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    Crisis, Disaster and Trauma - Covid-19 Response

    In response to the pandemic, the Crisis, Disaster and Trauma Section set up this web page to provide easier access to Covid-19 related resources.

    About

    The Crisis, Disaster and Trauma Psychology (CDT) Section of the British Psychological Society exists to provide its members with a central hub where issues of psychological trauma can be explored, research and evidence-based treatments can be examined, and ongoing standards of best practice can be established. 

    In response to the pandemic the section has brought together a collection of resources, psychological knowledge and expertise from across the psychological disciplines which will be updated as we become aware of other useful and relevant materials.

    Call to Action: The Mental Health of BAME Communities During Covid-19

    This blog aims to provide an overview of the impact of COVID-19 on BAME mental health.

    It has been written for a wide range of people, and as such, has been co-produced with a review panel of diverse ages, qualifications, and ethnicities.

    Find out more about this call to address the mental health of BAME communities.

    Resources

    It is heartening to see the number of excellent resources that have quickly become available for professionals and the general public during the current pandemic.

    However the problem quickly becomes not the availability of information or resources but how to sort and grade what is available in a reasonable amount of time.

    To help with this process the CDT Committee have produced the following resource list. 

    General Resources

    Public Health England, Public Health Wales, the Northern Ireland Public Health Agency, NHS Scotland, and the World Health Organisation have all produced a series of general and mental health related guidance documents.

    The BPS has also put together a coronaivurs resource hub designed for both professionals and the general public, while the official BPS journal, The Psychologist, has collected a number of psychological perspectives on the coronavirus.

    In addition, CDT committee member Sarita Robinson has written two useful pieces on managing the effects of lockdown.

    Psychologists’ roles and self-care

    The Division of Clinical Psychology has produced an advice document on staying safe and well during the pandemic, as well as a poster illustrating what psychologists can offer, and a useful infographic with links to guidance, apps and advice about working healthily under the current circumstances.

    They also have collected together some general guidance for psychological professionals during the pandemic.

    In addition there are several wellbeing apps available to NHS staff during the pandemic.

    Staff support

    The BPS Covid-19 Staff Wellbeing Group have produced guidance on The Psychological Needs of Healthcare staff as well as an accompanying webinar featuring David Murphy (BPS President) and Julie Highfield (Consultant Clinical Psychologist).

    The NHS have developed a new site to support their staff as well as a staff support phoneline, 0300 131 7000, which is now in operation form 7am to 11pm. In addition NHS Scotland have prepared some excellent material on psychosocial mental health and wellbeing support for staff.

    The Covid-19 Trauma Response Working Group have an extensive resource list which includes guidance for those planning staff support strategies, as well as an excellent infographic produced by the King’s Fund summarising this.

    The Association of Clinical Psychologists have produced guidance for clinical psychologists on mitigating the impact of Covid-19 at work, while Russ Harris has produced an e-book on the use of acceptance and commitment therapy principles to respond to the coronavirus crisis which may be helpful for self-care and staff support as well as work with clients.

    The Intensive Care Society have developed a wellbeing resource pack which is useful not just for intensive care staff but for healthcare staff generally, while both the World Health Organisation and the US National Center for PTSD have produced several pieces on the importance of psychological first aid.

    We have also included a link to the Royal College of Psychiatry web page, which collects several videos, including one on the importance of moral injury (Professors Greenberg and Wessely), as well as additional links to Williams, Murray, Neal, and Kemp's document on the top ten messages for supporting healthcare staff, Dr Will Curvis's guidance for facilitating reflective support groups, and Lorna Fortune's podcast on supporting physical health staff under extreme conditions.

    Children and young people

    Siobhan Currie, Secretary of the Crisis, Disaster and Trauma Section has collated some key principles to think about when responding to the current situation and its impact on your family.

    The Division of Education and Child Psychology have produced advice on talking to children about coronavirus as well as a document providing support and advice for schools and parents/carers during the current school closures, and the DCP Faculty for Children, Young People and Families also have helpful advice about how to talk to children about illness.

    The YoungMinds website has several helpful resources, including those that young people can access themselves, and the Reasons to the Cheerful podcast has a good episode about how to support children (which includes an interview with an educational psychologist).

    Other adults

    The BPS Division of Clinical Psychology as produced a briefing on the psychological impact of the response to coronavirus on older people.

    Remote therapy during the pandemic

    Social distancing has major impacts on the provision of mental health therapeutic care. The DCP, the UKCP, and the Association of Clinical Psychologists have all produced advice on providing effective therapy via video.

    Several other professional organisations have also produced advice on adapting different therapeutic approaches to remote working including the Tavistock and Portman Trust, the Eye Movement Desensitisation and Reprocessing Association (EMDR), the British Association for Behavioural and Cognitive Psychotherapies, the International Psychoanalytical Association, and the Group Analytic Society.

    Grief and bereavement

    Unfortunately this is a time with higher levels of traumatic bereavement. Cruse Bereavement Care and the Oxford Health Psychosocial Response Group have produced a range of guidance and advice aimed at addressing issues associated with loss and grief.

    In addition, CDT committee member Dr Noreen Tehrani has written an excellent piece specifically aimed at the emergency services (but which is relevant to all), along with a great infographic of helpful responses following bereavement.  

    Staff support

    Now more than ever it is crucial for health care organisations to provide healthy, supportive and compassionate working environments for their staff, in which the wellbeing of health care professionals is fully supported.

    All these resources should be read alongside the guide to The Psychological Needs of Healthcare staff as a Result of the Coronavirus Pandemic.

    Recommendations from the Covid-19 Staff Wellbeing Group Guidance

    It is important to understand that psychological responses will vary over the course of the outbreak, with different stresses during the Preparation, Active and Recovery Phases.

    Most organisations will have passed through the Preparation phase. Details below relate to the Active phase. Further links related to the Recovery phase will be added in due course. 

     

    Visible, Compassionate Leadership

    Leadership resources

    The Center for Creative Leadership has developed a resource package for leaders on topics that are crucial in today's climate, while The King's Fund also provides resources to support health and care leaders in the NCS, social care, public health, and voluntary/independent sectors. In addition, The Faculty of Medical Leadership and Management has collected together a number of resources on the general topic of leadership during a VUCA (volatility, uncertainty, complexity, ambiguity) situation.

    Prerana Issar, Chief People Officer for the NHS, shot a youtube video discussing the importance of inclusive leadership during times of crisis, while Michael West, Senior Visiting Fellow at the King's Fund, delivered a five minute overview on ways to maintain effective teamwork during the Covid-19 crisis.

    The Journal of the American Medical Association published a commentary disucssing the sources of anxiety amongst healthcare workers, the importance of identifying these sources so organisations can develop targeted approaches and provide specific support to their workforce, and the desire of health care professionals or visible leadership during this turbulent time.

    Compassion and self-compassion

    The guidance points out that 'your wellbeing is important too, be compassionate towards yourself’

    ‘Remember – this situation is unprecedented; it is okay to not be okay.

    ‘Experiencing symptoms of stress doesn’t mean you aren’t up to the job, it means you’re human’

    Self-compassion in its simplest terms, is compassion directed inward, with oneself being the object of care and concern. It has been found that those who are compassionate towards themselves are less likely to be depressed, anxious and stressed. Self-compassion is associated with psychological strengths and shown to have the ability to buffer and minimise Compassion Fatigue.

    Compassionate leadership

    A commentary published by The Kings Fund discusses why compassionate leadership matters in a crisis and how by working compassionately, courageously and honestly, leaders can support and care for their staff.

    Psychological resources for leaders and staff

    The Intensive Care Society has developed a wellbeing resource pack containing a series of posters that aim to improve our understanding of psychological wellbeing at work, the impact reduced wellbeing can have, and what we can do in response. It also includes tips for dealing with extraordinary situations such as Covid-19 and everyday working in critical care.

    The NHS have developed a toolking to assist users in checking their own emotional wellbeing or that of their colleagues, and all NHS staff have been given free access to a number of mental health and wellbeing apps from now until the end of December 2020.

    Stress, coping, and resilience

    Stress and coping

    NHS Education for Scotland have put together a PowerPoint document containing some easy-to-follow tips on stress, coping and resilience during this difficult time.

    The Clinical Neuropsychiatry journal recently published an open access article looking at previous research into how people have coped during past pandemics, in which the authors identified multiple coping strategies (such as behavioral activation, acceptance-based coping, mindfulness practice, loving-kindness practices, etc) that may be particularly effective in helping to manage distress and promote resilience and recovery during the current crisis.

    Self-care

    Michael Farquhar and Shreena Unadkat have published a blog on the BMJ opinion pages about the importance of wellbeing and self-care for NHS staff during periods of increased stress and uncertainty.

    In addition, the Royal College of Nursing has put together a poster outlining some important steps staff can take to protect their health, safety, and wellbeing during these challenging times, while Self Help UK have created a video on self-care for all during the current pandemic.

    Normalising psychological responses and delivering psychological care

    The BPS Covid-19 Group guidance states:

    ‘Actively encourage expression of concerns and fears. Listen with patience and compassion.’

    ‘Ensure human connection and methods of pre-existing peer support.’ 

    ‘Access to protected spaces for staff to be together even for limited periods.’

    ‘Give staff permission to step back and ensure breaks and rest.’

    Opportunities and permission to express concerns and fears

    Actively giving staff the opportunity and permission to express concerns in a safe and secure environment will help them to know that others feel the same and help put their feelings into perspective. Schwartz Rounds have been found to be incredibly useful. At the moment, however, because of social distancing, this is tricky.

    In response to this and the BPS’ suggestion that psychological support should be made available in different ways, the Point of Care Foundation who support organisations to introduce the rounds, have come up with story telling in Team Time, which has the core features of Schwartz Rounds, but in a virtual format.

    Responding to post-traumatic stress in line with evidence-based guidance

    Psychological first aid

    NHS Education for Scotland have created a comprehensive document which introduces the seven components of Psychological First Aid and taking care of yourself. The guidance is written to support those helping others in distress during and after the Covid-19 pandemic.

    The Covid-19 Trauma Response Working Group has been formed to help coordinate trauma-informed responses to the COVID outbreak. Their guidance is collated from research, best practice guidelines and expert clinical opinion.

    Moral distress and injury

    "Moral distress and injury are a risk as healthcare becomes limited and people are unable to act or respond within their own moral or ethical code and death and dying may not be handled in the way it usually is (with family etc.)" - BPS Covid-19 group guidance

    In the Covid-19 pandemic lives will inevitably be lost that could, in other circumstances, have been saved. This has the potential to cause moral injuries in key workers. The recent editorial in Occupational Medicine on the experiences of moral injury in front-line key workers, highlights both the potential risk factors for moral injury in frontline key workers, practical recommendations that may be beneficial and recommendations for clinicians providing psychological support during and after the Covid-19 pandemic. Similarly, the article by Dr Nathan Smith from the University of Manchester outlines both the core concept and several proposed practical recommendations.

    The British Medical Journal recently published an analysis by Neil Greenberg and colleagues set out measures that healthcare managers need to put in place to protect the mental health of healthcare staff having to make morally challenging decisions

    Compassion fatigue

    ‘Staff may begin to feel emotionally disconnected from their work, experience compassion fatigue, and may engage in avoidant or unhelpful coping’ - BPS Covid-19 group guidance

    ​Prolonged and intense contact with patients can sometimes overwhelm the psychological resilience of caregivers, so that the compassionate energy used by health care professionals exceeds their restorative processes. Compassion Fatigue (CF) is a phenomenon with signs and symptoms similar to Post Traumatic Stress Disorder and is often associated with the concept of Secondary (vicarious) Traumatic Stress. For CF to be tackled it needs to be acknowledged and recognised by healthcare managers and leaders. The following studies are not directly related to Covid-19, but will be helpful to better understanding Compassion Fatigue and its impact.

    The International Journal of Environmental Research and Public Health has published a systematic review of the various interventions used to reduce CF and the most effective strategies for mitigating its effects, while the Journal of Compassionate Healthcare published the results of a study exploring CF in acute medical care hospital nursing staff in June 2018, which confirmed that self-compassion can moderate the effects of CF and be used as a predictor.

    Patient and family care

    Lines of communication

    The BPS Covid-19 group guidance encourages health care providers to:

    Create systems of communication between (1) relatives/loved ones and clinical staff; and (2) between relatives/loved ones and the patient’

    A number of health organisations have also introduced strategies and programmes to support patient-to-relative communication during this difficult time, including the Life Lines project, which allows families to see and speak to their loved ones via a tablet using an app on a secure online platform, and MY Loved Ones, which has introduced several measures in Mid Yorkshire hospitals, such as the addition of dedicated family liaison officers and the provision of ipads on wards to facilitate video calls.

    In addition both The Queen Eliabeth University Hospitals Charity and children's charity Libby Mae's Angels have started campaigns to help keep patients connected with their relatives. 

    The Life Lines project allows families to see and speak to their loved ones via a tablet using an App on a secure online platform. It also provides families with the opportunity to meet the clinical team providing care, ask questions and to better understand the ICU environment where they are being treated. Here are other strategies health organisations have introduced to support patient-to-relative communication during this difficult time:

    End of life care

    The advice of the BPS Covid-19 group guidance is to:

    ‘Create a way for staff to manage end-of-life care in a dignified manner, with family involvement’

    In addition, Marie Curie has brought together the latest guidance on palliative and end of life care (including information that might help if you are working in primary care, community care or in a residential home), while Cruse Bereavement Care have collected a series of resources which show how bereavement and grief may be affected by the pandemic and what sort of situations and emtions bereaved people may have to deal with.

    Children and young people

    This is a challenging time for children, young people and all those that care for and support them. Different experiences will produce different psychological needs, and this will be an important factor when schools and support services come back together.

    The amount of information and resources can be overwhelming so we have curated just a selection which we will aim to keep updated. 

    General resources

    In the preparation phase CDT Section Secretary Siobhan Currie outlined some key principles to think about when the coronavirus situation has an impact on your family, while the Division of Education and Child Psychology produced their own document on support and advice for schools and parents/carers.

    Several key websites have collated resources and accessible guidance/support for young people who may not wish to discuss their worries with adults, including YoungMinds and our colleagues at the Anna Freud National Centre for Children and Families, who outline ways to manage mental health and self-care activities for young people.

    There are also extensive resources available for activities to do at home that might help children and young people to cope through this time, and the Southend Educational Psychology Service are a good source (and are also providing webinars for school staff).

    Talking to children and young people

    Taking time to talk and allow questioning in an open and honest way that is age or developmentally appropriate promotes positive mental health. Both the DECP and the DCP have produced simple guidelines for how to talk to children about coronavirus (and illness more generally), and The National Association of School Psychologists (USA) have written their own guide for parents wanting to talk to their children about the current pandemic (which is helpfully available in several languages). a parent guide for talking to children about coronavirus which is helpfully available in several languages.

    Bereavement

    The constraints of the Covid-19 situation and the compromising of their usual social support may introduce factors which could lead to complex grief for children and young people.

    The Northamptonshire Educational Psychology Service have produced guidance for schools, parents, carers and young people on how to cope with or support those who are experiencing bereavement during the current situation, while Winston's Wish have collected a variety of articles to help support children through the coronavirus pandemic, including guidance for unusual issues such as not being able to say goodbye in person.

    Resilience and self-care

    It is so important for those caring for children and young people to connect with their own feelings and mental well-being so that they can support others. 

    Our own staff support pages contain resources which will be applicable to teachers and school staff. In addition the DECP have published an advice paper about teacher resilience which focuses on belonging, help-seeking and learning.

    Transition back to school

    School staff and psychology services have begun to plan for the recovery phase and are thinking about readiness to rejoin. But while some children and young people may still have been attending school, some may also have experienced trauma or bereavement and there may be significant safeguarding issues. Mary Meredith has blogged about ways to help children to heal when schools re-open, and both The Northamptonshire Educational Psychology Service and The Southend Educational Psychology Service have begun to lay out plans for the tradition back to normal school activity.

    Beyond the pandemic: strategic priorities for responding to childhood trauma

    The UK Trauma Council considers that without a specific focus and sustained energy from Governments across the UK, the needs of many children and young people will go unmet – with long-term negative consequences for their lives. The focus should now be on understanding the impact of trauma on children’s development and wellbeing, and responding appropriately

    As the consequences of the coronavirus pandemic unfold, the UK Trauma Council has developed four recommendations that should be prioritised by all UK Governments to address childhood trauma in both the short and long term.

    These recommendations present a clear framework for action, to be taken forward in different ways across the UK.

    Post-traumatic growth

    The term "Post-traumatic growth" refers to positive psychological change experienced as a result of adversity which leads to a higher level of functioning (Tedeshi & Calhoun, 2004).

    It is also described as a "life-changing" psychological shift in thinking which contributes to meaningful personal change.

    As a society we are still in early days of processing and managing the pandemic and little has yet been written on about the potential for Post-traumatic growth in the context of Covid-19.

    Below we have collated together some of the thinking so far and we will continue to edit and update these resources as more become available. 

    Information about post-traumatic growth

    Scientific American recently published an opinion piece by Steve Taylor (Senior Lecturer in Psychology at Leeds Beckett University) about the possible positive effects of living through and surviving the current crisis, such as potentially becoming less materialistic, more altruistic, or gaining a newfound sense of intimacy and/or authenticity in their relationships with others.

    Simiarly, The Conversation hosts a piece from Lowri Dowthwaite (Lecturer in Psychological Interventions, University of Central Lancashire) which cites research from the SARS crisis in Hong Kong and the 2010 earthquake in New Zealand to describe the sort of potential collective growth that can result from facing a crisis collectively.