Danielle Lamb

Background: Healthcare can be a demanding career, and there is a rising interest in fostering the well-being of healthcare workers (HCWs). Aims: To examine self-reported use of mental health and well-being support available to HCWs and explore predictors of use. Method: Data were collected by a longitudinal cohort study. The baseline survey was distributed from April 2020, followed by three surveys at 6 months (time 1; n = 10 514), 12 months (time 2; n = 10 429) and 32 months (time 3; n = 6382) post baseline. Use of mental health support (e.g. therapy) was assessed at each follow-up, and 96 supports were measured at time 1 only. Multilevel regression modelling was used to explore baseline predictors. Results: At time 1, we developed seven support categories. Practical supports (e.g. free or discounted food or parking) were the most commonly used (58%), whereas employee assistance programmes were least commonly used (5%). Furthermore, 21% of HCWs reported never using any support. Mental health support access varied: 23% of participants had used support before August 2021 (time 1), 17% between March 2020 and January 2022 (time 2), and 21% between February 2022 and May 2023 (time 3). HCWs who were male, older and/or of Asian ethnicity had lower odds of accessing support, whereas those who reported symptoms of common mental disorders at baseline had higher odds. Conclusions: Most HCWs (79%) reported having accessed some support, whereas 21% had not. Practical and informal supports were most used, whereas uptake of employee assistance programmes was low. Future research should explore and address barriers faced by male, older, Asian and non-permanent staff to improve access and, in turn, the well-being, performance and patient care of these individuals.

Background: Moral injuries (MIs) may result from individuals being exposed to potentially morally injurious events (PMIEs). PMIEs have been a feature of work within much of the National Health Service (NHS) for many years, and the understanding of MI is now more commonplace, having been highlighted during the COVID-19 pandemic; however, understanding of how such events affect workers over the long term is lacking. Objective: To understand the development of healthcare workers’ (HCWs) experiences of PMIEs over a period of 3 years. Design and participants: We carried out follow-up semistructured qualitative interviews with 15 NHS staff who were previously interviewed on the same topic in 2021. All interviews were recorded, transcribed and analysed using reflexive thematic analysis following an inductive approach. Results: Three main themes and six subthemes were identified: (1) internal context and subjective experiences, (1.i) control in a rigid system, (1.ii) psychosocial dynamics, (2) external context and the moral cost of culture, (2.i) organisational culture, (2.ii) sources of MI, (3) responses to PMIEs, (3.i) maladaptive responses, (3.ii) adaptive responses. Key issues identified included perceptions of insufficient control over their work and work environment, low psychological safety and perceived misunderstanding of the value of their work from patients and colleagues, leading to a challenging organisational culture. We found that in the 3 years between the interviews many staff reported developing ‘secondary’ feelings of betrayal as a result of perceived ongoing governmental neglect of recognition for HCWs’ sacrifices during the pandemic and a lack of acknowledgement of governmental mistakes made in the acute period. Conclusion: Findings show an interplay between individual and organisational factors that HCWs faced while working in the NHS, underlining the need for wide-ranging intervention strategies. Since the HCWs’ original interviews in 2021, a secondary betrayal has developed, emphasising the need for interventions that can restore trust in the system.

Background: Moral injury (MI) can arise when individuals experience events that violate their moral beliefs. During the COVID-19 pandemic, MI gained attention among healthcare workers (HCWs). Reflective practice (RP) may help prevent or mitigate MI but remains underexplored. This narrative review examines existing literature on RP interventions addressing MI in HCWs. Aims: To synthesize existing literature on RP interventions to prevent or mitigate MI in HCWs. Methods: A semi-structured literature search was conducted in July 2024 and updated in August 2025 across four databases. Twelve studies evaluating RP interventions, including three studies identifying barriers to RP, were included. Across the 12 studies, the sample size was n = 793, involving nurses and other HCWs. Results: Most studies implemented structured workshops combining RP with psychoeducation and group discussion. Of the studies, 11 studies lacked control groups, three used pre-/post-test designs, while others relied on self-reported helpfulness. These studies provided preliminary evidence for the feasibility and perceived value of RP in addressing MI. The only study with a control group was limited by a small sample size, and the results were non-significant. Reported barriers to implementing RP included individual-level factors (e.g. lack of experience) and institutional obstacles (e.g. limited managerial support). Conclusions: Findings suggest RP holds promise as an intervention for MI in HCWs. However, the evidence base is limited by small samples and weak study designs. Further research using robust methodologies, including randomized controlled trials (RCTs) and longitudinal studies, is needed to evaluate RP across diverse HCW roles, including administrative staff.

Background: Maintaining healthcare workers’ (HCWs) mental health is vital to reduce staff absences and turnover, ultimately improving patient care. Most research focuses on clinical staff and single timepoints, overlooking non-clinical contributions. Aims: To examine mental health variations among all staff types over three years and identify those most at risk of poor mental health outcomes. Methods: Our prospective cohort study followed 22,092 HCWs from 17 English NHS Trusts. Online surveys assessed common mental disorders (CMDs), depression, anxiety, alcohol misuse, PTSD, moral injury, burnout, wellbeing, resilience, and post-traumatic growth at four timepoints from April 2020 to March 2023. Data were analysed cross-sectionally and weighted to represent Trust demographics. Results: Approximately 50% of participants reported probable CMDs at all timepoints. The most consistent predictor of poor mental health was having met the baseline cut-off for that outcome. No consistent differences emerged between clinical and non-clinical staff. Younger, female, lower-paid staff, those feeling unsupported by colleagues/managers, and exposed to morally injurious events were most at risk of poor mental health outcomes. Conclusions: All NHS staff types face persistent mental health struggles, with no significant improvement post-pandemic restrictions. Structural inequalities must be addressed long-term, alongside targeted, flexible support for staff in the short term.

Background: The COVID-19 pandemic raised concerns about the mental health of an already burdened healthcare workforce. This study examined mental health trajectories among healthcare workers (HCWs) across the pandemic and identified personal and employment factors associated with different symptom patterns. Methods: Longitudinal data were drawn from the NHS CHECK cohort, including clinical and non-clinical staff from 18 NHS Trusts in England (April 2020–April 2023). Growth curve and growth mixture models identified latent classes of HCWs characterized by distinct trajectories of probable common mental disorders. Secondary outcomes included anxiety, depression, alcohol misuse, and post-traumatic stress symptoms. Logistic regression examined associations between baseline personal and employment characteristics and class membership. Results: The analytical sample included 22,764 participants. For each outcome, growth mixture models identified two latent classes. Approximately 31% of HCWs experienced persistently high symptoms of probable common mental disorders, while 69% experienced persistently low symptoms. Similar patterns were observed for secondary outcomes, with small subgroups demonstrating worsening symptoms followed by improvement. Logistic regression analyses showed that being female, younger, single, working as a nurse, or having a pre-existing mental health diagnosis increased the odds of belonging to a high symptom class. Perceived support from colleagues and managers was protective. Conclusions: While many HCWs reported consistently low mental health symptom levels, almost a third belonged to a latent class characterized by persistently high symptoms across all time points. These findings underscore the need for mental health support for vulnerable HCW groups, embedded within routine NHS practice rather than limited to crisis periods.