How can digital Mental Health apps effectively mitigate the impact of stress and anxiety among carers?
In November 2020, a report by the UK Health and Safety Executive (HSE) Labour Force Survey confirmed that 828,00 workers were suffering from work-related stress, depression, or anxiety This is summed up as these workers having experienced burn-out. According to frequent media reports, this has worsened over the course of the pandemic, nowhere more so than among frontline social SCWs.
New and innovative interventions are required to support and rebuild the resilience of burnt out front line health and social care workers. In 2021, The UK House of Commons Health and Social Care Committee suggested that this support is,
“…not just needed during the waves of covid-19: it will be needed through the recovery as the health and care sector returns to ‘business as usual’.”
The NHS Data Model and Dictionary defines Social Care Workers (SCWs) as persons who
“…may be home care assistants, work in residential care homes, or be working with older people, children and families and people with disabilities.”
Early on in the COVID-19 pandemic, a report in Community Care (2020) noted that deaths among SCWs in England and Wales from COVID-19 were far exceeding deaths both among HCWs and those in the wider working population. A survey in April 2020 by carehome.co.uk reported that 32% of staff felt a need for support with their mental health to help them cope with the stress and anxiety they were experiencing during lock-down.
A more recent survey in 2021 by the GMB, a UK trade union representing care home workers, found 75% of 1,200 respondents saying that the COVID-19 pandemic has had a serious negative impact on their mental health. The care home workers sum it up as having experienced burnout. The World Health Organisation (WHO) defines burnout as:
“… a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed.”
According to the Guardian (2021), this experience of burnout, combined with the mandatory policy (in England) of “no jab, no job” for care home workers led to many leaving for unskilled jobs in retail and distribution. There they can earn up to 30%, more, with less stress. Therefore, valuable, yet undervalued, employees are being lost to the care home sector.
A recent UK Health Foundation blog by Shembavnekar et al (2021), compares contrasting attitudes to the perception of NHS staff (HCWs) as heroic whilst there is less media coverage about the significant emotional distress among care home workers (SCWs). Hines et al (2021) suggest that social care research is not an area that is perceived by the general-public as being as valuable as investigations into preventing or treating chronic illnesses such as cancer, COPD, or diabetes.
The UK House of Commons Health and Social Care Committee (2021) published a report on workforce burn out and resilience among NHS and Social Care sector. The report articulates how Covid-19 has put social care teams and in particular care home workers under immense pressure. The parliamentary committee report conjectures that this high level of burn out presents a real and present danger to the future operation of social care services in the UK.
These UK reports are corroborated in the USA by a 2021 survey conducted by the MHA trade union of 1119 of its HCW and SCW membership. The MHA survey concluded that members working on the frontline were experiencing conditions comparable to a war zone. The MHA report (MHA, 2021) that followed the survey, concluded that it was essential that the MHA worked with state governments to provide the means to support both HCWs and SCWs cope with this impact on their mental health. The MHA report did not distinguish between HCWs and SCWs.
Since the onset of the COVID-19 pandemic, other authors including Luceno-Moreno (2020) in Spain, and Longyear & Kushlev (2021) in the USA have noted a rise in the popularity in the use of MH apps among both HCWs and SCWs. This appears to correlate with the increased levels of stress and anxiety that HCWs and SCWs are experiencing on the frontline. Both groups of researchers recognise that these apps are being used by vulnerable populations.
Longyear & Kushlev also maintain that whilst the popularity of these MH apps seems to demonstrate a high level of acceptability, the claims made by the app developers as to the efficacy of their products require more regulatory oversight. Longyear & Kushlev emphasise that there is,
“…a need for a well-defined pathway for pre-market regulatory approval…”
to underpin any quality assurance mark that provides users with guidance as to the appropriateness and efficacy of MH apps.
Nonetheless there are barriers, not least the lack of any conclusive evidence as to the efficacy of the adoption of MH apps in the social care sector. Schueller & Tourous (2020) cite affordability as an important barrier that requires to be considered. End users have come to expect apps to be free. Yet, developers of such interventions require to be funded in the first instance to develop the interventions and then to be paid to make them available to the users for whom they are intended. Whilst end users appear to be happy to download free MH apps that have no obvious evidence base, employers or organisations are unlikely to be willing to purchase MH apps where there is no evidence of their efficacy.
Detailed multidisciplinary research involving clinicians, app developers and social care practitioners is needed to develop, evaluate, and validate the value of innovative digital interventions in order to integrate them into the delivery of mental healthcare to support frontline SCWs experiencing burnout. Moreover, as Pollock et al (2020) noted, if end-users were involved from the outset in the development of any MH apps, they would be much more likely to use them.
The House of Commons Health and Social Care Committee (2021) suggests that this support is
“…not just needed during the waves of covid-19: it will be needed through the recovery as the health and care sector returns to ‘business as usual’.”
Any new research that contributes to filling the knowledge gaps around the efficacy of MH apps in supporting the mental health of care home workers should be seen as significant. Especially so if this can be generalised to help those in the wider population who are living with the phenomenon of burnout.
Well@Caring is a derivative of IHL’s Well@Being platform. It is being co-created with care home workers to help mitigate the impact of burnout and is the topic of Alan White’s Post Graduate study at the University of Aberdeen.
References
Care Quality Commission (England). The state of health care and adult social care in England. 2021.
Clarke S., Human resources, innovation, people, technology. Home Care, 2022.
GMB Social care workers are more likely to report poor mental health than other workers – and the gap is widening. Trade Union Report. 2021.
Longyear RL, Kushlev, K. Can Mental Health Apps Be Effective for Depression, Anxiety, and Stress During a Pandemic? Practice Innovation. 2021.
Luceño-Moreno, L.; Talavera-Velasco, B.; García-Albuerne, Y.; Martín-García, J. Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic. Int. J. Environ. Res., 17, 5514. https://doi.org/10.3390/ijerph17155514, Public Health .2020.
MHA, US trade union report, 2021.
Schueller SM., Torous J. Scaling evidence-based treatments through digital mental health. https://doi.org/10.1037/amp0000654. American Psychologist, 2020.
The Guardian. Care workers in England leaving for Amazon and other better-paid jobs Retailer is luring staff with 30% higher wages, while some workers object to the care sector’s ‘no jab, no job’ policy. 2021.
The House of Commons Health and Social Care Committee. Workforce burnout and resilience in the NHS and social care. 2021.
UK Department of Health and Social Care (England). Adult social care workforce survey: December 2021 report.
UK Health and Safety Executive (HSE), Work-related stress, anxiety, or depression statistics in Great Britain.2020.
