here’s always a crying cupboard on every ward. It’s usually a stock cupboard or the toilet … that’s where you find people crying.” Anne, an occupational therapist specialising in stroke patients, says, half-joking, that there is “now a queue for the crying cupboard”. All of her patients now have Covid-19, and she describes her working day as harrowing. “I have stopped talking to my family and non-NHS friends about it because I think it’s too hard for them,” she says. Much has rightly been made of the threat to the physical health of NHS staff, which has been compounded by inadequate personal protective equipment (PPE) and poor government planning, but it is important to also be aware of the toll that the outbreak could take on their mental health. There were already much higher levels of mental illness within the NHS than among the wider population: a 2011 report in the British Medical Journal found that nearly a third of doctors have a mental health disorder. According to a study by NHS digital, the NHS lost 348,028 working days due to anxiety, stress or depression in just one month last year. Many staff were already at breaking point before the disease hit. The impact of coronavirus has been stark: half of health workers are suffering mental health problems such as stress and trauma as a result of dealing with the lack of PPE, colleagues falling ill and, in the most tragic scenarios, dying. Living with a perceived, continuous threat to life puts a person under intense psychological stress. This is exacerbated by feelings of isolation, or not being able to share what they are feeling. It’s a potential recipe for post-traumatic stress disorder (PTSD). The fact that the virus is novel compounds this. “Typically one of the symptoms of PTSD is that sense of uncertainty, being out of control,” says Claire Pooley, a British Association for Counselling and Psychotherapy (BACP)-accredited trauma therapist and trained nurse. “None of us know right now. Staff have to count on their own hospital trust, that it is doing the best it can for them, but at the same time there’s a sense of, ‘Well, is it ?’ And do we know if what we are doing is the right thing?” Pooley has been volunteering for the organisation Frontline19, which offers free mental health support for NHS workers. Set up in a matter of weeks, more than 1,500 therapists have volunteered so far. Pooley says clients are typically experiencing feelings of panic – with some having panic attacks for the first time – and that this is worsened by feeling unable to share their problems. “People are making them out to be heroes but they are potentially trying to hold on to their own fears for their safety, [because they feel] a huge sense of responsibility,” she says. While it’s necessary to praise the heroism of NHS staff in this crisis, it is also important to acknowledge that they can be vulnerable and need help, or else potential psychological problems risk being buried by a “wartime” narrative. As in the armed forces, there’s a pressure to be “strong” – especially, one nurse tells me, because “everyone is clapping for you”. Being unable to talk about what you’re feeling can have long-term repercussions when seeking help depends on being able to recognise symptoms. Awareness is improving, but it can still take a long time to realise that you are suffering from a mental health condition that could benefit from treatment. Better understanding of the symptoms of PTSD – which include hypervigilance, edginess, flashbacks or nightmares, intrusive thoughts, negative beliefs and avoidance – will help some healthcare workers realise they need help. Peer support is vital, too. Anne may not feel able to talk to her family about what she is experiencing at work but she has a network of friends and colleagues in the profession with whom she can share. Having had PTSD herself, she is involved in mental health planning at her trust. “At the moment, I’ve been really pleased to see such an emphasis on mental health support for staff,” she says. As well as Frontline19, staff can access employee assistance schemes, a number of apps and resources have been made available, and PTSD guidance has been drawn up by military veterans. The important thing, Anne says, is that it continues in the long-term, after the “flurry of support” that often follows a critical incident. For some staff, it could be six months or a year before symptoms develop. On Anne’s ward, the crying cupboard has been replaced by a “wellbeing area”, where staff can take a vital few minutes off the ward when it all gets too much. “I can’t tell you how valuable that is,” she says. They lost a colleague just the other day. Rhiannon Lucy Cosslett is a Guardian columnist In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org