"Existential dilemmas that NHS frontline staff faced during the Covid-19 pandemic in the spring of 2020: Reflections of an NHS staff counsellor"
Dr Jackie Sewell – Counselling Psychologist
Whether we like it or not, Summer 2020 has come to an end. This was of course a summer dominated like most of the year by Covid-19. Working as I did during the height of the pandemic as a staff counsellor in the NHS, it now feels the right time to reflect on the year so far. In particular, to reflect on the experiences described to me and other therapists by hundreds of staff as they struggled against psychological implosion.
The experiences described to me by my clients raise some key existential questions about responsibility, survival, identity, values and beliefs.
My memories of their experiences
When I reflect, I am left with two overarching memories. Firstly, the memory of the rich description by staff of their experience of the relentless and often fruitless battle to treat and care for Covid patients while at the same time, fearing for their own health – or even their own lives. Secondly, the memory of how most staff, despite the dreadful experiences they were describing and the obvious toll it was taking to their mental and physical health, continued in their role. They put their patients first.
It is this story of staff putting their patients’ needs above their own that captivated the nation; these staff now became heroes. However, what I heard from my NHS clients is that they didn’t see themselves as heroes – this would have made them superhuman. Such a status perhaps worked for the rest of us. It obscured the truth that these people who we depended on to save us and our families, were actually just like us. They had families too; they experienced anxiety and fears and some of these fears were realised as they saw colleagues – friends of theirs - die of Covid-19. What made their experience tangibly different from ours was that they were faced with dreadful - almost unimaginable existential dilemmas.
The challenges to their existence
From an existential perspective, we are all challenged by our responsibility to ourselves and to others. However, important factors such as context, and the meaning a particular relationship holds for us will inform our decision about the responsibility we feel we have towards another. This is more complex for healthcare workers. For those in the medical and caring professions, in ‘normal’ times, there is perhaps always a different expectation. They are called upon to care and treat others without fear or favour. However, what is not the norm (yet it is what staff had to grapple with during the pandemic), was that by treating or caring for such sick and completely dependent patients, they were putting their own existence in peril.
Previously held ideas about who they were as medical professionals were challenged in many ways. For example, for many, their identity, beliefs and values and indeed the oath that many take to do no harm - yet finding themselves unable to effectively treat their patients - instead watching them suffer, left some to question their identity as a healer or carer.
Having to make decisions about the responsibility they had to their own health, their patients and family led some to decide to forgo their family life and risk their own health to care for their patients. Now they were left with the guilt of the impact of their decision (sometimes to move out of the family home) on their children, partners and wider family. And on the subject of guilt, some described how having succumbed to the disease and off sick from work, they worried about the impact of their absence on their colleagues – the greater strain it would put on the ability of the NHS to cope and ultimately the impact on patients.
What next for healthcare staff?
One key question remains; given the experiences back in the spring, which left so many emotionally and psychologically depleted, can we really expect these same people to go through this all again if we have a second wave this winter? It is true that lessons have been learnt from the spring and new treatments are emerging; despite this, there is I feel a real risk that those who were – let’s put it bluntly, left traumatized by the first wave, will be re-traumatized. Such a secondary trauma should it occur; would increase the risk of serious psychological harm to these healthcare staff.
It is now the end of the summer; before winter arrives with vengeance, we have to put in place resources not just to support individuals in the NHS once they have succumbed to psychological stress, but also focus on developing mental health resilience now - specifically tailored to their needs. Finally, those of us whose job it is to provide psychological support and mental health training, indeed perhaps all of us, need to recognise how NHS staff face key existential dilemmas in a way most of us never will. The reality of the situation for many NHS staff is that they have to balance the responsibility they have towards themselves as an individual and as a medical professional, against that which they have to the rest of us who place our very survival in their hands.
September 2020
© Dr Jackie 2020 All Rights Reserved
Dr Jackie Sewell – Counselling Psychologist
Whether we like it or not, Summer 2020 has come to an end. This was of course a summer dominated like most of the year by Covid-19. Working as I did during the height of the pandemic as a staff counsellor in the NHS, it now feels the right time to reflect on the year so far. In particular, to reflect on the experiences described to me and other therapists by hundreds of staff as they struggled against psychological implosion.
The experiences described to me by my clients raise some key existential questions about responsibility, survival, identity, values and beliefs.
My memories of their experiences
When I reflect, I am left with two overarching memories. Firstly, the memory of the rich description by staff of their experience of the relentless and often fruitless battle to treat and care for Covid patients while at the same time, fearing for their own health – or even their own lives. Secondly, the memory of how most staff, despite the dreadful experiences they were describing and the obvious toll it was taking to their mental and physical health, continued in their role. They put their patients first.
It is this story of staff putting their patients’ needs above their own that captivated the nation; these staff now became heroes. However, what I heard from my NHS clients is that they didn’t see themselves as heroes – this would have made them superhuman. Such a status perhaps worked for the rest of us. It obscured the truth that these people who we depended on to save us and our families, were actually just like us. They had families too; they experienced anxiety and fears and some of these fears were realised as they saw colleagues – friends of theirs - die of Covid-19. What made their experience tangibly different from ours was that they were faced with dreadful - almost unimaginable existential dilemmas.
The challenges to their existence
From an existential perspective, we are all challenged by our responsibility to ourselves and to others. However, important factors such as context, and the meaning a particular relationship holds for us will inform our decision about the responsibility we feel we have towards another. This is more complex for healthcare workers. For those in the medical and caring professions, in ‘normal’ times, there is perhaps always a different expectation. They are called upon to care and treat others without fear or favour. However, what is not the norm (yet it is what staff had to grapple with during the pandemic), was that by treating or caring for such sick and completely dependent patients, they were putting their own existence in peril.
Previously held ideas about who they were as medical professionals were challenged in many ways. For example, for many, their identity, beliefs and values and indeed the oath that many take to do no harm - yet finding themselves unable to effectively treat their patients - instead watching them suffer, left some to question their identity as a healer or carer.
Having to make decisions about the responsibility they had to their own health, their patients and family led some to decide to forgo their family life and risk their own health to care for their patients. Now they were left with the guilt of the impact of their decision (sometimes to move out of the family home) on their children, partners and wider family. And on the subject of guilt, some described how having succumbed to the disease and off sick from work, they worried about the impact of their absence on their colleagues – the greater strain it would put on the ability of the NHS to cope and ultimately the impact on patients.
What next for healthcare staff?
One key question remains; given the experiences back in the spring, which left so many emotionally and psychologically depleted, can we really expect these same people to go through this all again if we have a second wave this winter? It is true that lessons have been learnt from the spring and new treatments are emerging; despite this, there is I feel a real risk that those who were – let’s put it bluntly, left traumatized by the first wave, will be re-traumatized. Such a secondary trauma should it occur; would increase the risk of serious psychological harm to these healthcare staff.
It is now the end of the summer; before winter arrives with vengeance, we have to put in place resources not just to support individuals in the NHS once they have succumbed to psychological stress, but also focus on developing mental health resilience now - specifically tailored to their needs. Finally, those of us whose job it is to provide psychological support and mental health training, indeed perhaps all of us, need to recognise how NHS staff face key existential dilemmas in a way most of us never will. The reality of the situation for many NHS staff is that they have to balance the responsibility they have towards themselves as an individual and as a medical professional, against that which they have to the rest of us who place our very survival in their hands.
September 2020
© Dr Jackie 2020 All Rights Reserved