Nathan Hodson reflects on being a junior doctor in mental health during the pandemic, the challenges for junior doctors on the frontline, and what covid-19 has meant for workforce morale.
Being a junior doctor in mental health during a pandemic
There are a couple of things you need to know about my job, if you want to understand what the pandemic has done to it. The first thing is that I work in a mental health hospital: mental health is exhausting and understaffed, but deeply rewarding. The other thing is that I’m a junior doctor and, like many junior doctors, I am in a training programme which will eventually lead to me becoming a specialist consultant (in my case a consultant psychiatrist).
Mental health workforce skills and the pandemic
Before the pandemic I worked in general medical wards. Then I took a year out to study health policy before pursuing my longstanding ambition to train as a psychiatrist. On my return to clinical work I encountered significant policy challenges threatening the quality of mental health care, not just now, but for years to come.
As junior doctors in mental health, we change jobs every 6 months to ensure we have a wide range of experience. We also have to take exams every 6-12 months. These exams determine whether we can progress to take on more responsibility for patients. Junior doctors are key to the provision of NHS mental health care so it is important that our training does not distract from delivering patient care. Besides, in the NHS there is a shortage of consultant psychiatrists and effective and timely training junior doctors is essential to plug that gap.
However the pandemic has made this more difficult. In the Spring many junior doctors in psychiatry were redeployed to hospitals where they had already worked. This reduces the diversity of experience they will be able to draw upon when they are more senior. Our exams were also cancelled, but not as a Dumbledore-esque celebration: all trainees are still required to take all the exams, they just have to do them six months or a year later. This meant that, once an online exams system was set up by the Autumn, many junior doctors sat multiple examinations in quick succession, stretching their study time thin. Moreover, the electronic system was unreliable and many junior doctors were unable to complete their papers and will be forced to retake in the Spring.
These retakes are distracting and disruptive. They pull junior doctors away from the care of acutely mentally ill patients. They risk delaying progression to consultant level, exacerbating staff shortages in the mental health workforce. They highlight the importance of efficient training of the consultant mental health workforce.
Mental health workforce morale and the pandemic
You can probably imagine that it is quite emotionally draining working in a mental health hospital. Lots of the junior doctors in the hospital are training to be GPs, or aim to become surgeons or radiologists or something else. Unlike me, they have not chosen to work in mental health. I think it must be even more exhausting for them. During the Summer we ate out to help one another out. We spent time relaxing in the break room. That was the thing that helped me get through the pandemic; it helped us build camaraderie and look out for each other.
As restrictions creeped back up the number of people allowed in the break room was limited and we could no longer meet up outside of work. Many of us chose to live in the West Midlands because it is so easy to visit family and friends around the country from here, but these sources of support were pulled away too. Mental health doctors have weekly supervision to check our mental health; my sense is that many others in healthcare and beyond would benefit from time to reflect and digest.
Connectedness and our common endeavor
The difficulty forming connections has been the same for lots of people who don’t work in the hospital too. I can understand why it has to be that way. In fact, the virus has shown how we are more deeply connected than it appears. Firstly, one person wears a mask and it protects not only their colleagues, but their colleagues' families, and their colleague's children’s teachers.
More than that, the pandemic has revealed how we all rely on each other.
Many people have gained a sense of how the United Kingdom fits together - the lorry drivers and supermarket workers, care workers and healthcare workers, teachers and police officers. I've always felt like practicing medicine was a form of public service; doing my bit for a country which gives me so much. During the pandemic it has felt like that more than ever.
Over the coming months and years, I hope we can nurture that sense and fight for a UK where we acknowledge that none of us can achieve our full potential alone. Instead the mix of private sector engineers, creatives, makers, administrators, designers, builders, plus third sector workers, plus public sector employees like me, ensures that # we can build the most beautiful system of human civilization, where those who struggle to look after themselves - some of my patients in hospital with chronic mental illness among them - are valued and cared for. For me, the pandemic has been a reminder that the best things we have arise through the strength of our common endeavor.