Urgent action needed to protect wellbeing of healthcare staff

The recent report by the World Health Organisation on the mental health of nurses and doctors should concern us all

Amid mismatched socks and memes of “it’s ok not to feel ok”, for World Mental Health Day, a major report was published by the World Health Organisation (WHO) on the mental health of nurses and doctors around Europe. This study, with 120,000 participants, reported that one in three experienced symptoms of depression, a quarter had anxiety, and 10 per cent had suicidal thoughts within the preceding year.

These findings are omens for the future provision of healthcare because if healthcare staff are not well, they will not be available to patients. Short staffing is a persistent theme in patient safety.

This is a genuine case of “a stitch in time saves nine”, as taking swift action to tackle poor mental health in staff will save a host of future problems. A similar study carried out the year before by the WHO European Regional Office had equally concerning figures, so it is past time to act.

Ireland

Factors that contributed to self-reporting of poor mental health were working more than 50 hours each week, temporary contracts, bullying, and the threat of violence. These results are relevant in Ireland.

In our health service: 23 per cent of doctors work more than 48 hours per week; around 400 frontline consultants are on temporary contracts in the HSE; 6 per cent of midwives state they are bullied every day; and the Nursing Midwifery Board of Ireland reports that over 4,016 nurses were verbally, physically, or sexually assaulted in the workplace in 2023. We have the full house of factors for poor mental health in staff.

The care element in healthcare has steadily become devalued, with a multitude of studies pointing to burnout in the caring professions. As one colleague who is retiring early from psychiatry said to me recently: “I don’t see the point of working anymore; it isn’t helping people. The system isn’t listening.”

Another colleague in nursing has retired early to devote her time to charitable missions abroad, where she believes her skills will make a difference. She cited the culture of blame as one of her reasons for not staying on.

“It’s too stressful. Every time a patient has a complication, it’s someone’s fault, and there’s a witch hunt. One missing word on a document and you’re it.”

It is not surprising, therefore, that the WHO study, which was funded by the European Commission (EC), reports that 11 per cent of staff are planning on leaving the profession in the year ahead, citing the negative effects of working in healthcare on their mental health. After years of state investment and personal commitment, to lose a tenth of staff is a bad outcome. Especially in the context of around 45 per cent of new graduates in medicine leaving for Australia each year.

Last year, the EC signalled alarm at the projected shortfall of over 900,000 nurses and doctors across the region by the year 2030. A mere five years away, 32 per cent of the population of Europe will be above the age of 65 years, many living rurally. In Ireland, the Department of Health is developing a workforce plan for healthcare, but it has not yet been published for consultation. Planning the workforce requires data from a variety of sectors and brings education, health, social protection, and finance together. One thing is certain though: We simply cannot afford to lose a further 11 per cent of our staff to poor mental health.

Interventions

With a substantial proportion of our population living in rural communities, as healthcare staff become thin on the ground, we have much to fear from the ‘Matthew effect’, where the rich get richer and the poor get poorer. The attraction of staff to major population centres will marginalise people living regionally to a less adequate health service unless specifically addressed. To a certain extent, this has already occurred, as some villages in Ireland do not have a GP. But initiatives such as the rural GP scheme have been successful at restoring primary care to several small communities. Employing doctors from outside Ireland is an example of creative solutions that hold promise.

Actions to tackle poor mental health rest on three legs: Employer responsibility, system change, and individual empowerment. In this WHO study, we get a glimpse of individuals sadly choosing to leave – that’s not the kind of action we need. Individual steps taken much earlier ought to knit with employers tackling excessive working hours and temporary contracts, along with a zero-tolerance attitude to bullying and intimidation across the health system.

Our healthcare workforce plan must include measures to improve staff working conditions and mental health. For ancient Roman military generals, omens, rather than scientific data, informed their strategising and planning. This WHO report is more than patterns of birds flying or leaves falling – this is healthcare staff clearly stating that their work is making them sick.

Our healthcare workforce plan must include measures to improve staff working conditions and mental health

We need their caring hands and hearts, not just for the urban and wealthy, but for everyone.