Introduction

Back on Track is the Improving Access to Psychological Therapies (IAPT) service for Hammersmith and Fulham in West London. As an inner city service it supports a diverse community and provides the full range of evidence-based interventions to meet their needs.

The challenge

Staff fed back that their wellbeing was being affected by working long hours and having to manage stressful clinical situations, particularly management of risk. A focus on key performance targets left some staff feeling their own wellbeing had a lower priority, which resulted in lowered morale. Some team members felt unable to take on new tasks or face new challenges because they were overwhelmed by the day-to-day demands of their role.

How it worked

A wellbeing team was formed from frontline clinical staff who had expressed an interest in this area of work. Funding and study leave was arranged so that wellbeing team members could attend relevant continuing professional development (for example, an employee wellbeing conference). This was a key first step to ensure they were able to learn from best practice in other areas. The wellbeing team then sent an anonymous survey to all team members asking the following questions:

• Does Back on Track care about my wellbeing?
• To what extent do you feel able to raise and discuss difficult and controversial topics?
• How comfortable are you in meeting your role demands?
• Am I able to adopt a healthy work-life balance?
• Is my mental health good?
• Is my physical health good?
• Are my energy levels high?
• Am I well, resilient and performing at my best?

Responses were categorised according to groups: High Intensity Therapists, Psychological Wellbeing Practitioners and administrative teams to identify themes within each group. The responses were fed back during a team away-day and the wellbeing team facilitated discussions in small groups about the most important changes to make. A variety of ideas from team members themselves were implemented:

• Reflective practice group: scheduled once a week at the end of the working week. This was based on the principles of Compassion-focused therapy (CFT). An additional ad-hoc meeting was scheduled following the EU Referendum to provide support to staff in relation to political changes,
• Mindfulness and yoga practice: for the first five minutes a team member provided a guided mindfulness exercise and during the week 15-minute practice sessions were scheduled. Reduced-fee yoga sessions were scheduled in the team base once a month,
• Review of risk management procedures: the team identified that management of risk to self was the most stressful part of the job – the feeling they had never done enough and being unsure about how to follow some of the policies. Risk management procedures were clarified and supervisors and duty workers were asked to emphasise to the team when actions had been completed, and for this to be documented by more junior members of the team,
• Thank you emails: the wellbeing team co-ordinated thank-you emails when anyone in the team had helped someone else,
• Wellbeing emails: sent regularly by the wellbeing team to remind everyone to spend time looking after themselves. They included short poems, prose and exercises based on the principles of mindfulness and compassion as well as practical advice – eg to have a lunchbreak,
• Monthly team social events ensured everyone could regularly participate in a social event,
• Better workstations: new equipment was purchased as a way of improving physical wellbeing (larger screens, sit-stand desks),
• Kitchen improvements: a team toaster to help improve the kitchen,
• Staff wellbeing information shared: a wellbeing zone was established on the team shared drive with information on wellbeing exercises, benefits for staff (eg discount schemes) and information on accessing further support (eg referral for staff counselling). Noticeboards were updated to ensure information about the wellbeing programme and staff counselling was visible,
• Recruitment campaigns emphasised wellbeing: the project was mentioned in all recruitments and the advertisement for senior posts stated the service was looking for individuals with an interest in improving staff wellbeing.

The only items that required funding were buying a toaster and sit-stand desks.

Impact

The anonymous survey was completed by the team in 2014 and again in 2016. The results are presented below:

Next steps

The wellbeing team is a key part of the Back on Track IAPT service. An essential part of the project’s success was the ongoing commitment, so the team knew this wasn’t just about short-term change that would be forgotten when another priority emerged. Some changes have been made – for example thank-you emails have been changed to a thank-you jar so comments can be made more discreetly. The service now offers a short ‘mindful walk’ for employees each week. Plans also include using a standardised questionnaire to assess wellbeing to help benchmark the service in the future, and starting a small gardening project in the patio at the back of the main team base.