If you look up the definition of the word “organisational” you will see descriptions such as, planning and preparation, structure and systems, working together, and culture. This is exactly what organisations need to focus on during a crisis response. Organisations may have a crisis management plan; they may categorise events as critical or crisis incidents or non-emergency and emergency. Coronavirus is at the highest level of a crisis response that organisations will have experienced. At FD Consultants we specialise in supporting organisations when managing a crisis response. We have been supporting humanitarian aid workers deploy to share their expertise in managing pandemics and setting up large medical centres, frontline workers such as the police, ambulance services and NHS staff to help them maintain their resilience and manage their anxiety through this crisis, and we’ve been supporting mental health charities psychologically care for the wellbeing of their staff. Globally we are all experiencing a crisis response. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) definition of trauma requires actual or threatened death experienced directly or witnessed. Whether we are directly exposed to trauma either through our work, such as frontline workers, or we have lost a loved one through Corvid-19, or whether we are indirectly impacted by the change in our living conditions and witnessing trauma through the media, we will all be impacted. Trauma symptoms are at the extreme end of stress and anxiety symptoms. Traumatic events activate our survival response, which will trigger the emotional and survival parts of the brain. This can leave us feeling much more irrational, emotional and reactive. Some NHS staff are choosing not to return home to their families, during this time, to protect them from contracting Coronavirus. As a nation we are becoming more and more physically disconnected from each other, although at the same time, there are many new connections being made remotely. At FD Consultants we are a network of trauma specialist therapists. One thing we are aware of is that when individuals are dealing with a present trauma, historical unprocessed trauma can be triggered and brought up to the surface. Additionally, those with current and ongoing mental health issues may find their symptoms are exacerbated. So how can organisations look after their staff well during this unprecedented time and activate their crisis response to cover all aspects of crisis management. Below we share some of FD Consultants learning and experiences and explore how our work has changed since supporting organisations through Coronavirus (Covid-19). Supporting staff psychologically through a crisis response
By increasing staffs’ resources will enable individuals to remain resilient through this challenging time. When we are highly stressed our immune system depletes, we want to do all we can to encourage individuals to remain healthy and resilient through this unprecedented time and give everyone the best chance they can to come out the other end well and healthy. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly. Get in touch with us today
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Feelings of guilt and frustration at ‘not being able to do enough.’ Making the decision or having the decision made for us to evacuate. Not knowing when or even if we will return to our countries and communities that we have dedicated ourselves to working with. Having to leave our partners behind to facilitate the pandemic response. Just being separated from our family, and feeling helpless. These are some of the sentiments I have heard expressed by our aid worker clients over the past few weeks. Those of us who work in the humanitarian aid sector are ‘change makers.’ We are active, go getters. We make the change that we want to see in the world. During this time, we face two potential outcomes; we are either working frenetically, on the front-line. Or, perhaps, as is more common, many of us are stuck at home, feeling disempowered as we watch a global response that we are no longer a part of. Working from home The humanitarian aid sector is known for its fast pace, ‘get on with it, or get out’ mentality. We invest a high degree of dedication and self-sacrifice in our work. For those of us at home, we are, in a way, being asked to put ourselves first, in order to slow the spread of this pandemic. We understand the importance of self-isolation and social distancing, but it feels strange, it feels that we are side-lined. Some of the symptoms of homeworking that I have seen with my clients, are feelings of tiredness and lethargy, foggy headedness and a struggle to focus. Other of us may be particularly prone to panic working at this time. Without the structures of an office, we wake up, invest all of our time in our work, and don’t turn off. Psychiatrist Gianpiero Petriglieri describes ‘panic-working’ as when the drive to do the best we can under stressful circumstances, leads us to an obsession with staying productive. It is when we frantically try to hold on to the world we once knew by working endlessly and to unattainable standards. It is important to note that both fatigue and panic-working are normal responses to the strain of trying to maintain work productivity whilst grappling with the anxiety and stress that accompanies managing home responsibilities, while faced with our shared ‘unknowns.’ The compassion approach To remain mentally well under our present circumstances, it is important to recognise our feelings of and our defences against helplessness. We need to accept a certain amount of the uncertainty, distress and disorientation that we are all facing. Just because we are ‘safely indoors’ rather than at risk on the frontlines, our personal struggle is of no less value. And, to consider that our own limitations under these circumstances are not our failure but our shared reality. We can help ourselves in this by reconnecting with our sense of belonging, our human need to connect with others in order to feel valued and supported. In addition to communicating with friends and family, having a shared purpose can underpin this sense of belonging. Having mutual concern and compassion for ourselves as well as for our colleagues and staff can be crucial to this. It is for us as individuals and for our organisations to encourage this compassionate approach. The frontlines For those of us who are still on the front-lines, it is no less important to be compassionate to ourselves. We are separated from our families for what is an unknown period. Team leaders and managers are carrying concern for the communities they are serving, their staff’s wellbeing, as well as families back home. As we have seen with the HIV and Ebola responses, staff, by participating in a pandemic response, may risk potential ostracism from families or community members because of the real fear and stigma of COVID-19. All of this can impact our mental wellbeing, making an already challenging situation more difficult, as well as affecting our morale. Organisational responses Organisations need to verbally recognise the strains and family concerns that are unique and pressing under the current circumstances. Organisations can recognise the uncertainty of the times, the struggles and restrictions which all staff face, including family and care-giving responsibilities, and thereby validate the experience of staff. By placing an emphasis on keeping staff protected from chronic stress and poor mental health, organisations will strengthen our shared capacity to fulfil our roles in this critical time. Managers and team leaders, both in lockdown as well as in the field, should be supported to share the psychosocial services that are available to staff, and to encourage and destigmatise the need to make us of them. We need to attend to ourselves and our teams and role model healthy behaviour towards our own mental health, work, physical health and the shared reality concern for loved ones. Frontline staff should be encouraged to form peer support groups, be provided with remote Psychological First Aid (PFA) - for which specific training and guidance can be offered by FD Consultants. All workers responding to the outbreak, both home-based and frontline staff, should be provided with access to remote psychological support services. Priority on mental health support should be treated as equal to ensuring physical safety and infection control. Regular reviews of frontline worker psychological status should be undertaken, and organisations need to be responsive to these needs. FD Consultants is well placed to meet this variety of remote needs, with specialist sector experience in remote PFA and psychological assessment and support provision. The future “As the coronavirus pandemic continues, this will also mean looking at how funding and support – which moves slowly at the best of times – can be shifted to help local responders already doing much of the work.” (The New Humanitarian, ‘Coronavirus and aid: What we’re watching’) Depending on the trajectory of this pandemic, the implications are that local and national staff will likely bear the greatest responsibility for frontline work and service provision for the foreseeable future. The mental health of national staff and community volunteers needs to be prioritised. National staff mental health care has always been a neglected area of support within international NGOs and there are clear areas where national staff mental health is de-prioritised in relation to international staff care. Investment in local actors needs to include prioritising the psychological health of local and national humanitarian and human rights workers. FD Consultants can help fill this gap through our remote service provision, through mapping local psychological service providers and ensuring trauma informed oversight and surveillance of local service providers. Resources
The coronavirus pandemic will, in a way probably only paralleled in times of war, be a levelling experience for mental health practitioners and their clients. Of course, the outbreak and all the measures that have been introduced to halt its spread will impact people in different ways. At the heart of the matter, though, here we all are, dealing with an unprecedented and life-changing situation. As I’m sure is the case for many therapists, the past few weeks have seen my energy and concern flitting between the personal and the profession. Each day it seems, fresh news and government guidelines have hit us, altering our lifestyles and personal freedoms[1] in ways that would have seemed unthinkable as little as a month ago. This will have called for difficult but necessary decisions to be made about how we carry out our work. Dealing with the practical, administrative and clinical challenges of closing down face-to-face practice and offering telephone or online alternatives is something many in our field will have had to tackle recently. In addition to this we will also likely be wondering how the pandemic will impact on people’s mental health, perhaps bracing ourselves for a surge of new referrals over the coming weeks. Moving from the general to the more particular, I imagine we all also have clients we will have felt especially concerned for recently due to the impact we perceive coronavirus and its implications will have on their lives. This could be due, for example, to loss of income or job security, a pre-disposition to anxiety, or known difficulty when it comes to coping with isolation or change. If ever there were a time for us to feel truly ‘in it’ with our clients, we are currently living through it. I’m curious as to how this reality will impact our practice. It is, of course, still early days. Overall, though, the potential to strengthen therapeutic bonds and to edify other types of supportive relationships is one thing about the pandemic I feel hopeful about. Of course, no one can ever truly match another’s lived experience. However, whether we like it or not, as therapists supporting clients with anxieties and challenges relating to the outbreak, we’ll inevitably be dealing with very similar difficulties ourselves at the same time. This creates a prospective bridge of understanding between ourselves and our clients although it is, of course, one to be approached carefully. The Impact On Us & Our Work So how to manage the impact of the pandemic in our work? For me, after the practicalities of how we actually ‘see’ or work with our clients whilst in lockdown have been addressed, self-care and self-disclosure feel like the next most important issues. Fundamentally this means looking after ourselves and ensuring our fitness to practice, and also considering how we share our own experience in the consulting room (or, for most of us now, across the ‘consulting screen’!). Rather than approach these topics with more strict guidelines and a regulation-focused mindset (which we’ll all be seeing plenty of elsewhere in life right now), I’d like to call for a softening in our attitudes towards ourselves and our fellow practitioners, and a thoughtful but increased flexibility when it comes to therapeutic boundaries. Self-Care, Sickness, Holistic Health & Grief To address self-care and fitness to practice first, by now we all know how vital it will be to avoid face-to-face contact with clients over the coming weeks, particularly if we feel so much as a flutter of ill-health, or if we believe we may have been in close proximity to anyone with the virus. We’ll probably be checking our own physical wellbeing scrupulously and monitoring for any symptoms that might indicate we have contracted Covid-19 and may be laid low, needing to cancel our appointments for a period of time. It’s not my intention in this short article to go into all the potential implications that being sick and cancelling sessions might have on one’s clinical work. Needless to say, though, this is a time to be making the most of supervision and considering the benefits of having a clinical will and chosen colleague to help contact your clients and manage your work should you fall seriously ill. Amidst all the chaos and changes, though, even if we continue to feel fundamentally healthy, we must, of course, look beyond the physical and check-in on ourselves as to how we’re doing holistically. Absorbing and dealing with harsh new realities in our work and day-to-day lives means we’ll have likely seen familiar personal resources and resilience boosting facets of our worlds stripped away recently. I, for one, felt this happen in several successive and savage blows the week before full lockdown kicked in when I learned the local art classes I attend to relax, socialise and channel my creativity were being indefinitely postponed. Next my yoga studio announced its closure and then, finally, the blanket ban on going to pubs, bars and restaurants was announced. On the strange new coronavirus timeline this feels like old news now. However, I remember clearly how unsettling it felt when, within a matter of days, a vast swathe of the things that usually keep me feeling balanced and happy were suddenly snatched from me, shrinking the parameters of my world. In many respects I’m still smarting from these losses although, like most of the population, I’ve started to find ways of adjusting. Modern technology, of course, brings us a myriad of ways of keeping in touch and, with pretty much all the activities and opportunities that have been taken away from me, I’ve been able to find online or stay-at-home alternatives (or, interestingly, let a few things go!). Nonetheless, I’ve come to recognise that, with so many of my own precious freedoms lost or drastically curtailed, in a way I’m grieving[2], and grief needs to be honoured and allowed to run its course. As a bereavement counsellor I spend a lot of time reminding clients that grief has the potential to be exhausting and unpredictable, and that trying to dodge or overcome these aspects of grieving is generally futile. Therefore, whilst it’s been great to recognise and savour some of the surprising ‘silver linings’ that lockdown has brought, such as the satisfactions of store-cupboard cooking, or the newfound opportunity to finish novels and watch old films, it’s also been important to yield to the tears, bad moods, tiredness and fear that have arisen as a consequence of reduced freedom and uncertainty. It might not be appropriate to show these parts of my personal process to clients during actual encounters with them. However, it feels like a duty in terms of my commitment to self-care as a practitioner to allow space in my life for those more difficult feelings to come to the surface and get worked through. Now is certainly not the time to aspire to ‘being brave’ in terms of being emotionally super-human. A New Attitude Towards Self-Disclosure From this tender new attention to self-care that I’m being called to make stems a new outlook on self-disclosure. Whilst living and working in a radically changed context might not, in itself, be reason to tear up the old rule book, former ways of working surely warrant rethinking now. If it’s evident – as it will be – that I’m facing some of the same kinds of challenges as my clients are, how virtuous or, indeed, helpful, is it for me to try to hide that from them? The tussle with authenticity that would ensue were I to attempt this is not something I would not want my clients to witness as I think it would appear awkward and alienating. Of course, I’m not advocating a ‘free-for-all’ of uncontained and unthought-through personal sharing with clients - particularly at a time when so many other aspects of their lives may seem in freefall and the predictable boundaries of therapy therefore feel more necessary than ever. The ‘golden rule’ of self-disclosure is something I’d still hold as fundamental – i.e. asking the question as to whether any sharing is being done for one’s own benefit and catharsis, or for the benefit of the client and the strengthening of the therapeutic relationship. It should, of course, always be the latter. However, now’s a time when, as professionals, we can perhaps experiment with self-disclosure a little more, with a view to conveying something human and relatable to our clients at a time when this is sorely needed. If we’re cautious to hold back from sharing anything too deeply personal, such as the impact that illness and isolation may be having on our individual relationships or finances, then we are unlikely to reveal anything that will drastically ‘rock the therapeutic boat’ or prove controversial. On the contrary, an openness to letting clients see that we’re also feeling the consequences of what’s going on is likely to feel normalising and relatable. In my experience over the past week or two, this hasn’t needed to be strategic or deliberate in any way within my practice – it’s usually felt quite light in touch and spontaneous. When clients have asked me how I’m doing, for example, I’ve been a little more honest than usual in indicating that there’ve been some ‘ups and downs’ for me over the preceding week. My reason? It may seem very strange if I suggested there hadn’t. When sharing resources or engaging in discussion about ways of coping with the practical and emotional challenges of lockdown I’ve also occasionally ventured into disclosing what has helped me. Reflecting on a session earlier today where a client and I were discussing home exercise routines (he his door frame resistance exercises and me my hula-hooping) I can report that this sometimes brings some much-needed levity and healing laughter into therapeutic exchanges! Conclusion It’s, of course, far too soon at the end of April 2020 to comment on what the impact of coronavirus will be on people’s mental health and, indeed, on the working practices and attitudes of mental health professionals. Individuals within our world of work will be writing and thinking about this for many years to come and, fortunately, it seems, we will soon have access to carefully gathered quantitative data on the matter[3] as well as our own qualitative observations. As the situation changes and the impact unfolds, though, one thing we can all currently do is observe ourselves, honour our feelings and find ways of processing them. Supervision, collegial conversations, personal therapy, journaling, creativity, exercise and contact with loved ones are all ways in which this can be done. However, this list is by no means exhaustive and part of what we will be called to do is to find out what works best for us. Even if we’re not explicitly sharing what we’re going through and how we address it with our clients, this will hopefully lead to us meeting them in a healthier place. We will also be modelling something vital about self-care at one of recent history’s most important moments. Author: Felicity Runchman ( FD Consultants Associate) Date: April 2020 References
[1] Everyone will have their own understanding and personal experience of the notion of ‘freedom’. I would like to acknowledge that I’m writing and using the term from an admittedly privileged liberal Western perspective here. [2] I’m by no means the first therapist to liken the phenomena so many of us are experiencing in the wake of the pandemic to grief as this interview with grief expert, David Kessler, indicates [3] See, for example, Guardian Article It’s odd. Very odd. Sitting in South Africa, in the Global South, and watching how the Global North responds to the coronavirus. I am from the UK, born in England, and all my family are there. Everyone apart from my mum, a renegade, who is under lockdown in a youth hostel in New Zealand, having packed up her life and set off on a bicycle. But everyone else is in Europe, at the epicentre of the virus outbreak. Speaking to my family, reading the BBC, it’s like looking into a dystopian future. I watch as the run on the health system begins, as people queue outside of supermarkets. I chat to my friend who is on lockdown with a tiny baby and she wryly tells me about her efforts to “get back to work”. I am working remotely from South Africa. Part of my day involves speaking to French professionals. Since March, my calls have become therapeutic interventions. “How are you managing during the lockdown?” “Do you have a garden?” “How are the children?” Here in South Africa, we have been on total lockdown since the early hours of the morning of Friday 27th March. They are calling it a “ruthlessly efficient fight” against coronavirus[1]. We are not allowed to walk the dogs, there is no “hour for exercise.” The South African response was swift, and brutal. We shut down our public spaces with a rapidity that a dictatorship would boast of. Ramaphosa, the president, has been applauded. South Africa shut down when we had only registered 400 cases. Since then, we have trained 10,000 field workers to carry out the most testing in all of Africa. Compared to the rest of the continent, we are strides ahead in our fight against the virus. And it is a fight, Ramaphosa has told us in no uncertain terms that we are at war with an invisible enemy. I mean for goodness sakes, we stopped the sale of cigarettes and alcohol. I am not quite sure for the rationale behind that – maybe public health – drunk people break rules? Or perhaps a rare insight into a puritanical streak in the underlying social norms of the country. And yet, if this is a war, what is the price that we will pay? And who pays most? South Africa is one of the most unequal countries in the world. When you look at the 6.6 million people filing for unemployment in America, I have a real sense that this will pale into comparison to the economic impact of coronavirus in South Africa. The economy has already been downgraded to “junk” status. At home, I sit on my laptop and support my little South African family; my husband, his sister and her husband and our three year old niece, everyone now unemployed. I have worked in the HIV response for many years and my LinkedIn is a smorgasbord of responses from the HIV sector; UNAIDS has been circulating an image of lessons that we can learn from the HIV response. It talks about the importance of involving communities in the coronavirus response and of removing the barriers to action – barriers such as insecure housing status, healthcare costs or the fear of unemployment. It talks about how we should be kind to one another and address fear and stigma. (see image) Yet even with the HIV response, we haven’t really learned these lessons. HIV remains an extremely stigmatised disease, often affecting the already dispossessed. When we look at the impact of coronavirus in Africa, the stark wealth and power disparities will only exacerbate the issue for those least able to respond. A recent study by the London School of Hygiene and Tropical Medicine looking at the impact of coronavirus in low income countries[2] made for sobering reading: modelling predictions looking at high-income countries suggested there would be a substantial excess mortality rate with un-controlled or partly controlled coronavirus measures. Yet the virus’ impact on people living in low-income settings or affected by humanitarian crises would be even more severe. This is partly because of more social mixing, higher existing rates of co-morbidities, including a population living with unsuppressed HIV or TB, and intrinsic weaknesses in national healthcare systems. In South Africa, 7.7 million people live with HIV, and yet only 62% of those people are on treatment. 2.9 million people living with HIV are not on treatment and are therefore susceptible to coronavirus mortality. In South Africa, it is our most vulnerable – those in urban slums, those without access to water, our homeless populations, those with multi-drug resistant TB – that will suffer most. It is no surprise that the government acted rapidly. While these sobering facts resound around my computer screen, I try and carry on as normal. I look at my future, the European reality, and I try to carry on working. If I were in the UK, I could volunteer with the NHS. In South Africa, I am on a tourist visa, not recognised by the Health Professions Council of South Africa. I fire off emails to Medicins Sans Frontiers, maybe they need me? As the world seems to stop, I try to find meaning. Am I living right? Am I doing enough? Sometimes I spend the day in bed. My story is not that of an individual. It may be personal, but in reality it is a global story. How many other people are there like me, who are sat at home? How many of us are struggling to remain upbeat, and struggling to be resilient? How many of us, who work in the humanitarian and development sectors, feel impotent? Some days I worry about my own mortality. My phone flashes as I go to bed, “13 year old dead in London from coronavirus. No underlying conditions.” Other days I shrug it off. For goodness sakes, I work in infectious diseases. What on earth do I have to be scared about – death? Yes, well, we all die one day. I am twenty eight and a model of physical fitness. Well, OK, not a model, but I am trying out yoga once a day – that has to count right? The point is, I know I am not alone. I am you and you are me. We are together at this time, facing the same challenges, and we are struggling to find the same meaning. In West Africa they say “on est ensemble.” We are together. Today more than ever, that is a global truth. At FD Consultants, we use a trauma informed model based on the term RESPECT, coined by Fiona Dunkley in her book, “Psychosocial Support for Humanitarian Aid Workers: A Roadmap of Trauma and Critical Incident Care.” RESPECT is a resilience toolkit, it’s an individualised way of how to look after ourselves during this time. It’s a way of building positive coping mechanisms to manage the impact of trauma, so that we can continue to find meaning and make a difference during this time. As Ramaphosa told us, we are at war. We are at war with an invisible enemy, and war is by its very nature a traumatic event. RESPECT gives us tools to foster our individual resilience in face of this trauma:
I read to unlock my relaxation, and I learn about how this crises affects my personal growth. I am in touch with my family daily, sending silly memes or laughing through Zoom calls. I ground myself through yoga, I get my cardio through dancing to Disney film scores, dangling my butt-naked niece on my hip, “under the seeeeeea”. I feed my creativity, drawing in chalk on the fence outside. And I challenge myself to turn off my phone when the social media becomes too much to manage. I breathe RESPECT and I take control. I will find meaning. If you are interested in any of the services that FD Consultants can provide, including remote support services, please contact us today. By Yasmin Dunkley, Independent Business Development Strategist with FD Consultants HIV and Sexual Health service provision specialist [1] https://www.bbc.com/news/world-africa-52125713 [2] https://www.lshtm.ac.uk/research/centres/health-humanitarian-crises-centre/news/102976#.XoWV8UOHVhk.linkedin |
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