We are on the penultimate day of Mental Health Awareness Week. It has been a week when there has been a great deal of focus on the mental health and wellbeing of all our citizens as we live through these strange Covid days. Lockdown has added to and created considerable mental health distress and ill-health for tens of thousands. For many help has come from support they have found online or on the other end of the phone. For many others help simply has not come and at best will be delayed. How we look after ourselves mentally as individuals and as a nation matters now more than ever before.

In my thoughts today, however, I want to focus on some of the conversations which I have been having this week with folks in the care sector. These have been conversations which have shown me the real fragility which exists out there in terms of the mental wellbeing of our care sector. They are conversations which have changed quite considerably in tone and concern.

I suppose the first thing to say is that I am detecting a real change in the spirit and the morale of people delivering care in our care homes and in the community. I am detecting a depth of emotional exhaustion which I have never seen before.

It is probably a truism to say that whenever we are faced with a challenge in life the adrenaline of initial encounter, the support of those around us, the sense of collective endeavour can serve to energise and renew us. I think that was what many people felt in the early days of the Covid nightmare. Undeniably some of this collective camaraderie was on the back of a failure on the part of the rest of society to value the role of carers at the start of the pandemic. There was the constant focus in media and politics upon the NHS and its workforce. I am not – lest I be accused of it – denying the importance of our NHS colleagues at any time far less in recent weeks – but undeniably whether it was by being barred from special shopping times or refused offers from companies for ‘NHS only’ employees – social care staff felt ignored and put aside in the early days of the pandemic.

That changed and the ‘Clap for Carers’ movement – a response which may come to an end this coming Thursday – helped to underpin the central role and critical contribution of social care and other key workers to the rest of society. In the midst of battling this virus there was a growing sense of us all being ‘In It Together.’ Political point-scoring was put aside, and we entered a no-man’s land of consensual support, collective solidarity and focussed attention on beating the virus not least in the care home sector where it was beginning to have a dreadful impact.

But over time I have detected a change in the mood. The uneasy political peace gave way to the articulation of blame and the apportioning of responsibility for action or inaction. Personalities began to dominate rather than community consensus. The media began to focus negatively and critically on the care home sector and the inevitable finger-pointing started. Workers were literally door-stepped and followed home by a media sensing a story and with little concern for the aching pain and loss frontline workers and families were living through. But despite all this there remained an astonishingly sacrificial professional commitment on the part of the care workforce focussed on saving lives, being present, consoling and comforting.

But there is no doubt 9 weeks into lockdown that people are exhausted.

There is a type of tiredness which is so intense that it reaches deep inside the marrow of our bones. It is an exhaustion which is more than physical, it encompasses our spirit and our very being, it removes the energy which keeps us going even when we are tried beyond imagining. It is this emotional and total fatigue which is happening to care workers, managers and providers across Scotland.

I have never before had to hold so many conversations with individuals who have been on the edge of emotion, who are simply drained of energy and very tired at the constant barbed criticism which they feel is being directed at them from all quarters.

There is a coronavirus burnout happening before our eyes across Scotland. It is an exhaustion which is emotional, mental, and physical and it has been fed by excessive and prolonged stress. The stress of keeping going, saving lives, granting compassion and simply being present. And all the time there is a ticking clock of critique in the background. And accompanying this there is an emerging individual guilt – however misplaced – of ‘Could I have done better? Did we do everything we could have?’

 We need to be alive to the reality of a burnout care sector, of workers, managers and others feeling they have lost purpose. This does not just necessitate a response at an individual level it requires a real ‘putting our arms’ around care homes and home care. It is imperative that the potential of support for social care is achieved and maximised, that there is a mutual appreciation of the professionalism of the care sector by health colleagues and vice-versa.

It is well known that although we may expend all our energies getting to the summit of a challenge it is in the process of descending from the peak that most harm and injury is caused. The care sector in Scotland has exhausted every energy in fighting this virus and is still doing so – unlike the rush to lockdown seen elsewhere and the silence of unclapped hands  – the battle is still going on; lives are still being saved and cared for.

The last few weeks have been a collective effort and it is imperative that the next few weeks are ones where health and social care, where worker and manager, where politician and commentator, continue to uphold the care sector as we work collectively to meet the challenge of this virus.

There is a burnt-out exhausted care sector in our midst, but it is also one which is strong. It is strong in its talent, its creativity, its compassion and professionalism. It will grow stronger still if it is really supported, truly valued and deeply cherished.

As we end Mental Health Awareness week, I hope we can all collectively continue to remember and focus on the amazing care in our midst. So, every Tuesday at 7pm I will try to light a candle and spend a minute to remember those who have died in our care homes, in our hospitals and communities; to remember those who care beyond calculation, those who go out from comfort to give compassion; those who work tirelessly even when exhausted and burnt out. I will remember until that day when we hear of no deaths from Covid19. May that day come soon.

Please join me in lighting a #candleforcare.

 

Donald Macaskill 

We are now eight weeks into the Covid19 pandemic in Scotland’s care homes and the extent of distress and trauma being felt by many residents, staff and families is really hard to bear.

I was going to write something positive this week about the way in which infections are declining, about the amazing  work that frontline staff, managers and owners are doing to keep spirits up and positivity going, and about the news that in one Health Board there are hardly any Covid positive cases in the care homes in the area. So yes, there is at last a sense in which we are turning a long slow corner … hope is on the horizon.

But on Thursday I received a letter of such honesty and beauty that I need to share  some of its content with you in this blog.

Mary is a nurse in a care home run by a family who have owned the home for many decades. It is a good home with plenty of individuals wanting to come in as residents and with very good and consistent Care Inspectorate grades. The staff are skilled, empathic, kind and committed. There really is, in Mary’s words, a home from home feel about the place. From her description this is a care home which is doing precisely what all good care homes do, providing life and energy and safety for those who need additional support due to frailty or age. Sometimes in all the debate and necessary focus on infection control of the last few weeks people have forgotten that a care home is not a ward, a unit or an institution but someone’s home. Places where people are encouraged to bring in possessions and furniture to make the loss of their own homes and spaces less acute and hard. Places where you are encouraged to wander and chat, to settle and be still, to dance and play, be active and alive.

Mary has worked in the home for nearly 13 years and she has nursed individuals through the rhythms of pain and parting, has given solace at times of sickness and celebrated when people have recovered and been restored to health. This is the nature of care home life, a life in tune with the seasons of humanity, comfortable with living through older age and enabling not existence but life to the fullest in the face of mortality.

Then the virus struck in Mary’s care home. Like the thousands of other nurses and care staff in Scotland’s care home sector Mary is skilled and experienced in dealing with viral outbreaks not least norovirus and seasonal flu. But Coronavirus is unlike any other. Its silence creeps and kills, it’s invisibility touches and destroys. Despite very stringent efforts, with adequate PPE and a well-trained staff the virus got into the care home. No-one knows how but it did. Mary writes:

“We have been living with this virus eating away at the heart of our home. In a matter of days, we have lost so many people it is just too hard. We have lost real characters  – people who made the place what it is with their laughter and jokes. We have lost folks who have been here for so long. And when I say lost that doesn’t even tell it as it is. The deaths were really hard. They were sudden and horrible. People need to know about this. No-one is talking about the horribleness of this disease… No one wants to know the real fear we feel as we sit there holding the hands of people as they pass… It is all just numbers out there read out every day. It is all about getting back to normal. I can never get back to normal… But it is our friends, people we know like a family.. I have lost so many… I cannot sleep at night because of the sadness I have… it is an emptiness I have never felt. I can’t even say goodbye to them.”

Mary is not alone. Others have written to me or reached out through social media to say the same thing that we are not telling the full story of the deep sadness that is being caused by this virus. That as a society we have become inured to the statistics turning them into data analysis, projections and comparisons.

All of us who have known and lost someone to the virus will live with that memory for ever. We have not had the chance to grieve. We have not had the moments of hearing the story of a life lived because there is no one to tell it to us. But those who have had to be present at the bedsides of residents and friends, those who have experienced multiple deaths in such a short period of time, their trauma is acute and aching.

It is each of our responsibility over months and years to uphold and support these people. We will need to be very alive to the reality that what some will suffer will be post-traumatic stress. We will as a whole society, from Government to provider, from neighbour to family, require to be present to listen, console, support and cradle their grief.

But it is not just for care staff. Our cradling and solace-giving needs to be for the families and friends unable to be present, for fellow residents who have lost friends, and indeed for ourselves.

I hope that in the coming days and weeks the increasing words of harsh criticism, of finger-pointing and blaming, will be quickly worked through. I accept that they are often a understandable response to grief and trauma and that they are sometimes necessary to assure and to hold accountable all of us for what we have done and not done. But they ill-serve us if we want to move forward as a nation, as a community and as individuals. We need to learn again how to be kind.

I really do hope that we are all able to be increasingly present for those who feel like Mary, emptied of hope and life. I hope we will remember that true community is when we work, act, sit and rest in a spirit of open honesty and togetherness.  

There are hundreds of stories which have been left untold. As we come out of this cruel time it is up to each of us to give space for their hearing, soothing for the sorrow felt, and comfort in the emptiness. Mary and others in our care sector deserve no less.