Emerging evidence of COVID-19’s unequal mental health impacts on health and social care staff

As we start to take stock of the unprecedented impact of the coronavirus (COVID-19) pandemic and make initial steps towards the recovery of our health and care services, evidence is emerging about the mental health impacts on health and social care staff in the UK: an estimated 3 million strong workforce.

We previously rounded up emerging evidence of the unequal impact of the pandemic on mental health among different groups. Here, we explore the mental health impacts on health and social care staff in the UK and what has been driving these.

Mental health impacts

Understandably, there has been much focus on mitigating physical health impacts of the pandemic on health and social care staff. But there is a sizeable mental health burden that has received far less attention. Health and  social care staff currently face a multitude of acute mental stressors due to their work and a spotlight has been placed on their wellbeing in the wake of the current crisis.

Evidence from previous pandemics suggests that health and social care workers have an increased risk of adverse mental health outcomes, including post-traumatic stress disorder and depression. Negative mental health impacts of this pandemic became apparent even in the early stages. Half of 1000 health care workers surveyed across the UK by IPPR/YouGov in April reported that their mental health had deteriorated since the start of the COVID-19 pandemic. The youngest workers (18–34 years) were hardest hit, with 71% reporting a worsening in their mental health.

In a survey of 1,000 people working in the social care sector in Scotland, also carried out in April, four in five reported that their mental health had been damaged by their work during the pandemic. More than four in five worried about taking the virus home to family, and three in five were worried about a lack of personal protective equipment (PPE).

As a professional group, health and social care staff – especially lower paid staff – have higher rates of pre-existing mental health conditions than the general population. This increases their risk of worsening of mental health as a result of the pandemic.

Amnesty international has reported on the impacts of the COVID-19 pandemic on the mental and physical health of health and social care workers globally. This study highlighted evidence of front-line staff reporting increased levels of tiredness, insomnia, stress, anxiety and depression.

What is contributing to these mental health impacts?

The mental health impact of the risk to physical health

During their daily work, health and social care workers have been at increased risk of COVID-19 infection. This risk of infection, together with fear of putting family members at risk, has been linked to increased mental stress in health care workers internationally. The risk of being infected with and the risk of dying from COVID-19 are not equal among all health and social care workers, which may bring an unequal burden of anxiety.

Of 119 NHS staff deaths reviewed by the HSJ in April, 63% were people from black and minority ethnic groups (only around 20% of NHS staff are from an ethnic minority background). ONS analysis also found elevated rates of COVID-19 deaths in social care workers compared with the general population, as well as among some of the lower paid health care workers (male and female nurses, and male nursing auxiliaries and assistants). This could mean that the mental health impacts of COVID-19 will fall disproportionately on staff from black and minority ethnic groups, and those in lower paid roles, though there is no data available at present to show this directly.

A shortage of PPE

Concerns about inadequate PPE during the pandemic have focused on the risk of infection. But there are wider implications of this for the mental health of the workforce. Studies have highlighted the negative impact on the mental health of staff when a trusted institution fails to adequately protect their safety and wellbeing.

Stress, anxiety and pressure in the workplace

During the pandemic, health and social care workers have had to work in even higher pressure environments than usual. During the peak of the pandemic, it was reported that up to 50% of clinical staff in British hospitals may have been unwell and appropriately absent from work, resulting in excess workload for those remaining at work. Staff have had to make decisions about how to prioritise scant resources to patients who are equally at risk, and how to best provide care for severely unwell patients with constrained or inadequate resources.

Personal circumstances

Caring responsibilities, including having children at home and caring for a family member with COVID-19, have been associated with adverse mental health outcomes. This may be heightened in health and social care staff in several ways. In a survey of health care workers across the UK, around a third of 35–44 year olds said childcare had become a problem.

There have been news reports of health and social care staff choosing to live away from family in order to continue their work and minimise the risk of infecting children and vulnerable household members. There have also been reports of staff in care homes ‘locking down’ with residents and not returning home to their families to protect the residents of the home. It is not clear how widespread these practices have been, but they are another potential contributor to poor mental health in health and care workers. Both being away from family support, and unable to provide care for family, may bring an added burden on the mental health of these individuals.

Addressing the mental health impacts of the pandemic on health and care staff

Evidence from the COVID-19 pandemic to date has revealed a substantial mental health burden on health and social care staff. Evidence from previous pandemics suggests this could lead to a long-term increase in mental ill health in the workforce.

There are real risks that mental health impacts could fall particularly heavily on staff from black and minority ethnic groups, and on those in lower paid groups, and further research is needed to understand this. It should also be noted that there has been relatively little research on the mental health impacts on social care staff compared with health care staff. This should be prioritised as soon as possible.

Understanding the unequal mental health burden of the pandemic on health and social care staff – and the drivers of this – presents an opportunity to enhance the health and social care system by embedding a culture in which the wellbeing of staff is paramount, and a chance to mitigate its inequalities.

As lockdown eases, there is an urgent need to invest in the health of our front-line workforce and to address the impact the pandemic has had on their mental health. What is needed is a recovery plan that focuses on the mental health of health and social care staff.

More on this topic:

• How might the NHS protect the mental health of health care workers after the COVID-19 crisis?

Investment in the workforce is crucial in supporting the recovery phase of our health and social care sectors. This pandemic could become a real opportunity for the NHS and social care to re-orientate a focus on workforce and build systems resilience by addressing the mental health impacts and inequalities. Creating a culture where staff are supported, motivated and nurtured to thrive should be a core strategy – not just for the COVID-19 recovery plan, but sustained into the future.

Esther Kwong is a Public Health Registrar at the Health Foundation.

Louise Marshall (@louisemarsha11) is a Senior Public Health Fellow at the Health Foundation.