COVID-19: how to help patients cope with the mental health impact of the pandemic
Nurses in every health and social care setting will encounter patients affected by anxiety, depression or suicidal thoughts
- The pandemic has created a ‘mental health emergency’ that is likely to have long-term effects, experts say
- As well as supporting patients directly, nurses can signpost them to a number of online and community resources to boost well-being
- Techniques and advice that can help your patients, plus advice on maintaining your own mental well-being
While the physical cost of COVID-19 has been devastating, with associated UK hospital admissions and deaths at levels unimaginable a year ago, the psychological and emotional impact of the pandemic has also been profound.
And although vaccines now offer hope for 2021, this mental health burden may endure.
Increase in suicidal thoughts recorded at the start of lockdown
Just the first few weeks of the pandemic had a major effect on the UK’s mental health, according to a study from the University of Glasgow.
Using a sample of more than 3,000 adults, the researchers found suicidal thoughts increased during the initial six weeks of the first lockdown.
Women, young people and those from disadvantaged backgrounds reported the worst mental health outcomes, along with those who had pre-existing mental health issues.
One in four respondents experienced at least moderate symptoms of depression.
The research was part-funded by the Scottish Association for Mental Health, which says the study shows that mental health ‘will continue to be a crucial issue in the coming months’.
The reasons COVID-19 has caused a ‘mental health emergency’
Mind’s head of workplace well-being programmes Faye McGuinness describes the pandemic as a ‘mental health emergency’.
As evidence, she cites bed capacity figures, crisis referrals, and the volume of enquiries to Mind’s information and signposting service.
And the charity’s own research into the impact of coronavirus on mental health found that 60% of more than 16,000 survey respondents said their mental health had deteriorated during lockdown.
Ms McGuinness suggests there are several reasons why more of us are currently experiencing poor mental health, including fears about contracting COVID-19, job losses and financial insecurity, and the isolation and diminished social support associated with lockdown.
Nursing Standard's well-being centre: free resources and podcasts for nursesRecognising signs of mental health problems in patients
This all suggest nurses in every setting will encounter people struggling with the far-reaching psychological impact of the coronavirus pandemic.
But what should nurses who are not specialists in mental health look for in their patients and how might they help?
‘There are many symptoms of mental health problems to look out for,’ Ms McGuinness says. Those indicative of depression and anxiety include:
- Low mood.
- Lack of interest in activities previously enjoyed.
- Difficulty sleeping.
- Irritability.
‘There is also a wide range of physical symptoms, including increased heart rate, weight gain or weight loss, and headaches,’ Ms McGuinness says.
Anxiety fuelled by negative internal dialogues
1 in 5
adults are likely to experience some form of depression during the COVID-19 pandemic
Source: Office for National Statistics
Anxiety UK partnerships and helpline coordinator Niamh Shepherd adds to that list hot flushes, sweating, nausea, a tight chest and breathing problems. ‘The difficulty with anxiety is that it can present in many different ways,’ Ms Shepherd says. ‘It can be triggered by something specific or it can seemingly come from nowhere.’
That said, concerns expressed by callers to Anxiety UK’s helpline in recent months have mostly related to health anxiety, with fears about COVID-19 prominent.
‘Initial support and understanding can mean a lot. Knowing you’re not alone with anxiety can be reassuring’
Niamh Shepherd, partnerships and helpline coordinator, Anxiety UK
Some have argued the unprecedented events of 2020 have inevitably generated anxiety in many of us and we run the risk of medicalising ‘natural reactions to the global crisis’. This is an argument noted by a correspondent to journal The Lancet Psychiatry recently, who nevertheless concluded that ‘the global community cannot, and should not, ignore the evidence amassing to suggest that people of all ages are struggling’.
How should nurses respond?
Ms Shepherd says callers to Anxiety UK’s helpline are offered immediate guidance on managing symptoms of anxiety – ‘breathing and relaxation exercises as well as self-care tips such as exercising’.
‘Initial support and understanding can mean a lot,’ she adds. ‘Knowing you’re not alone with anxiety can be reassuring.’
For longer-term support, callers to the helpline may be steered towards a range of resources, including online support groups, anxiety management courses, mindfulness, cognitive behavioural therapy and self-help books.
Of course, not all patients will volunteer information about their mental health, so if you have concerns about someone, finding a way to open up the conversation is important.
Advice from Samaritans suggests that even if the person is not ready to talk, it can be helpful to let them know that you’re there to support them when they are ready.
But simple questions such as ‘How are you feeling today?’ or statements like ‘Tell me more’ may be sufficient to trigger a discussion about emotional issues.
Samaritans’ active listening tips (see box) can help nurses to offer individuals support.
SHUSH: active listening tips from the Samaritans
Samaritans says that once someone starts to share how they are feeling, it is important to listen closely.
The organisation suggests the acronym ‘SHUSH’ as a useful means of remembering these listening tips, which can be adapted for use over the telephone with someone who is shielding, for example.
Show you care. Focus on the other person, make eye contact if it is a face-to-face consultation and always give them your full attention
Have patience. Effective listening is about creating trust with the other person. It may take time and several attempts before they are ready to open up
Use open questions. And avoid expressing your own ideas about how the person might be feeling
Say it back. Repeating what you have heard can help reassure the person they have your full attention and is useful as a way of ensuring you have not put your own interpretation on the conversation
Have courage. These conversations can be uncomfortable but do not be put off by a negative response or feel you must fill a silence
Source: Samaritans
Why all nurses should try to support patients’ mental well-being
Nurses who are not specifically trained in mental health may feel they should not be trying to support patients with psychological and emotional needs.
But the prevalence of mental health issues in the general population means that for every four patients a nurse sees, at least one is likely to have some kind of mental health problem.
And steering clear of presenting problems in a quarter of your patients could leave you in breach of the Nursing and Midwifery Council code, which says nurses must assess and respond to ‘people’s physical, social and psychological needs’.
‘Just getting people to use the lifeboat analogy and think “Who’s in my crew?” can be powerful’
Catherine Gamble, former RCN professional lead for mental health
Then there is Making Every Contact Count, Public Health England’s consensus statement on maximising support for population behaviour change, which has a focus on mental health and well-being at its core.
The document makes clear that mental well-being underpins people’s capability to ‘make and sustain health behaviour change’.
In other words, addressing mental health needs can bring wider health benefits.
Finally, communication is a crucial nursing skill and, while addressing complex mental health needs requires specialist intervention, listening and gently exploring anxieties and concerns is central to what nurses do every day.
Calm the mind: a simple breathing exercise
Anxiety UK’s Niamh Shepherd suggests nurses recommend that patients experiencing anxiety repeat this breathing technique.
‘When you start to feel overwhelmed, breathe in for four seconds, hold it for two seconds and breathe out for six seconds,’ she says.
‘This works with the parasympathetic nervous system to bring calm to the mind and body, which relieves the physical symptoms too.’
Harnessing support online and in communities
Mental health nursing colleagues are one obvious source of advice for general nursing staff who feel concerned about a patient presenting with COVID-19-related distress.
Former RCN professional lead for mental health Catherine Gamble also suggests reaching out via forums, such as Twitter.
‘Social media provides a huge platform to build networks you wouldn’t necessarily have thought of,’ she says.
As well as tapping into professional expertise, there is, in addition, a huge array of help and support available in local communities.
For example, a recent online summit organised by the South London Mental Health and Community Partnership looked at how, by working together, statutory and third sector organisations could meet the needs of people at risk of becoming mentally unwell because of the pandemic’s impact.
More than 400 people representing the NHS, local councils, charities, faith groups, service users, community groups and experts by experience joined the virtual summit, indicating that neighbourhoods have a rich seam of available help towards which general nurses can signpost patients and clients.
‘Nurses are a vital part of the fight against coronavirus and the amount of pressure they’re under can take its toll’
Benedict Phillips, head of service programmes, Samaritans
Former care minister Sir Norman Lamb, who chaired the summit and is also chair of the South London and Maudsley NHS Foundation Trust, says: ‘My firm view is that every part of the country should be thinking about the psychological fallout of COVID and how you best support people through it.
‘There is an enormous amount of activity already out there in the community and this is all about harnessing that and complementing it, rather than trying to replace it.’
What works for others: helpful suggestions on managing mental health
A survey by the mental health charity Mind asked participants what is helping them manage their mental health during the pandemic and lockdown.
The responses fell into five categories, which general nurses may find are helpful suggestions for their patients.
The categories, with sample comments from survey respondents, are:
- Be kind to yourself ‘Don’t put pressure on yourself to use this time for “self-improvement”. Just getting through is enough’
- Keep talking to others about how you’re feeling ‘Don’t be afraid to reach out for help’
- Develop a new routine ‘I try and start my day at the same time and do some yoga. It helps me get in the right frame of mind’
- Find activities that distract you ‘Go for walks if you’re able. Take photos of nature’
- Limit how much news you engage with ‘I find minimising watching bad news on the TV helpful’
Source: Mind
Do not neglect your own mental health
Ms Gamble suggests that offering patients a list of local and reputable organisations and websites is more effective than simply encouraging them to find their own sources of support.
Samaritans head of service programmes Benedict Phillips adds that, in safeguarding the mental health of others, nurses should not neglect their own well-being.
‘Nurses are a vital part of the fight against coronavirus and the amount of pressure they’re under can take its toll,’ Mr Phillips says.
‘That’s why Samaritans has launched a new confidential support line specifically for NHS and social care workers.
‘We’re also part of Our Frontline, which offers round-the-clock support, tools and advice to help key workers cope with these incredibly tough times.’
Who’s in my lifeboat? An exercise that can help patients
Former RCN professional lead for mental health Catherine Gamble suggests nurses can use the ‘lifeboat’ reflective exercise to help patients focus on sources of support: who, or what, can help them negotiate ‘stormy weather’?
‘Just getting people to use that analogy and think “Who’s in my crew?” can be powerful,’ she says.
‘It encourages people to think about their vulnerability and if they’ve got no one in their lifeboat, then you can have another conversation about what would help keep the person afloat.
‘Do they have social networks? Are they seeing their family every week and, if not, how could they set that up? Have they thought about an online class or a support group through Zoom?’
The lifeboat is also an exercise nurses can try themselves, Ms Gamble suggests.
Then, when explaining it to patients, instead of it being seen as part of a structured mental health assessment, it’s perceived as something more informal, ‘a gentle conversation’, she says.
Further information
- Scottish Association for Mental Health: New study reveals mental health impact of initial lockdown period
- Mind: The Mental Health Emergency
- Nursing and Midwifery Council Code
- Public Health England: Making Every Contact Count
- Samaritans: Well-being support line for health and social care workers
- Our Frontline