How did COVID-19 impact frontline workers?

Emma Scarborough

Emma Scarborough

UKCP psychotherapist Emma is a volunteer psychotherapist for Frontline19 as well as their Referral Coordinator. She also has a private practice working with adults, children and young people

Mental health challenges are the biggest cause of sickness absence in the UK with approximately 70 million working days lost each year, and our NHS healthcare workers are not exempt from this mounting issue.

Frontline19 is a service that was established in response to the first COVID-19 lockdown to support the emotional health needs of our NHS workers. The service aims to provide short-term, effective psychological support for the health and wellbeing of our frontline colleagues.


A snapshot of our work

With the help of volunteer counsellors, psychotherapists and psychologists offering a wide range of therapeutic models including trauma focussed interventions, we have been able to support our NHS clients. The vast majority cite stress, anxiety and depression as their reason for requesting support, but we are seeing increasing numbers of clients with trauma and PTSD diagnoses.


Moral injury

Moral Injury has without a doubt been a major cause of many of the presenting issues we are seeing amongst our clients. One volunteer described moral injury as having “responsibility without power which then triggers stress, shame and guilt”.

In my own experience as a psychotherapist and Frontline19’s Referral Coordinator, it is not unusual to hear about a trainee dental nurse redeployed to ICU, an intensive care unit with a 1 to 6 nurse to patient ratio (it should be 1 to 2), a doctor having to decide which patient should receive the last available ventilator and paramedics with inadequate PPE.  Crucially, these are people making life and death decisions without having the training, expertise or equipment to do so, and many have been left so traumatised that they have left their jobs or are on long term sick leave.

As a short-term service, it has also been important during the initial assessment to try and ascertain whether the client is bringing stress and anxiety caused by their work in over-stretched hospitals or if it is historic trauma which is now unmanageable because of their current workload.  I am very aware that I need to work with what is troubling the client in the here and now rather than uncovering archaic issues which are unlikely to be resolved after only 8-12 sessions, therefore leaving the client uncontained and vulnerable.

I have found myself needing to access more supervision than usual in order to manage my own distress at so many harrowing accounts of our clients’ work during the height of the pandemic, and even now as the mental health implications continue to be seen.


How can psychotherapy help?

We know that therapy supports positive outcomes, and feedback from our clients suggests that our service has enabled them to process their challenging experiences and to re-engage with their work.  At this year’s International Practitioner Health Summit it was acknowledged that the numbers of NHS workers requesting psychological support are growing post COVID and it is essential that we continue to provide this essential support.

As pandemic burnout takes a stronger hold, it is vital that the NHS overcomes the stigma attached to mental health problems and strengthens therapy provision for its staff by building on funding and initiatives like Frontline-19. An over-reliance on those psychotherapeutic professionals who can volunteer means that, in the long-term, services are harder to access. At a time when NHS staff face a real-terms drop in pay, it is the least they are owed for the sacrifices they have made over the past two years.


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