Editor's Note: We have made a couple corrections to this story
As the curtain rises, the senior partner of a busy GP practice struggles with the workload, his next in command is not coping with the pressures of COVID, whilst the manager is on the edge of a breakdown.
Although this is the opener of a play called "Beneath the White Coat" featured in this week's International Practitioner Health Summit: The Wounded Healer, it depicts a scene playing out in many GP practices, and hospitals in the UK as thousands of healthcare professionals struggle with burnout.
'Hope and Healing Beyond COVID'
Data from NHS Practitioner Health, the service offering NHS staff treatment for mental health issues and addiction, show that more doctors presented for care during the pandemic year (April 2020 to March 2021) than in the first 10 years of the service put together. A recent UNISON poll reported that of 10,000 NHS workers, 54% were looking to leave their jobs, of which 67% said they were doing so to protect their mental health.
The depressing implications of these figures on an NHS already overstretched before the pandemic, has been the catalyst for the focus of the Wounded Healer conference (March 17 and 18) on "hope and healing beyond COVID".
Professor Dame Clare Gerada - until recently a clinical leader of NHS Practitioner Health, and whose book inspired playwright Brian Daniels to write the play featured at the conference - stresses the importance of facing the problem of doctor burnout head on.
"Burnout is an occupational disease caused when you are not being able to do the job you want to do," she says. "People are not prepared to be sacrificial lambs like they were, and they are taking time off when they are unwell. Everyone is struggling."
Call for Paid Reflective Space
A number of organisations including the Royal College of GPs, the Royal College of Psychiatrists, Doctors in Distress, and NHS Practitioner Health, are making a joint call to the government and the NHS for urgent action to relieve the pressure on healthcare staff, by ensuring that each one has an hour a month of paid reflective space.
"This is barn door obvious to address the emotional impact of work, to gain support and to make the most of learnings from each other," states Gerada. "People are gobsmacked that people working in healthcare do not have reflective space to discuss the emotional impact of their work."
Charity Arts Programme 'Restore'
A key aspect of The Wounded Healer conference will be the focus on the role that arts and the humanities can play in reducing practitioner stress. The charity Doctors in Distress (DiD), which commissioned the play, has a recently-established arts programme called "Restore", which will be featured in the conference.
DiD started in 2018, and was established after the suicide of cardiologist Dr Jagdip Sidhu, when his brother Amandip found out that three doctors a month were taking their own lives because of work pressure. Now the aim is to reduce that to zero by 2025.
The Restore project provides NHS staff with the space to be creative, has plans to explore four different creative areas: expressive writing, visual arts, music and the 'still space'. Material from workshops on the first two areas will be featured at the Wounded Healer conference.
Use of the Arts to Support Medical Practice
Alongside provided facilitated peer support groups to talk about the emotional impact of medical work, the charity has also partnered with GP Katie Amiel, the founder of The Bigger Picture Collaboration, which looks at medical practice through the arts via the five themes of: connection, compassion, creativity, curiosity and contemplation.
Head of programmes at DiD, Susannah Basile, says that the inclusion of Restore alongside support groups and webinars was revealing the extent of stress in the profession. Comments to her after workshops include: 'I rediscovered joy', 'I'd been in a really dark place', and 'this has helped me to feel light again'.
"People just keep going, keep going until they collapse," she said. "We are growing as an organisation, and that would not be the case if there were not a need. We want to work preventatively, and to normalise talking about distress because, at the moment, there is a huge stigma."
Basile has spoken to a Foundation doctor who told her: "You do not talk about your wellbeing, you lie and say you have a migraine when you are having a tough day mentally. The fear of looking weak or of looking as if you can't do your job is too great."
Lack of Funds
Even acknowledging the problem is not enough. DiD was approached by an (unnamed) NHS trust aware of serious wellbeing problems among its students and Foundation students, and asking for help. But they had not got the £10,000 to pay for a 10-week programme for 40 people.
Can Military Survival Tactics Help?
If surviving under stress is to continue for NHS staff, could anything be learned from the military? Psychiatrist Neil Greenberg, who is Professor of Defence Mental Health at King’s College London, answers with an emphatic 'yes', although he highlights the differences in mindset between the NHS and the army, and in the way they are deployed.
"They are both teams of people doing incredibly difficult things - not individuals," he says. "It's about learning and translating. The military spend a lot of time creating supportive teams, but the NHS often has shifts coming on with changing supervisors, team members and different rotas. The NHS has lost a lot of natural camaraderie that comes from working in a team, particularly as far as mental health is concerned."
In the military, mental health professionals spend time teaching personnel about psychological wellbeing, and creating support systems through a structured method called TRiM (Trauma Risk Management). This aims to prevent secondary PTSD in front line people by involving non-healthcare staff in monitoring and managing colleagues.
"It's not penicillin for trauma, but it’s a good sensible approach," says Greenberg. "There's really good evidence that if you have staff with poor mental health, they are less likely to deliver high quality care."
'Psychologically Savvy Chat'
He also recommends giving all supervisors the confidence to speak to staff about mental health problems. A pilot of REACT - a one-hour active listening skills package -trained 2500 NHS supervisors over Zoom on how to have a 'psychologically savvy chat'. The results, published in Psychological Medicine, showed that beforehand 50% were not confident of having a psychological chat but one month after training, 85% felt confident.
Clare Gerada hopes that this week's wellbeing conference will bring new ideas to the table. She says: "It's about looking at the holistic aspects of being a doctor or a nurse rather than the scientific aspects. How does it make you feel and how do you engage with the caring compassionate part of it when you are in burnout?"
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