Adapted from BMJ 25 October 2025
A Care Under Pressure review by J. Maben et al has examined the causes and solutions to workplace psychological ill health in nurses, midwives and paramedics.
The NHS needs healthy, motivated staff to provide high quality patient care. Nurses, midwives and paramedics make up 56% of clinical staff in the NHS and they have high rates of mental health problems.
High pressure environments with heavy workloads and staff shortages are linked to mental ill health. In 2023 42% of NHS staff reported psychological unwellness due to work related stress. 32% said there was not enough staff to do the job properly and 74% said they suffered from unrealistic time pressures.
Psychological ill health in turn increases staff sickness and resignations. Other staff are under performing because they are at work while under severe psychological stress. Patient care suffers as a result. The estimated cost of this is 12 billion a year to the NHS. The review researchers think that they could save up to 1 billion a year if their recommendations were implemented.
Over 200 research papers were examined for the review. They found that aspects of the job and workplace were more important than the individual profession when it came to the causation of psychological distress.
Those who were most at risk were staff in roles that exposed them to trauma, newly qualified staff and lone workers.
They found that failure to take a long term view of effects on staff, the blame culture, managers who don’t listen to employees, and prioritisation of the needs of the system over the individual, were major causes of psychological distress.
Matters could be improved if the NHS invested in the provision of long term psychological support, reduce bullying and harassment, provide space and places for staff to share experiences and use an evidence based framework to evaluate interventions.
The stigma of having psychological distress in response to work needs to change. The blame culture needs to be tackled. Most staff are simply doing the best they can under very difficult circumstances. Essential needs such as access to hot food, lockers, showers, car parking, rest and break rooms are needed.
Improvements need to be tailored to the local workforce needs. The researchers have produced a summary, guidance and webinar of their work for leaders, nurses, midwives and paramedics.
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