Mental Healthcare in a Pandemic: Policy and Practice

Rebecca Burgess-Dawson is a National Clinical Lead (Mental Health) at Health Education England. Rebecca is a mental health nurse by background and during the pandemic she chose to be released from her duties at Health Education England in order to support services on the frontline.

My name’s Becky and I’m a mental health nurse.

I’m also one of the three mental health clinicians working within the mental health programme, alongside a clinical psychologist and a consultant psychiatrist at Health Education England, an Arm’s Length Body working with other parts of the NHS to ensure that people have the right skills, values and behaviours to create a workforce fit for today and ready for tomorrow.

I work as an integral member of the mental programme team looking at both the way mental healthcare can now and could in the future be delivered, and the best ways of training and educating all the workforce to be better informed about mental healthcare.

As a healthcare educator, I’ve always believed that there are two ways of being proficient in clinical practice to deliver safe and effective patient care and to support others to do so: competency and currency.

I received brilliant education and training to be a mental health nurse from some outstanding mentors and was proud to pass my exams and qualify; but that was a quarter of a century ago! So, I became competent, but if I wasn’t able to maintain at least an occasional role directly in practice, can I remain current?

This struck me as one of the biggest initial challenges when COVID-19 began to issue its challenge to the NHS.

As a respiratory illness predominantly, that portion of the workforce with skills in intensive care and environments where patients are ventilated were immediately required.

Those with skills from previous roles had to be “refreshed” with rapid yet robust training programmes, and new staff had to have their skills expanded and consolidated. Anyone redeployed into these roles needed their regular duties backfilled by someone else to ensure that services continued to function.

Once again, the will of the healthcare workforce amazed me.

Thousands of student nurses opted to join NHS frontline staff in its response to the COVID-19 pandemic by undertaking a paid placement directly related to helping in the pandemic response, and many more previous NHS staff volunteered to come back and add their efforts.

Health Education England responded with their e-Learning for Healthcare hub packed with learning content, that was made free to access anywhere in the world and without login requirements. Even now as infection rates thankfully fall, interest in an NHS career amongst the public continues to rise.

This gives me great hope for a bright future for the NHS’s workforce in the first instance.

However, as a mental health professional, in some ways I believe there is a whole fresh challenge yet to come, one which will have greater long term demands on the health of the nation.

There is hardly a place on earth where people have not been exposed to psychological trauma as a result of COVID-19 transmission.

Some have lost loved ones during physical distancing that has made the loss even more traumatic. Some people have experienced anxiety and fear like never before. Loneliness and isolation, and a reluctance to seek help from a compromised healthcare system have in many cases compounded the problem. Those with pre-existing mental health issues may have not been able to access or have not yet come forward for treatment.

I have been extremely proud that Health Education England allowed me to be released to undertake an opportunity to be on the “frontline” during the pandemic.

However, in an apparently counterintuitive response, several services that I initially approached with that offer said that a reduction in referrals and interventions coupled with my potential transmission risk meant that they would prefer I did not assist them!

Over the last few weeks, as physical distancing requirements have eased somewhat and the transition is being made to recover “normal” functioning, I have been asked on a daily, and sometimes hourly basis if I can provide assistance to my local mental health services.

It’s been an absolute honour to help whenever I can.

Observing and experiencing emergency mental healthcare once more has reinforced to me that the flexibility in delivering

• directly to the workforce the education and training that they need right now

• in a place accessible to them

• and in a format they can combine with busy clinical practice

has to be one of the key learning outcomes for us as policy makers and implementers in the future.