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This content is taken from the Maudsley Learning & The Tavistock and Portman NHS Foundation Trust's online course, COVID-19: Psychological Impact, Wellbeing and Mental Health. Join the course to learn more.

Skip to 0 minutes and 0 seconds So I just want to give you a few tips for my view, particularly from my academic work, about how managers in health care services can take care of their staff. In broad terms we should think about how you prepare stuff, how you support staff whilst they’re doing challenging work, and then how you go about recovering staff back to whatever new normal is going to be afterwards. Now I think in terms of preparing staff we want to make sure that thy’re properly informed about the sort of work that they might have to do. That includes talking to them really honestly about the morally challenging aspects of dealing with Covid 19 patients.

Skip to 0 minutes and 35 seconds Those discussions should not be sugarcoated and people should be allowed to make an informed choice about whether they’re able to do the work. They should also be prepared to support each other and that should mean that they are aware that they should buddy up when there on shifts and that when they finish a shift buddies should check in on each other to make sure that you’re doing OK. Really importantly, we know that supervisors have a key role in protecting staff’s mental health.

Skip to 1 minute and 3 seconds and all of our research evidence shows that having a supervisor who can have a psychologically savvy conversation with a member of staff, who knows what to look for and who can be supportive is really, really important in terms of protecting their mental health. So the main aim in any health care team doing challenging work is to try and support the team as much as possible to be able to be psychologically and trauma aware, and also to be really supportive. It’s also a good idea to make sure that you have expert advice.

Skip to 1 minute and 33 seconds Mental health professionals around, but their role is to support the team and certainly not to come in and do psychological debriefing or to try and provide a too early interventions when actually the answers to most people have problems are within the team and within the social support network of that team. However, mental health professionals can really help in terms of making sure that supervisors can have these psychologically savvy conversations and that they’re supported in doing so.

Skip to 2 minutes and 2 seconds And also where someone can’t be helped in the short term a good mental health professional, taking very much of return to duty, focus can help individuals, either get back to work quickly, or if they do need evidence based care they can help him to go and get it. Another important mechanism that’s useful is peer support, so we know that peer support programs such as TRIM, (Trauma Risk Management, can be really useful. These allow individuals to speak to trained colleagues in order to identify whether they’ve got difficulties and if they have got difficulties, then they can be supported, often using practical problem solving approaches rather than having to come to mental health professionals.

Skip to 2 minutes and 44 seconds I think the last thing to say, which is of great importance, is that once we begin to get into a new normal, whatever that is, it’s really important that staff are actively monitored to check on their mental health, because we know that many people with mental health difficulties won’t come and seek help, so that active monitoring may need to go on for some time. It shouldn’t take the form of formal mental health screening but using a case finding approach where individuals can check on their own mental health anonymously to see how they’re doing and can be given tailored advice about where to go to get additional support that can be quite helpful.

Skip to 3 minutes and 21 seconds It’s also again really important that supervises talk to staff who are returning from these challenging duties to find out what their experiences were and also to be able to reassure them that the organisation has got their back and that they very much want to nip things in the bud rather than let people deteriorate into having mental health difficulties. Overall, what we should be aiming for is a really supportive environment, both whilst they’re doing the work and afterwards we should be monitoring them, encouraging supervisors to be proactive and for colleagues to be supportive and overall what we’re aiming for is for people to experience what’s called post traumatic growth rather than to develop illness.

Coping as a team of key workers during COVID-19

Professor Greenberg nicely summarised the key point at the end of his video - we want to create supportive workplaces and teams, where colleagues and peers care about and talk to each other, and leaders have a proactive role.

We heard about three stages of support and steps that can be taken - preparing teams, support during a crisis, and recovering teams after a crisis.

  1. Teams should be informed as clearly as possible about what is to come, and be encouraged to support each other. For example, through a ‘buddying’ system.
  2. During a crisis, support from leaders and managers is critical, as is peer support, while mental health professionals can facilitate this rather than directly providing therapy and interventions (more on this to follow).
  3. Coming out of a crisis, active monitoring of staff, reassuring them, maintain an open dialogue, and sharing experiences are important.

This guidance can be clearly applied to Carol’s experience as a manager of key workers. We’d like to examine her experience in more detail alongside the concept of containment.

Image of Carol

Let’s pull together a few strands from Carol’s story:

  • We heard that Carol doesn’t want to show “weakness” in front of her team.
  • She has noticed that members of her team seem angry, upset, or worried and she wants them to be okay.
  • We learned that managers and employees can be in the same position: equally worried and uncertain about COVID-19.

Containment

The term containment, when used in therapy, refers to the process by which someone helps us get in touch with overwhelming or difficult feelings and ideas. They do this by first noticing and really listening to our concerns, and then passing them back to us in a more manageable form.

You may recognise this experience. Have you ever met with a manager, colleague, or friend feeling full of worries, “filled up” with stresses – and then come out feeling less anxious, validated, and with a clearer picture? This is because they have made room for our anxieties, just as Susan described earlier.

We may have also had the opposite experience. This can happen when someone makes us appropriately more concerned and attentive to an issue. At other times it happens when someone doesn’t have room for any extra worries, and can’t take our worries in. This is common at times of high stress or crisis, such as the current pandemic.

Imagine, for example, going through turbulence on an aeroplane. You make eye contact with the flight attendant and they are more terrified than you. This would be frightening. You would experience your worries being amplified back at you. This is what Carol told us in week 1 that she is trying to avoid doing this: she doesn’t want to worry her team with her own stresses or vulnerabilities.


But now imagine you see a completely unresponsive flight attendant, with a blank face, oblivious to the turbulence and your concerns. This may also feel ‘uncontaining’. Ideally, the attendant would convey, through words, facial expressions, or gestures that it’s normal to be worried during turbulence, but it’ll pass and that they are there with us through it.

Carol needing to show she is fine and wish that her team could be fine may mean that her team has nowhere to share justified concerns, and so the worries stay with the team, disrupting their work.

Carol has to try to find room in her mind, amid her own worries, to listen seriously to her team’s concerns and validate their feelings. This can be doubly difficult for managers during this time of uncertainty.

In these circumstances we can try to fall back on the example from the supportive flight attendant:

  • Taking seriously someone’s concerns - this involves being emotionally affected.
  • Sharing someone’s worries - “I’m here to help, and here if you need me”.
  • Normalising someone’s worries - “It’s normal/understandable to feel that way” or “It’s ok not to be ok”.

This can often help ‘contain’ difficult emotions rather than not engaging with people’s concerns, dismissing them, telling them they don’t need to feel that way, or promising to fix or take away people’s worries.


The appropriate containment of anxiety can help teams and organisations function properly while looking after staff. However, managers and leaders need to have enough ‘space’ or capacity in their minds to contain this anxiety. This demonstrates the importance of attending to the psychological health managers and leaders so that they are able to meet their own needs and those of their teams.

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This video is from the free online course:

COVID-19: Psychological Impact, Wellbeing and Mental Health

Maudsley Learning