Mental Health for NHS Staff: Self-Care Comes First

July 2018

Christopher Lorenz, Co-Founder and Head of Science at Soma Analytics, and Karl Priebe, Soma Psychology team member and Project Manager for the NHS research project, speak with Judith Chapman, Clinical Development Director of Berkshire Healthcare Trust, and leader of specialist psychological and IAPT services.


Since the NHS is the biggest UK employer, this webinar delved into some interesting questions about the challenges being faced, as well as what these look like on a day to day basis for employees and patients.


Possible solutions, such as creating communities and using smartphone-based interventions to leverage the amount of time available for improving health and wellbeing, were also discussed. Key results from the successful Kelaa Mental Resilience case study were presented.


Other key takeaways included Judith’s three stress busters:

  • Be a role model.
  • Breathing exercises for relaxation.
  • A positive self-script, “This too will pass.”


The NHS: Employee and Patient Challenges


Christopher: In the news we hear about the budget cuts, we hear about the pressures the NHS is under, how does that translate to your everyday work and the work of your work staff?


Judith: I think it really impacts the frontline staff but also the support teams.


  • The increase in pressure on the demands.
  • Perhaps not being able to take their breaks.
  • Staff shortages in some areas.
  • Public awareness creates another pressure.
  • Everybody wants to do their best and give people enough time.


Not being able to give people the time that they need and then moving onto the next client and the next patient. These people aren’t always quite thinking of their own self-care and their self-needs.


Christopher: Is Berkshire a mental health specific Trust?


Judith: It’s a mental health and community trust. It serves people’s physical and mental health needs out in the community.


Christopher: What does that look like on a day-to-day basis? What are the challenges or the pressures that staff face?


Judith: Staff have really, quite unwell patients on mental health wards, and are also looking after people with learning difficulties where communication isn’t always easy.


We’ve got crisis services where there’s an ongoing demand of calls, of needing to actually support somebody who’s really quite unwell, make sure they’re safe.


The ongoing increase in long-term physical health problems in the community section and the physical health demands they face. How to get the support they need in the community, working with our social care colleagues and in our new health system.


Christopher: We talked a little bit about how that impacts health and wellbeing, if you work in this type of role you always have to put the patient first, right?


Judith: Yes. Our staff are very dedicated, so they do put the patients first.


They report that they feel supported, but it’s actually about having the time and the tools for self-care, and to have the space to talk about some of the problems.


It’s not just about the demand, this type of work can be quite upsetting and quite challenging. Sometimes they have to deal with verbal abuse and difficult people.


Christopher: I think you mentioned this affects one in six people?


Judith: Yes, one in six of our staff, and nationally out there, will report having received either some threat, violence or verbal abuse.


Christopher: And that’s only what has been reported, so I guess that that figure might be even higher?


Judith: Yes, it might be.


We are trying to ensure that people are supported to speak up in the workplace, whether it’s being bullied by colleagues, difficult clients, difficult patients, to make sure that everybody is aware.


The agenda is open now, looking at what we can do to support people.


Tech-based Solutions in the NHS: Kelaa Mental Resilience


Christopher: Why were you specifically interested in this research project, in rolling out a smartphone-based solution or intervention?


Judith: I think it’s always exciting to try something different.


I also lead some digital work for the Trust and have a team that works with psychological health care for our patients.


We see a large group of clients improving the access to psychological therapy services, looking after the public, but what are we actually doing for people inside? How can we find new and innovative ways to spark interest and spark something different that some people will find really helpful?


Christopher: Now Karl, from your perspective as the project manager, what’s your external view on this? How do you think the project and our participants and users were different from other projects that you’ve managed and rolled out?


Karl: Working with the NHS, working with Berkshire as a mental health and community trust obviously has its different challenges.


A lot of people that we worked with are in a client facing, clinical and therapeutic roles. The feedback was, it’s often hard to take a step back from treating others and to look at how you’re doing.


A lot of them were very familiar with what we were implementing but it was important for them to hear it from someone else.


We’re caring for the carers, that was something that was very special about the project.


Christopher: If you’re dealing with patients it’s very task orientated, it’s very time constrained, you always prioritise time with your patient over your own time, right?


Judith: Yes, that’s right. It’s a very giving role. Often your own needs might be suppressed.


Finding that time for self-care and caring for the carer is really what the project was about.


  • Having some tools to help them find that time to give it priority.
  • Making it part of their normal routine.


Karl: I think what was nice about it also was that they’re bite sized.


  • A couple of minutes a day where perhaps inner communications aren’t a priority.
  • Between sessions and clients.
  • During a five or ten-minute break.


It’s mobile and so easy to use as well.


Judith: Literally, people might only have one or two minutes, but actually trying to find that one or two minutes, I think that’s what the project did.


Karl: Even just a one or two-minute breathing exercise. That’s so important and I think we’ve made a lot of people realise that.


Christopher: What is the Kelaa Mental Resilience App? How does it work?


Karl: Kelaa is the platform. It’s an app on your phone. It provides:


  • Two to five minutes of very bite sized daily interventions.
  • It’s all science backed, and evidence based.
  • Topics ranging from:
    • Happiness
    • Positive work relationships
    • Sleep and sleep education


There are also questionnaires within the app that give you a chance to review how you’re doing. It’s important to be able to measure yourself. You can see your levels of wellbeing, resilience and stress as well.


Christopher: One key factor in making a project like this a success is to have the executive buy-in, which we have with you two, to really have the drive and push behind it and really make it an organisational priority.


Karl: I’d also like to say a big thank you to the research and development team at Berkshire, Gwen Bonner, as well as Dawn West and Shannon Gardner. They’ve been a great help in rolling this out.


Judith: It’s totally a team approach, you can’t do anything really, by yourself.


Karl: Exactly.


Judith: They really bought into it and it was really helpful to have a team across the Trust in helping people to engage and signup.


I think the groups we chose to pilot it were really key, and the fact that it was on their phone, being so accessible for them. Soma are coming to them, with the tips and the help, and in their pocket.


Christopher: We have these smartphones with us all the time, 24/7. For me, the last thing before I go to bed, I read something on my phone, set the alarm, in the morning I wake up, I snooze the alarm. It’s ubiquitous, it’s computationally powerful. Technology is so advanced now, so why not use this technology to deliver personalised interventions?


Judith: And especially just before you go to sleep to make sure that you are going to have the right frame of mind, so it’s a positive rather than perhaps looking at something else, because we know how important sleep is.


Christopher: How was the rollout of the project? What was the feedback you’ve encountered from the members of your team or the organisation?


Judith: Generally, I’ve heard nothing but positive feedback.


  • How it helped them to focus.
  • How surprised they were to find time for it, when they thought there wasn’t time.
  • A sense of community, a few people in the team were doing it together.


Karl: Intervention is one part, but it’s also opening up the conversation. It’s creating a Trust wide type culture change around talking about their mental health. So, that’s very important.


Judith: This is very important to our board of directors. We’ve implemented various mechanisms on raising the profile of wellbeing and this was a very useful way of adding to what we’re already doing and actually challenging, “Are we doing enough or the right thing?” So, we’re excited with the results.


Christopher: You mentioned awareness as another tool to really apply change, and this brings me back to where we first met, which I believe was at the Roundtable, as part of the Farmer/Stevenson Review, which was commissioned by Theresa May.


One of the key takeaways was that you have to provide these interventions, which we’re doing through the app, but you also have to concentrate on actually creating the awareness for it and making people aware of health and wellbeing and opening up these conversations, which is a really, really important factor.


Judith: And we have, like most Trusts, developed our wellbeing strategy for our staff. It’s a continual process and we’re always learning; coming up with new ways to actually invent change, invent positive behaviours and it’s paramount because we need our staff to be well.


Christopher: We talked about the qualitative feedback, let’s have a look at some of the quantitative feedback.


Karl: It was a randomly controlled trial. When participants signed up they were randomly assigned to either Group A, which was an intervention group which used the Kelaa app for four weeks or Group B which was the control group, which didn’t receive the app, they received the app later.


In just four weeks of using the Kelaa app there were quite drastic changes. What we actually saw, in terms of quantitative results was:


  • 5.5% decrease in stress.
  • 5.6% increase in resilience.
  • 5.5% increase in wellbeing.


We didn’t plan that, that’s just how it came out but it’s really clear to see that there were increases in all of those areas, which is pretty fantastic for four weeks on the app.


I think people were quite surprised, it really made a difference.


With Group B we actually saw a really high uptake of the app. Once they’d seen the results from Group A there was no stopping them, they were downloading it, by hook or by crook, which was really good.


That’s the quantitative, but I’ve also been doing some qualitative research as well, talking to people from the Trust and the people that say the sleep tips have improved their sleep.


A lot of people are doing the three good things, and then you spoke before about focus and productivity, the term ‘eat your frog’, which as a term we use here at Soma.


Hearing that being reverberated back to you is quite powerful because it means that people are taking on board what it is and they’re implementing it, and it’s showing good results.


We’re very happy with it and that’s also down to the level of engagement from the Trust. Everyone getting around it and helping it happen. It’s a real team project.


Christopher: I think NHS Berkshire was a very conducive environment.


Judith: And I think it was the name of the frog as well, there was some humour around it. Hopefully it’s been a very useful start for how public services can see how an app can really make a difference.


Karl: I think because it’s such a new thing to do, to use an app in this sense, results like these, they speak for themselves really.


Judith: I think it got a little bit addictive, having to look at the next thing, get your next tip. So, that in itself is quite reinforcing, about the culture and the changes.


Karl: Small changes produce big results.


Billboards, Misconceptions and Stress Busters


Christopher: There are three questions I like to ask all of my guest experts on this webinar and I’m very keen to hear your answers. My first question is, what do outsiders, people outside of the NHS, get wrong about working in the NHS?


Judith: I think sometimes there’s quite a lot of bad press about managers and I think sometimes they get it wrong that managers don’t care. From most surveys conducted the staff do feel the organisation care and want to make a difference.


Christopher: If you could rent a big billboard for one day, what would you put on the billboard?


Judith: We need more staff but actually I think it’s about training adequate numbers and really getting ahead of that, for doctors, nurses, therapists and allied workers.


Christopher: And last but not least, you are a mental health expert yourself, what are your top three things our viewers can takeaway, what are your top three things to bust stress? What are your stress busters?


Judith: I think the most important thing is to actually lead by example and be a really good role model.


  • Taking breaks.
  • Doing self-care.
  • Including self-care in appraisals for every staff member:
    • “What is your top goal for your self-care?”


My next one is to take some time to do some relaxed breathing, so breath out. I have something that reminds me, which I find really helpful but between meetings or when you’re just feeling, “Oh goodness me, here we go again,” just take some deep breaths and think about self-care.


While I’m doing that I will have a really positive self-care script: “This too will pass. It will be better tomorrow.”


Would you like to learn more about Kelaa Mental Resilience?


Soma Analytics is an award-winning digital health company innovating in the sphere of mental wellbeing and stress management. The lead product, Kelaa Mental Resilience, includes a smartphone application for the users and an analytics dashboard for HR, providing a platform for employers and employees to work together on improving mental wellbeing and productivity. The Kelaa platform enables integration with EAP providers or other existing wellbeing initiatives. Soma Analytics works with large organisations that have seen significant benefits, such as a 16% reduction in stress, or a 20% stress-related cost reduction.


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