I’ve worked as a psychiatrist with the military for years – the NHS could benefit from what we know about mental health

With good leadership, as well as properly preparing and supporting staff in the way the British armed forces have, most will avoid developing longer-term difficulties

The UK government has said that we must act as if we are a country at war facing a deadly invisible enemy. In this war, there is no doubt that the NHS is on the frontline. Demand for care is at an all-time high and from what we have seen in Italy and Spain our hardworking NHS staff will be faced with making the kind of harrowing decisions that are more usually made by commanders operating within defined rules of engagement during conflict.

The military has already shown what it can do by leading the huge task of turning the Excel Centre into the NHS Nightingale Hospital with room for up to 4,000 beds in a matter of weeks. However, as well as logistics, the armed forces can also share their experience in supporting staff during times of crisis.

As a psychiatrist who has spent 23 years serving with the British armed forces including time in Iraq and Afghanistan, my experience of supporting our troops through difficult and stressful situations is extensive and I know there is a lot that the NHS can learn from how the armed forces help those on the frontline.

Using my military experience, and the research work carried out by myself and colleagues at King’s College London, I have been working with others at the Royal College of Psychiatrists to provide guidance for our mental health staff on how to assist colleagues in general hospitals and the temporary Covid-19-specific services, such as NHS Nightingale.

One of the most important lessons for the NHS is the value of good leaders in times of crisis. Studies show that teams operating in the most arduous environments are more likely to function better. The right team ethos and psychologically savvy conversations between supervisors and employees can help stave off the onset of serious mental health difficulties. Essentially, much of the resilience of an organisation lies in the social bonds between staff, rather than within individuals.

If we are to support NHS staff well, then timely and effective preparation is key. NHS leaders need to have frank discussions with staff about the challenges that lie ahead, not to sugar coat them but also not to overstate the trauma they are likely to face.

These discussions should address the difficult decisions that staff may have to make. We know that military personnel are at risk of what is called “moral injury” which is when you are placed in a situation which starkly is at odds with your own normal moral code. For example, leaving a local child in danger because of the threat of explosive devices that could threaten your entire unit.

For staff who are put in these morally challenging situations, for instance where there are not enough ventilators, or other lifesaving equipment, we recommend supervisors speak with their teams along the lines of a system known as Schwartz Rounds. This is when staff get together with their leader after their shift and talk honestly about what did and didn’t go right, the difficulties they faced and the associated emotional reactions. While staff will be pushed for time, this sort of approach is likely to reduce the potentially damaging mental health impacts of working on a stressful hospital ward.

The final and important lesson from times of war is that despite the challenges they face, most people on the frontline will not suffer from a mental illness. With good leadership, as well as properly preparing and supporting NHS staff, most will avoid developing longer-term difficulties. Indeed, many may expect to psychologically grow as a result of the challenge. For those that do need help, we should provide evidence-based care both in the short term to help NHS staff get back to work and in the long term, continuing to help staff who have unfortunately developed mental health disorders once this crisis is over.

Professor Neil Greenberg is the lead for military and veteran’s mental health at the Royal College of Psychiatrists