive mental health support. They need it tailored for them. All health and care staff have given their all. Many have been redeployed, have been working in fear without adequate PPE, have lost colleagues or members of their own family, and have never been trained for something like this. The Government need to act. They cannot simply cherry-pick who they are going to support.

Just as Ministers have an obligation to protect the physical wellbeing of frontline staff by providing them with PPE and ensuring that their work environments are as safe as possible, they also have an obligation to protect the mental wellbeing of frontline staff, guaranteeing them access to psychological therapy if and when they need it, and need it they certainly do. It should be a moral imperative for this Government to ensure health and care staff have the practical and emotional support they need to do their jobs. Based on what little support they have been offered so far, it does not seem like it is.

It is not as if the Government have not had ample opportunities to address the growing need. Labour recognise it and we have put forward our own plans to support the mental health of the entire health and care workforce. Our care for carers package, which we launched in June, would have guaranteed access to counselling and psychotherapy to all 3.1 million health and social care workers. It would be offered nationally and completely confidentially. Currently, that is not available to the majority of the workforce. The package was designed in consultation with those on the ground—nurses, paramedics and porters—who are leading the fight against coronavirus. The Labour party has said that not a single frontline worker in our NHS or care workforce will be left behind. Everybody is equally valuable.

I want to share a couple of testimonies. During our consultation, an ambulance worker and member of the GMB trade union said:

“My team of ambulance staff have lost a close colleague to Covid, as many have in the nursing and care sectors. Every death is tragic. The stress on the team, the issues of grief and loss, the fact that it could have been them, for some survivors guilt, it has had a big mental health impact…I worry about my colleagues and future patient care.”

Care home workers were just as fraught. One told me:

“It has been really emotionally hard supporting residents when they are dying without their loved ones close by. Then we have had to support and reassure their family members and provide information about their last moments. There’s a lot of questioning going on—could I have done more, could anyone have done more, were the residents’ lives valued in the way we would want them to be?”

She continues:

“I am a really strong positive person and I have been a carer for over 15 years. But at the moment I really don’t think I could mentally carry on if there is another wave of Covid, I just don’t think I would have the strength to go through it again. There is definitely going to be a mental health crisis in the care sector.”

Those types of testimonies are sadly far too common. Staff are desperate for help, yet nothing has been forthcoming from this Government. Care for carers would have given the workforce the support they need, yet in June, when I requested a meeting to discuss the proposal, the Health Secretary and the Minister responding today refused to meet me. Given the sheer scale of the problem, I ask the Minister whether she will meet me to discuss the care for carers package, so that together, with a cross-party, conciliatory approach, we can give our frontline care and NHS workers the mental health support that they need. I hope she will reconsider the offer.

Ahead of winter and a second spike, the Government must learn the lessons of the spring. We must fight for the mental health of those who have supported us so courageously during this crisis. Just last week, the Centre for Mental Health predicted that 10 million people across the UK will need mental health support as a consequence of covid—8.5 million adults and 1.5 million children. If we are ever going to be in a position to match that need, we need to first protect the mental wellbeing of our healthcare workers. Only then, if we do that thoroughly and fairly, can we expect them to protect the physical and mental health of the nation. I hope the Minister agrees that without the proper resources being made available to our frontline staff, we risk further damaging the health of our country.

I echo the sentiments of the hon. Member for Tooting (Dr Allin-Khan): it is an absolute pleasure to see you in the Chair, Ms McDonagh. I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing the debate. I have heard her speak many times in Westminster Hall, including when I have been in the Chair. She always speaks with passion, particularly on this subject, and she always bring her experience as a consultant psychologist. We are the better and the richer for it.

The onset of the covid-19 pandemic in March was the beginning of a hugely challenging time for all our frontline staff, who have so brilliantly supported our essential frontline workers. I echo everything that has been said in praise of our frontline workers. They have been beyond exceptional—beyond words. I spoke to some of them this week. When they were going into work in March and April, every day it got a bit worse. Every day they had no idea what they would face that day, but they did it, sometimes working 12 hours without a break. Those staff in ICU went on a hugely emotional journey with their patients. As we know, the pathology of covid once someone is in ICU changes very rapidly. That took some getting used to for the staff who were nursing those patients—one moment they thought they were doing fine, and the next their condition fell off a cliff. That was hugely challenging emotionally for the staff who were nursing those patients.

I endorse everything that has been said in the debate, and I give my thanks and praise to staff. They worked long hours doing emotional and draining work, which is why it was important to ensure that support was put in place. We know that staff resilience has been tested to the nth degree, and the Government recognised early on that this would be a difficult situation and that we had to prioritise the mental health of the staff who were working in those very challenging conditions—not just staff in ICU and in hospitals, but staff who were working in care homes and social workers, too. That is why, at the beginning of covid-19, we commissioned NHS England and NHS Improvement to develop a comprehensive package of emotional, psychological and practical support for NHS workers. We ensured that the same offer was in place for all social care staff and their colleagues in the NHS, wherever possible.

Throughout the pandemic, NHS and social care workers have been able to access a dedicated and confidential staff support line operated by Samaritans, which is open from 7 am to 11 pm. It is there for people if they have had a tough day, if they feel worried or overwhelmed about what they are facing at work, or if they have a lot on their mind that they need to talk through. Trained advisers are available and can help with signposting to further services, or they can simply listen in confidence. A text helpline runs parallel to the phoneline and is open 24/7 to all NHS workers, social workers and care staff. A separate bereavement helpline has also been established by Hospice UK; it is manned by a team of fully qualified and trained bereavement specialists. So we had one-to-one care, the helpline, the text service and the Hospice UK bereavement line available for frontline staff.

Alongside the helplines, workers were given free access to a range of mental health and wellbeing apps, including Daylight, Sleepio and SilverCloud, and there have been over 150,000 downloads of these apps by key workers. For NHS workers, virtual staff common rooms have been established in partnership with NHS Practitioner Health. It has given staff the opportunity to reflect, share experiences and find ways to cope with how covid-19 is affecting their life at home and at work. Line managers have also been given the tools that they need to effectively support their teams through covid-19. For example, mental health conversation training has helped to equip NHS managers, supervisors and those with caring responsibilities for NHS staff to confidentially hold local, supportive and compassionate mental health and wellbeing conversations.

In addition to everything we have done through the NHS and the Department of Health and Social Care to provide a complete safety net and blanket of support around our NHS staff, the trusts went further. There are amazing stories of what some trust managers put in place straight away for their staff, including making space in the hospital where staff could go and download, and talk about their day; putting in place a practice of buddying up with another NHS worker; and putting into practice the process of staff not just finishing shifts and giving a handover report, as they used to, but then having a coffee session afterwards to debrief and go through what had happened that day. NHS trust managers also need to be praised for the huge package of care that they put in place for their staff, going over and above what the NHS supplied. NHS England and NHS Improvement also launched a new framework that enables employers to buy in additional occupational health and support for their staff.

Additionally, in partnership with the trusts, chief social workers published guidance for social workers and social care professionals, which can be accessed via Skills for Care. It explains the need to support the emotional wellbeing of employees during and after the pandemic, what managers can do to support that and what social care professionals should do to support themselves. To support our frontline workers more widely, NHS mental health services have remained open for business throughout the pandemic; no mental health services closed or ceased to look after patients during the pandemic.

In fact, during the pandemic we were able to accelerate parts of the long-term plan. For instance, 24-hour mental health crisis helplines opened across our trusts throughout the pandemic. Every one has been established and every one is now open. They have not been open long enough for us to gather data on how many people have used them and how they have been accessed, but I have heard anecdotally from ambulance support services, who are aware that the helplines are being used, that they know the helplines are working because there are fewer call-outs for mental health crisis.

To increase support throughout the covid-19 pandemic, we provided £5 million to national and local mental health charities, through MIND and the mental health consortia. On 22 May, the Chancellor announced a further £4.2 million for mental health charities as part of the Government’s UK-wide £750 million package of support for the voluntary sector. These additional moneys for mental health charities will support adults and children, including frontline and key workers. However, we still have to go further. We continue to learn from our experience during covid-19.

On 18 September, we published, “Adult Social Care—our COVID-19 Winter Plan 2020/21”, for adult social care settings outside the range of support we are making available, to ensure we support the workforce throughout the winter. A tough winter is coming, so as well as everything we have put in place, we need to go further to ensure that those services continue to be provided throughout the winter and that we have well-established support for our frontline workers.

As part of what we are doing throughout the winter, the NHS is in the process of setting up a first wave of staff mental health hubs, which will provide proactive outreach and engagement; overcome barriers to seeking help for frontline staff; build capacity in local employer organisations or teams; provide rapid clinical assessment; and provide care co-ordination and supported onward referral to deliver rapid access to mental health treatment. These hubs will be particularly useful and successful because we can focus mental health services into the infrastructure of the hubs. That will be of huge additional benefit, along with everything else that we have been providing to frontline staff. We are committed to providing essential mental health support to our frontline workers as they continue their work in response to the covid-19 pandemic. Ensuring that the health and adult social care sectors are well staffed with colleagues, to look after patients and prevent the pressures from becoming too great, is an absolute top priority for the Government.

The hon. Member for East Kilbride, Strathaven and Lesmahagow asked a question about clinical negligence claims against staff. There is a clinical negligence scheme for trusts that provides indemnity cover for all staff. I knew that was in place, because I signed it off at the beginning of the pandemic; I just could not remember what it was called. No staff member or frontline worker needs to worry. This is, I believe—I will be corrected if I am wrong—aside from what is provided by the Medical Defence Union and what normally applies. This package, which I believe came about as part of the emergency coronavirus regulations, is available to all staff, and all staff are covered.

We are committed to continuing to provide services to staff. If I went through every trust and listed every measure and initiative that has been put in place to support staff, I would be here for quite a long time. As well as the helplines, the apps, the one-to-one psychological care sessions provided to frontline staff, the trust support, the download rooms, the buddying up and the coffee debriefs, additional trust-by-trust measures have been put in place. As we know, staff were also provided with free meals. A huge package went in, and rightly so. This was not just a job during the recent pandemic, and it will not be in the future.

The hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned post-traumatic stress disorder. We are going into a difficult winter, so I made inquiries this week as to what evidence we have about the rise in mental health issues that she spoke about, and other things. At the moment, we are seeing that the pandemic has had an impact on those with pre-existing mental health issues, as we would expect. Somebody who already suffers from bipolar, schizophrenia or a medically diagnosed mental illness will have found the pandemic challenging, and they will still find it challenging. The same is true for people with eating disorders—I think the hon. Lady has spoken about this—which I regard as the most serious of all mental health issues, because they are linked with morbidity. One in five people with eating disorders dies, and that is the highest morbidity rate of all mental illnesses. There is support here. That is why we have provided funding to increase the capacity to deal with those who have eating disorders and who need quick access to someone they can talk to.

We know that those with pre-existing mental health conditions are going to suffer. It is really important that we unpack wellbeing from mental health. There is some very unhelpful dialogue taking place that does not help people at all. We may see in the newspapers or hear people saying that suicide rates are going up, but they are not. We have no evidence of that; in fact, the recorded suicide rate from April to June was down. That could be for a variety of reasons, and we will not know what the true rate is until next year. However, we know that writing and talking in such a way has an impact out there, and that is why we ask the media to be careful about how they discuss suicides. We all need to be careful about how we talk about mental health. As for whether there is going to be a tsunami of mental health problems, I asked the clinical lead director of NHS England about that yesterday, and there is no evidence of that either.

We know that the other group of people who will be impacted are the frontline workers who have gone through the pandemic. As we know, post-traumatic stress disorder takes a long time to manifest, so those people may not even be presenting. We are expecting a problem, but it has not manifested itself yet. I do not have to tell a clinical psychologist how long it can take for the impact to fall out, but apparently it can be some time. We have prepared for that and we expect to see it in the future, but it has not happened yet.

I say that we should unpack wellbeing and mental health because a lot of what people are experiencing now—anxiety, apprehension, fear of the unknown and fear of covid—is a wellbeing issue, and it is normal to feel like that. Nobody ever goes into an adverse situation without experiencing such emotions. It is okay, and very normal, to feel anxious and fearful in an adverse and quite frightening situation, and people will develop their resilience. We want people—particularly frontline workers and students—to reach out and talk to their friends and their family, and to use the support networks that they would normally use to get through a difficult situation.

The problem arises if those feelings persist over a long period, and if that happens, we then urge people to seek help. However, we are not at that point, and we are not seeing that manifest yet in referrals or people seeking help. What we know is that people are going through a phase of anxiety. We therefore launched Every Mind Matters, because we need to provide people with the tools to get themselves through a difficult situation of anxiety and fear. Every Mind Matters launched for adults and, on 8 September, for children. It is now launching for students, too, alongside Student Minds.

Interestingly, when we talk about mental health, there is almost no such illness that cannot be helped in some way, and no experience of wellbeing that cannot be assisted, but people need the tools. They need improving access to psychological therapies services, 70% of which are available online, and tools to get them through such difficult situations. Those tools are available on Every Mind Matters, which I believe has had 2 million downloads for adults. They are there to help people get through. It is amazing that people do not know what they should do—I did not, until I looked into this—and how they should help themselves to get through a difficult situation now.

I caution everyone that we need to be careful about the language we use, such as “falling off a cliff edge”, or the “tsunami” of mental health issues. According to the clinical lead at the NHS yesterday, there is no evidence to support any of that yet. Hundreds of surveys are going on, some of which are showing that some people’s mental health has been improved—some people are enjoying working from home and do not ever want to go back to doing the commute, which they now realise was making them feel pretty miserable. They are welcoming the social change that has occurred. It is not at all a case of one size fits all, and that is why we need to be careful.

Hopefully, we are prepared, particularly when it comes to frontline workers. The services that they require have been put in place, after consultation with frontline workers, and we will have even more ready as we move forward into the winter.

Thank you, Ms McDonagh, and I thank everyone who has spoken. It is vital that we continue to raise awareness of mental health, particularly for frontline workers. Saturday is World Mental Health Day, so it is apt that we have spoken about the issues today. The fact that 2 million people have downloaded the Every Mind Matters app shows that the population are reaching out for mental health support, that mental health is at the front of their minds and that they want support to build their resilience.

It is absolutely correct to view mental health as a continuum, but something such as a pandemic can push people who were perhaps coping well previously towards the end of the continuum where they need additional support. Those supports have to be stepped and matched to their clinical needs. Some will have acute clinical needs, and others will be able to cope with the support of family and friends or colleagues, and in different ways. Support needs to be matched. We need to ensure, right across the UK, that best practice is shared; that people work together so that when something is rolled out, it works extremely well; and that there is dialogue and sharing for all staff in the NHS of the four nations.

Before I finish, I want to mention that next year—when we have events back, which I hope will be towards the summer—the all-party parliamentary health group will host awards for staff who have shown themselves to have supported others, whether patients or their communities. I would be so pleased if the Minister and the shadow Minister were able to attend. I can let them know about it well in advance.

I also want to bring up something that I wrote to the Prime Minister about, which I hope to hear about at some point in the near future and which can perhaps gain cross-party support. That is to have a national memorial for those who served on the frontline and lost their lives during this pandemic. I hope that is another discussion that can be taken forward from today.

I thank everyone who took part. I know it is late afternoon on a Thursday, but it is so vital to pay tribute to all those on the frontline who have been there to support our needs in this time of crisis. We must always be mindful of supporting their needs, too.

Question put and agreed to.


That this House has considered mental health support for frontline staff.

Sitting adjourned.