Providing rapid-access mental health services for NHS staff

Overview

The mental health and wellbeing of healthcare workers was a concern for the NHS long before COVID-19. But the pandemic led to a dramatic increase in requests for mental health support for staff, while having a detrimental effect on those with pre-existing mental health conditions.

At the height of the COVID-19 pandemic, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) set up a new service providing rapid access to multidisciplinary mental health support for all staff within the five trusts across Cambridgeshire and Peterborough.

Key benefits and outcomes

• The Staff Mental Health Service (SMHS) has had persistently high demand since established. Approximately 4 per cent of staff accessed the service and over 1,000 referrals were made in the last two years.
• The service contacts patients within 72 hours of referral. Around 80 per cent of referrals are offered an initial assessment within two weeks.
• Analysis from patients completing treatment shows significant improvements in relation to depression, anxiety and PTSD symptoms.

What the organisation faced

Reports and evidence show healthcare workers have higher mental health needs and an increased need for mental health support compared with the general population. The COVID-19 pandemic added even more extraordinary pressures and stress.

CPFT recognised an increase in mental health needs of staff, as well as a detrimental impact on those with existing mental health conditions. Key issues triggered were around stress-related mental health problems, depression, anxiety, PTSD or general difficulties responding to stress under the conditions at the time.

Occupational health teams saw their mental health work drastically increase, with some reporting up to half of their workloads related to mental health.

While there are services within the NHS to support staff, these may not be adequate for those with moderate to severe mental health issues, and are not always accessible, especially for shift workers.

What the organisation did

At the height of the pandemic, the deputy medical director at CPFT made the case for a wider, dedicated mental health service for all staff within the five local trusts, independent of their job role, providing rapid access to mental health assessment, diagnosis and treatment.

The service delivers multidisciplinary mental health support and can accommodate people with prolonged and persistent conditions. The team consists of consultant psychiatrists, clinical psychologists, mental health nurses, an occupational health nurse and dedicated administration staff.

The aim is to make a difference in keeping staff well, so they in turn can more effectively care for others.

To access the service, patients require a referral - from the trust’s occupational health team, their GP, through staff support and wellbeing services or another mental health service. They are then contacted within 72 hours to discuss their needs and offered an assessment within two weeks, unless it is decided their needs are better met by another service.

At the assessment stage the clinician will discuss the best approach and arrange a specialised treatment plan to support individual needs.

Results and benefits

SMHS undertakes annual evaluation work which aims to define the socio-demographic and clinical characteristics of people referred to SMHS and identify differences to the general NHS population.

The first evaluation examined the 15-month period since launch. It showed SMHS had a persistent demand in its first year, corresponding to 2 per cent of the total workforce of the local trusts.

More detailed findings included:

• 515 referrals to the service in the first year.
• 39.6 per cent of patients were off work at the time of referral.
• 81.2 per cent of patients were female; 75.3 per cent were of white ethnicity.
• 14 days was the average duration from referral to assessment.
• 85.3 per cent of patients had moderate to severe depression; 80.9 per cent had moderate to severe anxiety symptoms.
• 82.5 per cent of patients scored higher than the established cut-off for traumatic stress, measured by a validated PTSD questionnaire.

A health economics analysis of the service is also currently underway. The SMHS team won competitive funding from the Evelyn Trust to fund this project, in collaboration with the Health Economics Research Group at the University of East Anglia.

The study aims to find out who needs use of the service; most appropriate treatments depending on mental health needs; and whether the service is cost effective. It’s expected this study will provide more robust evidence around cost effectiveness of the service, as well as the benefits around factors such as presenteeism and retention.

The service also receives direct feedback from patients. Analysis from patients completing treatment showed significant improvements in depression, anxiety and PTSD symptoms, with many confirming they are more ready to return to the workplace after treatment, even after long absences, and can focus on work better thanks to timely assessment and treatment. 

Overcoming obstacles

The main obstacles encountered related to funding and recruitment.

Funding

As a new project without clear, proven outcomes, obtaining funding was the biggest challenge. CPFT managed to secure funding through COVID-19 pandemic funds as well as STP (Sustainability and Transformation Partnership), which is funding dedicated for new projects.

Funding was initially secured for a 15-month, fixed-term pilot project and a small team of staff. However, demand for the service quickly doubled compared to what had been anticipated and CPFT built a successful case for recurrent funding to meet this demand and grow the team. Current funding is overseen by the Cambridgeshire and Peterborough Integrated Care System.

SMHS is currently negotiating an expansion of the service to primary care workers and those in local authorities, such as social care staff.

Recruitment

Recruitment was particularly challenging for SMHS in relation to psychology professionals. While the service is now fully staffed, it had a vacancy for a psychologist for several months, which was difficult to fill.

Top tips

• NHS Trusts should be aware there will be staff in their organisation with complex mental health needs.
• Rapid-access services are crucial to providing appropriate mental health support for healthcare workers.
• Services should keep track of data and evaluate performance to inform decision making.
• Investment decisions from senior staff and swift action on the ground pays off.
• Occupational health support is essential in providing reasonable adjustments for staff alongside mental health input.

Contact

For more detailed information about this service, see the SMHS website or email muzaffer.kaser@cpft.nhs.uk.