This update featured in the August/September 2020 Mental Health Nursing journal (Vol 40 #4). For those who aren’t Unite/MHNA members, you can buy your copy online via PocketMags or join and get 6 copies per year posted to your home and access to our back-issues online.
Although may aspects of life still retain a certain level of unsualness, despite some politicians’ efforts to make sure we head back to anywhere that has a bank card reader, some aspects of my job have certainly gone back to the old normal.
For a few weeks since my last update I’ve been working with our members in one trust in the North East, Yorkshire & the Humber. During July the organisation ran a consultation to reorganise their 0-19 year-old services.
Normally this would have been ‘problematic’ as running a consultation while services transition into the school holidays would have been unwise.
To do it during a global pandemic while some people are trying to take a moment’s breath as we navigate from the first wave into a potential second wave is even more difficult. Supporting our members in both groups and via individual discussions has been ‘different’ in that we are having to use video-conference software.
At the same time, the health professionals are having one-to-one meetings with managers and competitive job interviews, and this has also been difficult for staff.
I’m sure we’ll all talk about the comparison often over the next few months, but the way these health professionals are being treated now in comparison with the original COVID-19 message of money not being an object and staff getting their weekly applause, is deplorable.
Impact on newborns
More and more organisations are reporting the impact that coronavirus is having on our population, some of which is being highlighted in this journal. As I write this, the ink has only just dried on a new report from three First 1,001 Critical Days members, ‘Babies in Lockdown’.
As the report highlights: ‘Over 200,000 babies were born when lockdown was at its most restrictive, between 23 March and 4 July.’ The survey of 5,474 respondents suggests that the impact of COVID-19 on these babies could be severe and may be longlasting. The report also found:
- 6 in 10 (61%) parents shared significant concerns about their mental health.
- A quarter (24%) of pregnant respondents who cited mental health as a main concern said they would like help with this, rising to almost a third (32%) of those with a baby.
- Only around 3 in 10 (32%) were confident that they could find help for their mental health if they needed it.
- Almost 9 in 10 (87%) parents were more anxious as a result of COVID-19 and the lockdown. There was a notable variation among respondents who reported feeling ‘a lot’ more anxious: White 42%, Black/ Black British 46%, Asian/Asian British 50%, parents 25 years old or under 54%, and parents with a household income of less than £16k 55%.
Suicide by female nurses
Another recent report is ‘Suicide by female nurses: a brief report’, authored by the National Confidential Inquiry into Suicide and Safety in Mental Health. This was commissioned by NHS England/NHS Improvement in response to a report by the Office for National Statistics that identified female nurses as having a risk of suicide 23% above the risk in women in other occupations. The report says:
- 281 nurses who died by suicide were identified over the six-year study period; of these 204 (73%) were female – these were the main focus of the study.
- Female nurses were older than other women who died by suicide; nearly half were aged 45-54 years (n=87, 43%).
- The most common method of suicide for female nurses was self-poisoning (42%). • More than half (60%) of female nurses who died were not in contact with mental health services.
- 102 nurses who died were identified as patients; of these, 81 (79%) were female and their clinical histories were examined further.
- Their age distribution was similar to that of nurses in the general population who die by suicide, 40% being aged 45-54 years.
- Female nurses who were patients were similar to female patients in other occupations. The main primary diagnoses were affective disorders (59%), followed by personality disorders (19%). Overall 41% had a history of alcohol misuse and 20% reported a history of drug misuse. Nearly two-thirds of female nurses had a history of self-harm (64%).
- Self-poisoning accounted for 48% of the deaths by female nurses. The main drugs taken were psychotropics (33%), opiates (31%), and paracetamol (19%).
- Although prevalence of experiencing adverse life events within three months of death was similar across the groups, female nurses were reported to have more workplace problems (18%).
- There were few differences in the care received by the female nurses and by women in other occupations, though it was less common for nurses to have had a previous short psychiatric admission of seven days or fewer, and they were more often prescribed SSRIs/SNRIs.
In response to the report, I was invited to a ‘round table’ by NHS England/NHS Improvement to consider the report and next steps. Attendees emphasised the fact that this report easily predated the current COVID-19 crisis. While the pandemic may reinforce a need to act on the mental health of NHS professionals, it shouldn’t divert attention from the fact that female nurses needed targeted support before January 2020.
At the meeting there was a presentation on early thinking about a package that could be offered. I’d call this early thinking not because of a slow response from professionals but because it is predicated on the commitment on funding (but more on that shortly).
More meetings are planned, and I will of course keep members updated in this journal and on Twitter. As always, if you need any help or support, please do get in touch with your local Unite representative or contact me directly.
People plan and promise
Another long-awaited document has just been published. The NHS Long Term Plan (in England) has had a problematic history with its People Plan derivative.
We have been promised the full People Plan for ages but it has been delayed. Important documents are often like buses – you wait ages for one to come along and when it arrives it’s quickly followed by a second.
Alongside the People Plan we also saw a new People’s Promise, billed as ‘a promise we must all make to each other – to work together to improve the experience of working in the NHS for everyone’. While this contains some important words, at its launch I did question how this would differ from the NHS Constitution, launched in 2012, which set out the ‘rights for patients, public and staff’. I put the following question to Matt Hancock and Prerana Issar, NHS England/ NHS Improvement’s chief people officer:
“How will #OurNHSPeoplePromise succeed where the NHS Constitution has failed [assuming the constitution has failed if we now need a promise]?”. No answer was forthcoming at the time, so I’ll have to wait till I next see either of them to ask again.
The People Plan did mention mental health nursing, although only to say: ‘…and the development of bespoke Return to Practice and preceptorship programmes for mental health nursing’.
Again, on launch day I highlighted that this falls far short of the promise Matt Hancock made in 2018 at the All-Party Parliamentary Group for Mental Health.
I highlighted the perilous state of mental health nursing numbers in England and he said: “A whole package [on #MentalHealth nursing] of work is needed and this will be published as part of the NHS Long Term Plan”.
I also said that the day before I’d been involved in the All England Learning Disability Nursing Steering Group and had highlighted how their profession needed to see recognition of the work required to grow their profession. Learning disability nursing didn’t even get a mention.
Matt Hancock also made an appearance at the Royal College of Physicians to talk about his solution for all the problems in the NHS. You can watch the talk online. I felt it was a confused presentation. He invoked the spirits of David Lloyd George, Horatio Nelson, Martin Luther King and George Orwell while talking about his seven lessons.
One of my criticisms of his speech was picked up by Nursing Times, where he seemed to be suggesting that NMC revalidation was one of the “bureaucratic barnacles” that needed removing. You can read more about that at https://bit. ly/30x6I79, or look at the thread about the launch and Hancock’s speech at: https:// bit.ly/3gLu6DP.
On all-England plans, a similar steering group has been created for mental health nursing and I attended the first virtual meeting last month. Again I’ll be sharing more on this in this journal and on Twitter.
I hope this plan will reference and be influenced by a few other pieces of work. One is the NMC’s work on post-registration specialist practice qualifications. I’ve been involved in this work and encourage any members who have an interest to join the upcoming webinar focused on mental health nursing. You can find out more information about that via the NMC’s website.
Tune in for #mhTV
In my last update, I highlighted the work we’ve done on #mhTV. Our weekly episodes are reaching about 1,000 people via the live stream on a Thursday at 7pm, and you can watch on catch-up via our Facebook and YouTube pages or listen along on our podcast, #MHpod. You can find the links to subscribe on p21.
Recent episodes have included #BlackLivesMatter, co-occurring mental health and substance use issues during COVID-19, the politics of substance use, moral injury, the Euripides Study, LGBTQI+ and student mental health nurse voices. We also did a wider Unite in Health session with the NMC and the Health Care Professions Council (HCPC) about regulation during COVID-19.