Tackling mental health stigma within the NHS now is critical

A junior doctor smiling
Dr. Stephanie Slater

Junior doctor

As part of the Our Frontline campaign to support the mental health of all those out working to protect us during the coronavirus crisis, we’ll be regularly sharing stories, tips and other thoughts about what life is like for them at the moment, in their own words.

Stephanie Slater is a junior doctor training to be a GP. Here she shares her experience, and calls for NHS staff and management to recognise how important it is to look after their mental health during the pandemic.

A young doctor wearing hospital overalls and a stethoscope, standing in a hospital corridor smiling at usIn 2017, during Foundation training, I was told by my supervisor that I was too empathetic to be a doctor.

I was working in a post with a challenging rota, where lunch breaks were frowned upon, negative outcomes were common and my seniors seemed stressed and burnt-out. During this meeting I started crying and admitted that I was struggling to cope. Rather than encouraging me to seek support for my mental health, the supervisor suggested that I might consider a different career.

In stark contrast, when I became unwell requiring time off work in a different post, my supervisor told me directly that my mental health was more important than my job. She encouraged me to seek support from my GP and facilitated a phased return to work. At the time I was embarrassed and ashamed to be struggling, but this supervisor changed how I treat myself and I will be forever grateful to her. I was formally diagnosed with anxiety in November 2019.

Taking time off felt like a moral dilemma

Taking time off felt like a moral dilemma – my colleagues had to take on extra work and I was so worried that my absence would affect patient care. I never wanted a mental health diagnosis because I was told by many that it could affect my employment opportunities. Throughout training I was not taught the importance of looking after my mental health. Working in healthcare can be rewarding and positive, but I was ill-prepared for the gruelling working hours and psychological stress involved. I tell my patients that their health is more important than their job but I find myself in a career where practising what we preach is not yet encouraged.

The hiding and disguising of our mental health fosters negativity and distrust amongst colleagues. Now more than ever we need to work together to tackle the Covid-19 pandemic. Medical staff are facing the virus every day, looking after patients who are reliant on machines to breathe for them, risking transmission to loved ones at home and being subject to sudden changes to rota schedules and redeployment. Little wonder there has been a rise in anxietyAnxietyAnxiety is familiar to everyone; it is usually a normal, useful and effective response in times of heightened stress, and something which can be understood and resolved. However, some people experience intense and prolonged periods of anxiety, which if left...Find out more, depressionDepressionDepression is a low mood that lasts for a long time, and affects your everyday life. In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life but makes everything harder...Find out more and PTSDPost-traumatic stress disorder (PTSD)Post-traumatic stress disorder (PTSD) is a type of anxiety disorder which you may develop after being involved in, or witnessing, traumatic events. The condition was first recognised in war veterans and has been known by a variety of names, such...Find out more.

Whilst significantly more funding is required to improve access to mental health services, it is also vital that leaders take urgent action to improve the mental health culture in the NHS. Our Frontline has recently added new resources for NHS leaders and managers Supporting the mental health of NHS staff: the role of leaders, managers and champions The NHS workforce is facing one of its greatest ever challenges. Prioritising mental health and wellbeing is vital, now more than ever. These guides from Mind and the BMA can help. View toolkit on creating a better working culture and improving conditions for staff’s mental health. Our Frontline was launched by the charities Samaritans, Mind, Shout 85258 and Hospice UK in April 2020 to provide free round the clock, one to one mental health support and resources for those working on the frontline out of a concern for the acute and long-term impact the pandemic could have on key workers’ wellbeing.

Those in leadership and management positions are the ones with the power to break down the barriers that can prevent staff from seeking help

As well as creating more resources for NHS staff to take care of their own mental health, it’s an important step to see guides aimed at those in leadership and management positions as they are the ones with the power to break down the barriers that can prevent staff from seeking help. I would ask managers to spend a shift with a junior doctor, nurse or HCA. I often hear seniors encouraging staff to maintain a work-life balance whilst in the same breath requesting that they pick up extra shifts or insisting that they have a ‘proper’ lunch break whilst dictating a never-ending list of admin and clinical jobs to complete. Whilst this disconnect remains, I do not see how positive change can occur.

Help-seeking behaviour should be encouraged together with reassurance that no negative consequences will follow. There is power in direct conversation – even if it’s over Zoom – and all supervisors should be trained in mental health support. Wellbeing pamphlets and seminars scheduled in the middle of the working day are a nice gesture but they aren’t enough to solve the problem. NHS leaders need to make it clear that mental health is as important as physical.

A hospital doctor wearing protective equipment, sitting on a bench next to a coffee machine looking downwards

Teaching and training should focus on how we can look after ourselves in order to benefit our patients. At induction, mental health support ought to be signposted – the NHS Practitioner Health Programme provided me with invaluable support following my diagnosis and yet many of my colleagues have never heard of it. I have also benefited from meeting with a Trust Junior Doctor Coach, but with rising numbers of NHS staff experiencing poor mental health, more support is needed. I find it ironic that we do not have access to talking therapy through work.

Building morale through improving teamwork and communication would enable staff to find positivity in an otherwise stressful day at work, and facilitating increased opportunity for two-way feedback would demonstrate that our opinion is valued. Debriefs following significant events should be mandatory, time-protected and include someone who is trained in mental health support. Lack of ‘safe space’ at work also has a negative impact. It’s important for all staff to have somewhere they can exit ‘work mode’ even for a few minutes.

I hope you know that it's OK not to be OK

Raising awareness of mental health is all well and good, but the stigma will remain until NHS leaders choose to demonstrate its importance through actions to support their staff. For anyone struggling to cope right now, I hope you know that it’s OK not to be OK, that self-care is not selfish and that you are never alone.

Health care workers can access free, round the clock, one to one mental health support provided by Samaritans, Shout85258, Hospice UK and Mind through Our Frontline.

Samaritans also launched a dedicated, confidential helpline for NHS staff which you can call 7 days a week, between 7am and 11pm on 0800 069 6222.

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