Raj Persaud On coping responses

Published: 19/08/2004, Volume II4, No. 5919 Page 19

You do not have to be a psychiatrist to know that working in the NHS is stressful. It is a strain not just for frontline staff - who tend to attract all the public sympathy - but for managers and other staff, too.

When NHS staff are referred to me as a psychiatrist and complain about the level of work stress they face, I explain that the real issue is the problems attached to their inadequate coping responses.

There are basically only two coping responses we can mount in response to a stressful life event: 'problem solving' or 'emotionally focused' coping.

This was a recent conclusion in the US by the FBI Behavioural Sciences Unit in a study of the psychological reactions of those who have been taken hostage. In my experience, working in the NHS increasingly resembles being taken hostage by armed gunmen.

'Problem solving', according to the FBI, involves taking action to make the world a less stressful place. If you are taken hostage you try to escape. This is problem solving. So if a bullying consultant is rendering your life a misery, a 'problem solving' approach would be to get a group of colleagues together to help persuade them to change their personal approach.

'Emotionally focused' coping basically means adjusting your internal emotional state so you are less upset by the bullying consultant. If you are taken hostage by armed gunmen, 'emotionally focused' coping is about sitting tight but passing the time in as pleasant a way as possible.

My experience with health service staff is that they keep trying to perform problem solving when many problems they face are simply not solvable. There is little or no consensus in the NHS as to what constitutes a solvable problem.

This lack of agreement makes staff feel they are on a treadmill where no matter how hard they labour, they do not seem to get anywhere.

One of the most therapeutic things any meeting or group of colleagues can begin a project with is a mutually agreed understanding of what is not expected of them. The very high expectations of the public, politicians - and that the staff have of themselves - are the core cause of the stress we all experience.

I have attended several recent conferences where staff heatedly debated what to do about the high levels of teenage pregnancy they deal with.Yet teenagers will still be getting pregnant for many years to come, despite all our best efforts, so this may not be possible.

Everyone leaves the meetings feeling terribly stressed. This is precisely how you would feel if you believed that this, and a whole series of other difficulties, were problems you had to solve, regardless of whether they are actually solvable or not.

Dr Raj Persaud is consultant psychiatrist at South London and the Maudsley Mental Health trust and Gresham professor for public understanding of psychiatry.He presents All in the Mind on BBC R4.