As 2020 lumbers on, the burden it has put on frontline workers to keep the world going has yet to lift. From primary school teachers to obstetricians to carers, there are many in the UK and across the world who have had to reckon with the immense and unprecedented pressure of working in essential roles through a global pandemic.
The mental impact of being one of those who must go into work has been acknowledged, with the mental health charity Mind publishing advice on how to cope with the stress. It follows, then, that the work itself, especially if it involves caring for the young, the vulnerable or those in need of medical support, will have its own impact.
As reported by the World Health Organization (WHO), going out to work during the COVID-19 pandemic has meant frontline workers are putting their physical, mental and social wellbeing at risk. The prolonged exposure to stress can have consequences for the emotional and mental wellbeing of frontline workers. These include:
- Triggering the onset of common mental disorders such as depression and anxiety or post-traumatic stress disorder (PTSD).
- Developing or returning to unhealthy behaviours like using tobacco, alcohol or other substances, which may lead to substance use disorders.
- Frequent absence from work or reduced productivity while at work.
As previously reported in our piece on WFH burnout, the risks of extended periods of stress and burnout are already well documented: workplace burnout is defined by WHO as an occupational phenomenon and was added to the ICD-11 (International Classification of Diseases, 11th Revision) in 2019. This is even more evident in those who are now classed as frontline workers. According to the 2018 NHS staff survey, 50% more NHS staff now report debilitating levels of work stress compared to the general working population and year after year, around 40% report being unwell as a result of work stress during the previous year.
This is not only a problem in the NHS. Before the pandemic it was reported by Education Support, a charity which gives mental health help to education professionals, that nearly three-quarters of teachers and 84% of school leaders now describe themselves as "stressed", and more than a third of education professionals have experienced a mental health issue in the past academic year. Almost half (49%) believe their workplace is having a negative impact on their mental health and wellbeing.
This has all been exacerbated by COVID-19. Of the data we have so far, it’s suggested that almost half of UK doctors are suffering from burnout in 2020, according to a survey by the British Medical Association, and there have been warnings that nurses and care staff are particularly at risk. On top of that, a recent WHO survey found that the pandemic has disrupted or halted critical mental health services in 93% of countries worldwide.
With all this in mind, we spoke to three frontline workers about how they're coping in such an overwhelming work environment. While there is overwork and despair, there is also hope – that we will continue to recognise the value of their work, the impact of that work on their emotional and mental wellbeing and push for better governmental support. Because the truth is, we'd be nowhere without them.
Sarah*, 26, is a primary school teacher
My work has changed a lot over the past six or so months. At the start of the pandemic, we were on rota: I was in school looking after the children of key workers and vulnerable children some weeks, and when not in school, I was working from home, setting and responding to work, phoning parents and my students.
From the ‘reopening’ of schools at the start of June (I say ‘reopening’ as schools were still open from March, just not to everyone), I had a bubble of 10 key worker children from several different year groups which meant frantic running around the classroom, trying to simultaneously teach four different lessons to four different year groups. Since September, I’ve been back in school with my own class (or bubble) of 34 children. While completing all the usual requirements of teaching (planning, making resources, marking work), I am also having to upload every single lesson and resource onto Google Classrooms for any child who is isolating to access, which takes longer than it sounds.
On top of that, most children have missed around four months of formal schooling! This has had a huge impact on academic attainment but also on the children’s mental health. I work in a deprived area and lots of these kids spent months locked inside with no outdoor space. We’re still finding out how lockdown has affected our children.
I feel like I'm on a tightrope and it doesn't take much to tip me over the edge right now.
I’ve been teaching for a few years now but the tiredness I was feeling as we came to the end of the first half term is like the tiredness I felt during my first year. A normal working day for me is 7.30am to 6pm, including eating a hurried lunch while marking books. My workload has significantly increased this year and the exhaustion that comes with that has taken a toll on my mental state – I’ve been feeling a lot more emotional over the past few weeks and it doesn’t take a lot to be totally overwhelmed. In the final week of term I had observations and parents’ evening, both of which I had been dreading. I kept having horrible dreams that week, like waking up in bed and being covered in spiders! So I think I have been feeling really stressed out.
At one point in the term, I had the arrival of a new student who spoke no English. I was so overwhelmed by her arrival (my class is already incredibly big) that I had to take a breather and let my incredible teaching assistant take care of the class for a few moments. That’s the first time I’ve ever had to leave the classroom because of how I was feeling. I feel like I’m on a tightrope and it doesn’t take much to tip me over the edge.
I’m really fortunate in that my line manager is incredibly supportive. They try to do any extra work they can for me and find me extra time out of class where possible. Really, we need another class teacher to share the workload with, but sadly a lack of funding doesn’t allow that to happen.
During the first wave, some people seemed to be under the impression that teachers were at home on extended jolly. There was so much teacher bashing on social media and some news outlets, which was demoralising to read at a time which was already difficult. I want people to know how hard teachers have been working through the pandemic, continuously changing in line with new advice and policies which the Department for Education LOVES to release just as we’re going to sleep. Often, schools are hearing about announcements (school closures, free computer equipment for students) at the same time as the general public. This means that we get a sudden surge of calls and emails from parents about things that haven’t yet been communicated properly by the government, which can cause tensions in our relationships with parents when we can’t answer their questions. I think some people think teaching is this career where you clock out at 3pm each day and enjoy 13 weeks holiday a year and I would just love people to know that this has rarely been the case (never in my experience), and even less so as we approach the second wave.
Clinical work has become a much greater part of my life. Within my speciality particularly, we already have a national shortage of doctors with the necessary skills to safely look after women and pregnant patients during the antenatal period, labour and postnatally, and this number has sadly reduced with the requirement for shielding, self-isolation and staff sickness. This has meant those clinicians still able to work have been required to work harder shifts and longer hours to ensure safe cover is always provided. The type of care we provide has also changed, with much more focus on urgent and emergency care, meaning less predictable workload or shifts and more time spent looking after acutely unwell women.
The initial period actually inspired me to work harder. Genuinely, for the first time since working as a doctor I felt valued and appreciated and like I had a purpose. I am very lucky that I love my job and couldn’t imagine doing anything else, but it isn’t an easy one. Maternity and gynaecology is a highly emotive speciality in normal times, let alone during a pandemic, and the impact of the job that we do on us personally can often be forgotten. My current worry is this is already starting to shift back to the pre-pandemic state, with healthcare professionals being expected to put up with long hours, no breaks and challenging working conditions, without full recognition or remuneration for the job they do.
I have had to develop more resilience over the last few months and accept that being flexible and adaptable is vital, whether this be accepting regular changes to my working pattern, the exact role that I am doing or the system/processes I am working within as these are all frequently changing and are all things that are out of my control. I have had to raise my own self-awareness of my physical and emotional wellbeing in order to ensure I am able to work safely and provide the necessary care for the patients I look after.
Many of us feel a huge sense of responsibility towards our patients and the NHS, but this can be at a cost of our own wellbeing and of those closest to us.
I have been fortunate that although I have worked harder shifts and longer hours than I ever have, I have remained within my own speciality and surrounded by a familiar environment and colleagues. I have good support from people at home who understand the job I do and the responsibilities it comes with. I am mindful though that during the initial first peak, routine/elective workload was reduced to enable us to focus our time and energy on providing safe emergency services for our patients, and provisions were put in place such as free parking, free meals and better rest facilities to help us where needed. I am concerned that if we are expected to continue working with rising acute workload, while also increasing the number of routine clinics and operating lists we undertake, without the supporting provisions that were previously in place, that those doctors currently able to work will be stretched too thin and become too exhausted and we will see more doctors unwell or leaving the profession. It has certainly been a long few months within the NHS and I think we have to have a strategy to ensure doctors are looked after as winter approaches and the pandemic continues. Many of us feel a huge sense of responsibility towards our patients and the NHS, but this can be at a cost of our own wellbeing and of those closest to us.
It’s important to remember that us frontline workers are going through this too, all of the same uncertainties and anxieties are understood and shared by us with you. We are all trying our hardest to provide the best care we can, as timely as we can and be the best clinicians possible for you. The NHS has been struggling with staffing shortages and wellbeing issues for a long time and unfortunately the pandemic has exacerbated these issues significantly.
The majority of healthcare professionals have worked tirelessly from March and most of us are happy to, but please remember we are humans too and not physically or mentally immune from the effect of COVID-19. We need looking after too.
The Childcare Worker
Rebecca*, 23, is a residential childcare worker in a children's home for young people with learning difficulties
As the young people were not attending school during lockdown, we had to work 12-hour days: these are common on weekends and during the holidays, but I always say we worked the summer holidays about three times over with no break!
There is an attitude at my workplace that the kids come first, because of course they do, but my colleagues and I have completely given ourselves to the work during this pandemic and that's a lot to take on board. We are constantly asked to pick up extra shifts (which we do without hesitation, because we love these kids) and despite management recruiting, most people walk out after their induction, going "This isn't the job for me". Multiple staff have left since August and we are yet to see anyone replace them, so the workload increases. It's nice to earn a fair amount (averaging around £1,700 take-home pay since the pandemic started) but if I can't have a day off with my partner then what's the point?
I think there has always been a potential for me to develop manic depression (it runs in the family) but my mood has been all over the place and I am currently seeking a diagnosis for cyclothymic disorder, as I can see my mental state deteriorating from the stress. This has been going on since August, when I was involved in an incident that was quite traumatic for me.
My colleagues and I have completely given ourselves to the work during this pandemic and that's a lot to take on board.
I have been called up on my conduct and my professionalism lately, as feedback from a visitor said I could have taken a better tone with a young person. After looking back at what they meant with my manager, I do understand I could have had more patience, but it was an extremely stressful day and a safeguarding issue came up that I was trying to sort out as well. I am just finding myself becoming completely overwhelmed and I've become such a crybaby.
I definitely feel burned out. I am generally quite a stressed person anyway but working around 210 hours a month for about six months with no massive break has been exhausting to say the least. My manager has tried to reassure us that this isn't the ‘new normal’ but it's hard to feel like that is the case.
I am one of those people that muddles along going "Everything's fine!" and then my manager sits down and talks to me and I just start crying. I started a mood log to try and track any potential triggers for my mood to switch. My manager and I have drawn up a plan to adjust my shifts so that I will be able to do a week of night shifts (which I enjoy) and then a week of days, as doing both within the same week can be tiring. Hopefully I will have more consistent days off with this type of shift pattern. I am also filling in a Wellness Recovery Action Plan (WRAP) sheet so more adjustments can be recorded for me. Now that she knows how much I'm struggling, my manager has been very supportive and I feel silly for not going to see her sooner.
My colleagues and I work an extremely difficult, emotionally draining, sometimes physically dangerous job (I am permanently scarred on my arm from the incident in August). The hours are long and your clothes get ruined sometimes! I don't feel like we were involved in conversations around carers because our job is quite niche and I feel like people only consider adult care workers. I know we're not saving lives like NHS staff, but we have kept these children with complex needs safe and happy during a global pandemic; surely that counts for something. My colleagues go above and beyond for our young people and they should be so proud of themselves.
*Some names have been changed