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NHS medics battling to save lives on the coronavirus frontline are seasoned professionals.
Part of a health service battered by austerity over the last decade, our doctors and nurses have grown used to overwhelmed hospital wards, double shifts and making split-second decisions under pressure.
But experts say the unique challenges of Covid-19 – and the sheer volume of patients needing critical care – are pushing NHS workers to breaking point and that a PTSD (post-traumatic stress disorder) crisis looms for the NHS.
PTSD is usually associated with soldiers or sex abuse victims, but the condition can affect anyone who has experienced a traumatic event or witnessed threats to a person’s life.
Sufferers are known to “re-experience” the trauma, often with nightmares, vivid flashbacks and even physical reactions, such as sweating and increased heart-rate. Angry outbursts, suicidal thoughts, sleep deprivation or feeling detached and emotionally numb are also symptoms.
The condition is notoriously difficult for doctors to spot, as symptoms can begin months or years after the trauma.
Andrew Molodynski is the British Medical Association’s mental health policy lead and consultant psychiatrist at Oxford Health NHS Foundation Trust.
He believes the risk of a PTSD epidemic is not yet recognised and could see “tens of thousands” off sick either during coronavirus or in the months and years that follow.
“There are well established links between trauma of any sort and PTSD, and health workers are being exposed to prolonged anxiety, uncertainty, pressure and witnessing death on a scale most will not be used to,” he told HuffPost UK.
Doctors, nurses, paramedics and even staff such as cleaners and porters are at a heightened risk, he believes.
A lack of personal protective equipment (PPE) – despite scores of health and care workers thought to have lost their lives to the disease – as well as the struggle to prioritise the sickest and most needy while seeing patients separated from family due to infection controls are taking a toll, he said.
“Many – tens of thousands – of NHS staff with PTSD, amongst other conditions such as depression and anxiety caused by or contributed to by the overall Covid-19 situation, will lead to large scale staff absences and also increased suicides amongst those who have saved and helped so many,” he predicted.
“I don’t think a staff member having PTSD is likely to cause an incident. More commonly it will lead to staff sickness and the need to be off work and have treatment at a time when the demands will still be huge.”
Laurence Alison, professor of psychology at the University of Liverpool, said NHS staff will not just be haunted by what they have seen, but the decisions they will have to make.
Doctors will struggle with “colliding values” – such as wanting to connect families with loved ones who could be dying, but needing to protect others from the contagion.
“I think that is going to be a struggle, because part of what makes them who they are is their compassion for others and their identity as caregivers,” he said.
Realistically, health managers are no longer in a position to prepare staff for the mental health challenges, he added.
“In an ideal world, the preparations would have been made months ago but as with any critical incident, you are trying to catch up,” he said.
“For example, a lot of people will find it easier if they are told ‘you have been through something awful, you will feel sad, you will feel angry’.
“If people know those things, it can be a lot easier to deal with.”
With many predicting the availability of a vaccine being months or even years away, Allison said the mental health marathon could be just beginning.
“There is also the ongoing nature of it,” he said.
Labour’s shadow minister for mental health, Dr Rosena Allin-Khan, who continues to do shifts on the frontline as an A&E doctor, said there were already signs of the strain being put on NHS staff.
“It’s heartbreaking to witness the toll this virus is having on the mental health of frontline staff,” she said.
“Anecdotally, we’re hearing of rises in frontline staff attempting suicide and of more NHS staff seeking mental health services.
“I’m getting messages at 2am from frontline workers who are unable to sleep because of the stress they are under at work and the risk of passing this virus onto their families. Many frontline staff are palpably scared to go into work – and it’s taking its toll.”
The NHS is working to set up a helpline specifically aimed at staff struggling with the pressures of the pandemic.
It will be manned by as many as 1,500 volunteers and will be open between 7pm and 11pm, while a text service will be available around the clock.
Molodynski describes this as “a good start” but says the government has not “publicly or behind the scenes” given PTSD enough thought.
He suggests an NHS covenant similar to that being brought forward to support the military.
Asked what else could be done, he said: “Public support helps [as does] camaraderie within and between NHS teams, but neither of these will be enough.
“We need to be developing now a system that can provide decent quality medical and psychological input for these staff as they start to present down the line.
“Some have already presented but many many more will. The current mental health system can barely cope as it is and waits can be over a year for basic care – this would be unthinkable for NHS staff scarred by what they have done and seen.”
The psychiatrist said austerity has already left mental health services “genuinely unable to meet the needs of the population humanely”.
Of the PTSD crisis he predicts post-Covid, he added: “This surge cannot be accommodated and will likely lead to an excess of deaths, especially as the recession or depression we are entering will very significantly raise suicide rates too.”
Allin-Khan also said ministers should be thinking now about how to ensure there was a universal standard on mental health once the coronavirus peak subsides.
“The government must ensure that mental health support is available now, for all NHS workers and care staff, for as long as they need it – this must include PTSD services,” she said.
“There must be a national mental health package – not a postcode lottery depending on the resources that local trusts and councils can offer.
“We proudly clap for our carers and NHS workers every Thursday. We need to also show our gratitude by protecting their mental health in the coming weeks, months and years to come. They deserve it.”
Liverpool University has set up an online resource to support NHS staff with their mental health. It can be accessed here.
HuffPost UK has approached the Department for Health and Social Care for comment.