Sunday, February 27, 2022

COVID-19 and staff mental health for those supporting people with an intellectual disability


 Mental health among healthcare staff in general has long been an issue of concern, although there may be particular problems faced by healthcare workers within different disciplines/areas of healthcare. Research we had conducted with the IDS_TILDA cohort had found that although there was a plan in place for people with intellectual disability to manage self-isolation if they COVID-19 symptoms, many struggled to fully understand these plans or adhere to them.  

The current research involved interviews with 13 healthcare workers who were working with people with intellectual disability during the COVID-19 pandemic. We carried out these interviews from November 2020 to January 2021, a hard time in terms of lockdowns and restrictions.

The word panic was often used to describe the initial emotional response to the pandemic. At the same time as working hours increased, there was a sense of isolation within the workplace, with staff less able to interact with each other. One individual taking medication for mental health problems reported they were on their maximum dosage since the pandemic.    

The changes in the work environment were a great challenge for many staff, with rules around social distancing difficult to adhere to when many of the people they worked with wanted or needed to have greater physical proximity. Many staff were moved to different locations or shifts, leading to greater unpredictability. (Care provision for people with intellectual disability usually tends to be relatively predictable, with routines making things easier for service users). Excessive workloads and unpredictable work patterns created a vicious circle, with greater levels of staff absence heightening workloads.   

On a more positive note, participants acknowledged there were supports available to them, and some were quite willing to talk about how they took up the offer of services such as employee assistance programs. Nonetheless, concerns were voiced that some colleagues would be reluctant to display the anxiety they felt. More informal support from managers and colleagues was also discussed; these can build on the shared knowledge of peers. Many people we interviewed wanted to focus on the future, in terms of how we may not fully understand the impact of the pandemic on mental health until sometime after it had ended. The value of having mental health supports that can be accessed directly and anonymously, without having to go through a liaison person within an organisation, was also highlighted. 

Some of these challenges the participants talked about have long been an issue for healthcare workers (e.g. excessively long working hours), but the difficulties faced were worsened by the particular challenges during COVID-19 and the associated lockdowns. It was promising to hear some staff talk about their willingness to seek and accept help; however, as we come out of lockdowns, and as the threat of COVID-19 is gradually falling, the findings sound a warning around the possible effects of future systemic shocks to a care system that already places a lot on the shoulders of healthcare workers. 

This work was made possible by funding from Trinity College Dublin COVID fund. It was a great opportunity to work closely with Dr Fintan Sheerin, the Head of School at the School of Nursing & Midwifery, as well as Dr Yaohua Chen, who worked hard to complete this project.  

Sheerin, F., Allen, A. P., Fallon, M., McCallion, P., McCarron, M., Mulryan, N., & Chen, Y. (2022). Staff mental health while providing care to people with intellectual disability during the COVID‐19 pandemic. British Journal of Learning Disabilities. doi: 10.1111/bld.12458

Related posts

COVID-19 and people ageing with intellectual disability: part 1

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Wednesday, February 16, 2022

The impact of COVID-19 on people ageing with an intellectual disability: part 2



In a previous post I discussed a survey of people with intellectual disability during the first wave of the COVID-19 pandemic. The results spoke to the challenges of lockdown as well as the resilience of the people surveyed. Given the major impact of the COVID-19 lockdown on people with an intellectual disability in Ireland and internationally, a new survey was carried out across Ireland during the summer of 2021. Nearly all participants had received at least one dose of a COVID-19 vaccine.

The report based on the survey was launched by Minister Anne Rabbitte (Minister of State with responsibility for disability) on 27th January. The Minister praised the contribution of the longitudinal findings of IDS-TILDA and how they've helped inform government policy to help improve the lives of older people with intellectual disability. She praised people with intellectual disability, families and services in working hard to protect public health during the COVID-19 pandemic, as well as those who took part in IDS-TILDA. In the chat, it was great to see international attendees as well as people from a wide variety of organisations from around Ireland.  

Prof Mary McCarron, principal investigator of IDS-TILDA, introduced the overall IDS-TILDA project. It has been running for over a decade. Given the existing level of research infrastructure within IDS-TILDA, the team were able to mobilise quickly to gather data in 2020 about COVID-19.

There were 682 people from the IDS-TILDA study who took part in the latest COVID-19 survey. Between the first and second survey, there was an increase in those with symptoms of COVID-19 and a modest increase in those who were tested (this survey was done in summer 2021, when there wasn't as many self-administered antigen tests etc.) People living in residential settings or community group homes were more likely to test positive for COVID-19 than those living independently/with family. Symptoms generally didn't last for more than a few weeks. 

Almost all participants who had symptoms or tested positive had plan in place to self-isolate. It was also encouraging that most participants reported being able always/often adhering to lockdown rules. At the same time, a majority were more likely to be sedentary during the lockdown.. Around a third had side effects of getting the vaccine, although these were generally mild and short-lived (the most common was redness/swelling of the arm, which I suspect may in some cases may have been related to getting an injection per se rather than the contents of the vaccine). 

Nonetheless, the pandemic continued to be a source of stress/anxiety for most participants, with key reasons for this including being separated from family and friends and not being able to do one's usual activities. Almost all participants experienced significant life events. Only a minority of participants reported being unable to attend funerals or see a family member in a critical condition. However, Prof McCarron mentioned that this is something that may have more long-term effects on those who did have such experiences. Sadly, there were 28 participants who knew someone who died of COVID-19. Prof McCarron noted that during the first survey, there was probably more a feeling that this was a short-term thing that would end in the imminent future or as soon as there was a vaccine. But ongoing restrictions dragged on.

Nonetheless, most participants reported positive aspects of life during the pandemic. For example, people had more time to rest and relax. People were anticipating going to get their hair cut/beauty salon, going to visit family and friends more, and bringing family out for a proper party!

Prof McCarron also mention moral injury among staff caregivers. There was a lot of stress among caregivers. There is a new paper on another study from the team on this topic. 

There was a lively panel session after Prof McCarron's presentation. Prof McCarron praised the preparedness of services and the willingness of participants to be involved in these surveys. Mei Lin Yap spoke to her own experience of becoming an aunt during the pandemic, with major life events happening during restrictions. Prof Seán Kennelly (National ID Memory Service) made the point that resilience can come at a cost. It's great that services "risen to occassion", but we need to be careful about expectations being changed in the long run (e.g. delays in access to care etc.) Maria Kavanagh from Stewarts Care spoke of how services knew about vulnerabilities service users might have, and so used this understanding to lobby on behalf of people to reduce risk (make sure there was PPE, and associated training). They also prepared accessible information and collaborated with other organisations to develop training programs and share knowledge and resources. Alison Hartnett (National Federation) spoke of how the study has given evidence that guide services in their practice. The pandemic is a story of interdepedence; things wouldn't have turned out the way they had, had people not worked with each other and gone above and beyond to keep each other safer. Under-staffing has been a major problem, where there could be up to 30% of staff out sick at any time, with those still able to attend exhausted.    

From an international perspective, Prof McCallion (co-investigator with IDS-TILDA) brought a USA perspective, mentioning a greater number of people living outside the service system compared to Ireland. COVID-19 has been divisive along political lines. The need for greater technology for social connectedness is great, looking at older parents having enough tech know-how as well to make the best use of things. From the UK, Chris Hatton, who was heavily involved in a similar study to IDS-TILDA. However, unlike IDS-TILDA, they didn't have the same level of longitudinal research infrastructure. The UK may have been a worse picture than Ireland. England in particular has been slow to lockdown and quick to lift restrictions, with higher mortality rates for people with intellectual disability.   

The report is available for download from the IDS-TILDA website: https://idstilda.tcd.ie/wave4/covid19launch.php 

Related posts

COVID-19 and people ageing with intellectual disability: part 1

If you like this post, follow me on Twitter: @ArchivePsych