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Covid 19 Psychological Support: Psychological Support Tips for Public Health staff

Support for HSE staff during the Covid 19 emergency

Psychological Support Resources

The following resources have been distilled for your information by the Psychological Support Team whom were redeployed to provide psychological support to Public Health Staff in the East of Ireland during COVID-19; through October 2020 to present. The team consisted of Mary Morrissey (Psychology Lead at Health Intelligence Unit, Research and Evidence and Principal Clinical Psychologist at Connolly Hospital, Regina Barry (Administration redeployed from the National Office for Suicide Prevention). 

Psychological Support Resources

Caring for yourself incorporating Self-care in Everyday Life

The resilience bucket is an analogy used to demonstrate the importance of including self-care and healthy coping strategies into our daily routine to help keep stress and feelings of overwhelm at bay. 

This YouTube video (one minute and eight seconds) explains the resilience bucket well: 
https://www.youtube.com/watch?v=2TEeoQROLqM

We all have a resilience bucket, which fills up with everyday stressors. To stop the resilience bucket from overflowing and making us feel overwhelmed, we need drain holes in our bucket to release the water, i.e. stress. These drain holes represent our self-care and healthy coping strategies, which are important in preventing the bucket from overflowing and in turn, causing us stress and burn-out.

According to this analogy, if we maintain our self-care then we can cope with the stressors. 

Make sure that you have drain holes in your bucket to help cope with stress.

These may include talking to a friend, going for a walk, having a cycle, practicing mindfulness, reading, baking, cooking a nice meal, breathing in for three seconds and out for four seconds. Whatever you do to unwind, relax, enjoy life and cope with the stressors of everyday life, ensure that they remain a prominent part of your life during stressful times. Our interests are often the first things to go when we get busy but they are essential to cope and keep feelings of being overwhelmed at bay. 


The value of living in the Present Moment

The Greek philosopher Heraclitus said ‘nothing is permanent except change.’ He maintained that change is the only reality in nature.  It can certainly feel like that at present.

Throughout the course of COVID-19, we can find ourselves thinking about what life used to be like and trying to manage the pressure of work and home. Last week I wrote about keeping an eye on stress levels. This week I want to focus on the value of living in the present moment and how we can use mindfulness to help reduce stress.

Be here, now.  Although we can’t completely stop our minds from thinking about stressful things, it is important that we make a conscious effort to appreciate the here and now and be present.  Many studies have suggested that mindfulness is good for our inner stability. Some people may think it’s not for them, yet many people over the last few months reported back that they found mindfulness helpful.

Mindfulness is about deliberately pausing and paying attention to the present moment, without judgment. It gives us time to connect with ourselves and the world around us, experiencing what’s going on. 

Practising mindfulness is a great way to help you relax during stressful times. Since there are so many different mindfulness practices available we decided to record a few short mindfulness exercises for you.

Here are two short (two minute) guided mindfulness recordings:


Tips to manage Anxiety 

Sometimes our body lets us know that we are anxious or stressed way before we think we are, so it’s important we learn to listen to and take care of our bodies, as well as try to help our minds.

Anxiety, as you will know, affects the body in two main ways:

  • the autonomic nervous system (ANS) speeds up, e.g. breathing and heart rate changes, sweating, feeling sick, dry mouth, butterflies
  • muscles tense, e.g. pain at the back of the neck, chest tightens, feeling shaky, headaches, voice tremors, jelly legs

 We can have something called the fight or flight response.

When the fight or flight response is activated, changes occur in our bodies to put our minds and body on alert, in order to protect us from the real or perceived threat. The changes help us fight or run from danger, e.g. if we were being chased by a bear. Most threats now come from our minds, e.g. the fear of making a fool of ourselves, fear of failure, fear of not being good enough, fear of not being able to cope. We need the fight or flight response in order to survive.

However, as we know, the fight or flight response cannot distinguish from perceived threats and actual threats. Therefore, the body reacts regardless and in turn, further stresses the mind and then the body. Faint/freeze is also a physiological response where we become almost like ‘deer in the headlights’

It is good to keep an eye on how much caffeine you take, getting exercise and doing breathing exercises.

Belly Breathing is a form of relaxation which involves breathing from the diaphragm. Belly breathing is good if you have a lot of ANS signs. Follow the steps below:

Mindfulness shoulder stretch here is the short (two minute) guided mindfulness recording. This is for any of you who may need a moment to move your body and release some shoulder tension. It is very short yet it can bring great benefit after or during a busy day.


Managing Emotions

When starting into another lockdown we will all have different emotional reactions.  We might feel anxious, upset, angry or relieved to have some certainty.  

When thinking about this emotional response to change, we might want to think about how we manage our emotions at this time.  Here are some tips and information for managing emotions during the lockdown.

“Tips for healthcare workers to manage emotional responses to unprecedented circumstances” produced by Principal Psychology Manager, Daniel Flynn (outlined in a 5 minute YouTube clip), attached here: 

https://www.youtube.com/watch?v=oLSbA-_ehnM

In the video Daniel Flynn uses the acronym CALM, which stands for:

C: Checking the facts

A: Accepting and acknowledging all of our emotions

L: Letting go of judgements that might fuel anger

M: Being Mindful in managing our emotional response

Please see the following webpage for additional useful information and guidance on understanding and managing emotions:

https://hse.drsteevenslibrary.ie/c.php?g=679077&p=4885789

In terms of managing the individual emotions, the obvious ones are fear and anxiety and it is not only about your thought processes but also how they are affecting you physiologically with the possibility of feeling tension or tightness.  Perhaps mindfulness can be helpful.


Tips for Getting A Good Night’s Sleep

Many of us have experienced heightened levels of stress during COVID-19 and this has been proven to negatively affect the quality of our sleep. Sleep as we know is critical to physical health and effective functioning of the immune system. It’s also a key promoter of emotional wellness and mental health, helping to beat back stress, depression and anxiety.

Tips to get to sleep and remain asleep

For any of you who may have had some sleeping challenges before COVID-19 or if they’ve only come on recently, there are steps that you can take to improve your sleep.

The following link from Aware outlines tips on how to manage your sleep during COVID-19

https://www.aware.ie/blog/minding-your-sleep-during-covid-19/  These tips include:

  1. Routine: Get up and go to sleep at the same time. Set routine for your working day
  2. Exercise: regularly but not too close to bed time
  3. No daytime naps
  4. Keep a journal: or notepad by your bed at night and if you wake during the night with a lot of thoughts you can write them down in the notepad and address them in the morning, rather than in the middle of the night. This is common when we are busy
  5. Wind down before bed. Don’t do work or watch anything COVID related at least 2 hours before bed
  6. Bedroom environment: Keep your bedroom cool, quiet and dark
  7. Relaxation: Try a relaxation technique before bed (you can use the mindfulness practices below, or longer practices are available on the Stress Control Course Website: https://stresscontrol.ie/relaxation-mindfulness/
  8. Don’t spend long periods of time in bed: if you can’t sleep after 20 minutes get up and do something relaxing in another room (if possible).

Tips for getting back to sleep

If you wake in the middle of the night you may also like to try this quick visualisation practice which involves you lying in bed visualising yourself asleep:

 Imagine that you are up on the ceiling looking down on yourself in bed, seeing yourself feeling comfortable and cosy asleep in bed.  You might want to add the affirmation ‘I am falling into a deep and relaxing sleep now.’

Another exercise which you might find helpful is:


Psychological First Aid

Although everyone is affected in some way by the current situation with Covid-19, there are a wide range of reactions and feelings each person may have. Some people may have mild reactions, whereas others may have more severe reactions. This event is unusual as we know in healthcare as you are also personally affected by the pandemic yourself and your own family; life is not as we have previously known it to be. 

You may notice some of the following:

  • Increased anxiety, feeling fearful, feeling numb
  • Feeling overwhelmed, confused
  • Feeling stressed
  • Finding yourself excessively checking for symptoms, in yourself, or others
  • Becoming irritable more easily
  • Feeling insecure or unsettled
  • Fearing that normal aches and pains might be the virus
  • Having trouble sleeping
  • Feeling helpless or feeling a lack of control
  • Having irrational thoughts
  • Experiencing a change in eating habits
  • Some or none of the above

Many of you will have heard of Psychological First Aid (PFA). PFA is practical support. This week’s email I will discuss in more detail what it is and how you can provide PFA to yourself and your colleagues.  While many of us are working remotely. There are some good pointers in ‘Look- Listen and Link’ approach. (From HSE Covid-19 Contact Tracing centre’s CTC’s Staff Support Guidelines page 4)

Look

  •  Check for safety
  •  Check for people with obvious urgent basic needs
  •  Check for people with serious distress reactions

Listen

  • Approach people who may need support
  • Ask about people’s needs and concerns
  • Listen to people and help them to feel calm
  • Listening properly to the people you are helping is essential to understanding their situation and needs, to help them to feel calm and to be able to offer appropriate help.

Learn to listen with your:

Eyes - giving the person your undivided attention
Ears - truly hearing their concerns
Heart - with caring and showing respect

Link

  • Help people address basic needs and access services
  • Help people cope with problems
  • Give information
  • Connect people with loved ones and social support

Managers or Team Leads can support their staff by:

  • Regularly monitoring staff wellbeing and promoting a culture of open communication
  • Ensuring good quality communication of accurate information
  • Ensuring sufficient rest breaks and recuperation time 
  • Allowing staff  to implement necessary self-care activities
  • Encouraging peer support
  • Acknowledging they will face similar stressors, with potentially additional pressure due to the level of responsibility associated with their role; it is important to model good self-care strategies 
  • Reminding staff of available supports such as Occupational Health/Employee assistance programme EAP /Psychological support 

For those of you who would like to an avail of free training in Psychological First Aid PFA through the John Hopkins University website linked here: https://www.coursera.org/learn/psychological-first-aid


Helping and support a co-worker who may be experiencing stress or distress

Be accepting and non-judgmental. Help the person determine what the problem might be, without minimizing his or her feelings or judging him or her for feeling distressed.

If a co-worker confides in you, reinforce that choice. Acknowledge your recognition that he or she hurts and has sought your help. Support them to seek people or services that may be of help.

Know your limits as a helper. While talking to the individual, you may find that you are unable to provide adequate assistance or do not feel comfortable trying to help someone cope with his or her problems. If this is the case, it is important that you indicate in a gentle but direct manner that professional assistance is free and available, and that you will assist your co-worker in finding competent professionals.

Use the resources available to you. Know the resources that are available to you. Raymond Maloney Manager-Psychotherapist 01 6352393, 087 9120085. Don’t hesitate to contact these resources https://www.hse.ie/eng/staff/workplace-health-and-wellbeing-unit/employee-assistance-and-counselling-service/ EAP for consultation if you are not sure how to proceed.

Here are some helpful tips to for responding to difficult phone calls from the public here are some tips, many of you will be quite familiar with this area and if you have additional suggestions of what works best please let us know:

• Remember, this is not personal.

• Maintain a professional, courteous, calm and quiet approach. Staff should never respond in a similar manner.

• It is important to consider what is causing the person to be aggressive.

• Do not rush. Allow time for the person to calm down.

• Most people can be talked down in time.

• Engage in conversation and allow him/her to air their grievances.

• Listen attentively and hear what they are saying.

• Allow the person to talk and avoid distractions.

• Speak quietly and clearly in return, and explain any actions you intend to take.

• Be clear, direct, non-threatening and honest as this will help people to calm themselves.

Knowing how to respond to patients or the public in distress is really difficult. To help you combat this difficult task, Dr Eva Doherty, Director of Human Factors in Patient Safety, Royal College of Physicians of Ireland, created a video offering advice to healthcare staff on how to help and care for a patient in distress during COVID-19. You can check out the video at the link here:

https://www.youtube.com/watch?v=Or5KbnboF2o&list=PLxg8QR5B9BvV4EvBcgE6DgkSlYKfeqzn5

If you have a difficult call and you may find it useful to take a few moments out. Perhaps to breathe in for 3 seconds and out for 4 seconds or here is a 3 minute exercise which may be helpful.


Managing Your Wellbeing

Throughout each phase and stage of COVID-19, it is crucial that we look after ourselves and our wellbeing but how do we do this?

There are a number of theories on how to promote wellbeing. One theory that has been extensively researched is Martin Seligman’s (2011) theory of wellbeing entitled PERMA. Please see link for more information:

 https://www.youtube.com/watch?v=jqqHUxzpfBI

According to the PERMA model, if we include the following areas into our daily lives we will have good wellbeing, be happier and thrive in our lives.

  • Positive emotions (do things that make us happy)
  • Engagement (engage in activities rather than being passive participants)
  • Positive Relationships (people we enjoy to be around)
  • Meaning (being a part of something greater than ourselves)
  • Accomplishment (experience a sense of achievement)

However, incorporating these 5 areas into your life during COVID-19 may seem like a tall order. For now, just being aware of these areas can be helpful. Try to notice and capture if there is any area that may need boosting in your life. 

Aware, the Irish charity which aims to support people living with depression, anxiety and bipolar disorder, have created a short 2 minute video of how to manage mental wellbeing during COVID-19. The video may be found here https://www.youtube.com/watch?v=c0mLm3Kgb3E and it advises that we follow the below points:  

  • Limit your consumption of news & rely on trusted sources
  • Keep connected with your community, colleagues and loved ones
  • Look after your physical health & follow the tips outlined above
  • Breathe – try breathing in for 4 seconds and out for 8 seconds
  • Relax by practicing mindfulness, meditation, yoga or start a new hobby (or take up an old one)
  • Be kind – Sow yourself and other compassion

For more information please see www.aware.ie

A new video-based mental wellbeing programme called Minding Your Wellbeing is now freely accessible.

Brought to you by HSE Health and Wellbeing, this evidence-based programme provides a unique opportunity for people to learn more about mindfulness, gratitude, self-care and resilience. The programme consists of 5 video sessions (each 20 minutes in length) which can be accessed here: https://www2.hse.ie/healthy-you/minding-your-wellbeing-programme.html


The Importance of Staying Connected and providing Peer Support

Talking to one another can help to manage our stress and reduce the likelihood of mental health difficulties.  Sometimes we can get what we need from a practical, supportive, open and honest conversation with our colleagues or we may find it helpful to talk to a mental health professional.

 We can be very supportive of our colleagues in times of need or distress by

  • Provide an empathic, listening ear.
  • Be non-judgmental, present, caring and kind
  • Offer practical support and advice to try mitigate distress
  • Identify colleagues who may be at risk
  • Facilitate pathways to professional help (e.g. offer Employees Assistant Programme)

Peer support should:

  • Invite
  • Listen
  • Reflect, honour, validate, normalise
  • Reframe
  • Encourage learning/ teaching
  • Offer advice of ways to cope (you can use these emails as a guide)
  • Avail of useful resources (like the ones offered in this email)
  • Close any conversation with the plan to check in with each other again

Although you may be working from home and not physically with your colleagues it is still helpful to stay connected with each other as we know and offer support to one another.


Dealing with Uncertainty

As we are now into December, and out of our second lockdown we might be feeling that we haven’t been able to have much control over our lives recently - like we're out of the driver's seat and just along for the ride. Usually, the more in control we feel over what's happening in our lives, the more motivated, happier, and less stressed we are. At a time when we're all reaching to take back the steering wheel, it's helpful to shift our focus and actions to what we can control and influence. As the coronavirus outbreak has shown, life can change very quickly and very unpredictably. As Christmas approaches, you may be worried about when the pandemic will end or if life will ever return to normal.

To cope with all this uncertainty, many of us use worrying as a tool for trying to avoid unwelcome surprises. Worrying can make it seem like you have some control over uncertain circumstances. But there are healthier ways to cope with uncertainty—and that begins with adjusting your mind-set.

A method to deal with this is the CIA model:

Control

Influence

Accept

  1. Control the Things That You Can Control

Think about the things you can control, rather than what you can’t control. For example this could be your daily routine. Try to maintain a positive attitude, sleep well, eat well and make sure you have some sort of routine. Creating a to-do list the night before can help us plan our day ahead, and give us a sense of routine and normality we are otherwise missing.

  1. Influence What You Can Influence

We cannot control the uncontrollable. What we can control though are our responses. We can seek out facts, we can build scenarios of how to respond, and we can weigh up our choices and their consequences. Try reducing the time spent watching, listening, or reading news articles. Limit the time you spend on social media for example. Help others by spreading your own positivity whenever you interact with them.

  1. Accept – but Manage – What You Cannot Control Or Influence

Sometimes, an issue will genuinely be beyond your control or influence. The more time spent focusing on these things, the more likely you are to become stressed. Once you accept that these are out of your control, it can actually help you feel more in control. Our energy needs to be focused, not on predicting the outcomes of the unpredictable, but on shaping the world we want to create for the future.

When the uncertainty seems overwhelming, take a few deep breaths and focus practically on the present, engaging in something relaxing or rewarding that is within your control, e.g. listening to music, doing a fitness activity or chatting and laughing with a friend.

Mindfulness encourages you to be more present to your thoughts and feelings, as well as your body, in a curious and non-judgemental way. Here is a link to a meditation for coping with uncertainty: https://www.helpguide.org/meditations/coping-with-uncertainty-meditation.htm

Or you might want to use an exercise to accept and manage the thoughts as we have them.  Here is a brief 3 minute mindfulness exercise called leaves on a stream:


Benefits of Gratitude

There has been very good news this week about the development of the Covid-19 vaccine. This had given us all hope and optimism for the future.  This prompted me to make this week’s theme the benefits of gratitude.

  • Making a note of what has gone well and what we are thankful for might take just 5 minutes at the end of the day.  Noticing what we have and what we have done can make us feel more positive about our lives.  It also has a positive impact on our psychological well-being and self-esteem.
  • Feeling grateful or thankful can stop some of the negative emotions.
  • Keeping contact with our friends and colleagues makes us appreciate the support and friendship we need to get through the difficult times.
  • Showing our gratitude to others also can help make them feel more positive.
  • Some people find that their belief or spirituality can help focus gratitude on others.
  • Gratitude is one factor that can help people find meaning in their job, along with applying their strengths, positive emotions and flow, and hope (Dike, Duffy, Allan, O’Donnell, Shim, & Steger, 2015)
  • Showing gratitude at work has a positive impact on staff mental health and stress.

 

Expressing Gratitude Steps

Given that expressing gratitude is strongly associated with greater happiness. Gratitude helps people feel more positive emotions, relish good experiences and deal with adversity. Therefore, this mindfulness practice is about expressing gratitude and kindness to others.

  1. To begin the practice, sit comfortably in your chair. Sit up straight taking a dignified posture. If it feels comfortable for you, gently close your eyes.
  2. Take a deep breath in and out
  3. When you’re ready, bring to mind someone in your life for whom you feel gratitude. Perhaps they have done something for you, or have supported you, or made a difference in your life. This may be a friend, loved one, manager or  colleague or someone else.
  4. Picture this person in your mind’s eye and acknowledge your gratitude for their presence in your life.
  5. You may begin to express gratitude for this person by opening your heart and sending them wishes of kindness and thanks.
  6. Quietly or in your head, say to yourself “thank you”...”thank you for being there for me”...”thank you for being a part of my life”.
  7. As you say these phrases, think about this person for a moment. Notice how your body feels when you think about this person. Check in with the physical sensations of your body using your breath as an anchor.
  8. Take a deep breath in and out
  9. Say to yourself again to this person  “thank you”...”thank you for being there for me”...”thank you for being a part of my life”.
  10. Take one more deep breath in and out
  11. The practice will come to a close in few moments.
  12. If you liked this practice, you can practice this any time throughout the day. This can be a powerful practice that helps us to connect to the many small things in life for which we can be grateful for.
  13. Plato once said “be kind for everyone you meet is fighting a hard battle”
  14. When you are ready, take a final deep in and out lowly and gently open your eyes. 

Steps: https://hse.drsteevenslibrary.ie/Covid19PsychSupport/ExpressingGratitude


Minding your wellbeing this Festive Season 

As we move into the festive season we look forward to a new and hopeful year. Although we all hope to enjoy some festive cheer, we also need to be aware that this year in particular we also face anxieties, seasonal depression and stress. This can leave us feeling more fatigued and burned out than usual.


At these times it’s very important to plan ahead to avoid feeling overwhelmed. The Christmastime can bring a lot of demands be they financial, social or familial. You cannot choose when the festive season comes, but you can choose to help yourself get through it.

Here are some tips to consider this festive season:

Have realistic expectations –Comparing ourselves with others can have a huge impact on how we feel. Don't expect that the festive season will be perfect. If things don't turn out as planned, it can have a negative impact on your self-esteem. Social media and consumer advertising can add to these feelings of inadequacy and lower our mood. Limiting our social media usage over the festive period can help with this. This year will be quite different for everyone.

Finance – Many people struggle financially at this time. Family Kris Kindles can be a great way of reducing financial stress so that you buy one present for one person rather than one for every person in your extended family. If you are feeling overwhelmed with any issues, the EAP is available to staff for support; Call 0818 327 327 to speak to someone who can help.

Healthy habits - At times like Christmas, it's easy to fall out of your normal routine. Your body clock can change and it's not unusual to over-indulge in many different ways. As a result, your motivation levels can drop and you can feel bloated, sluggish and unwell. Maintain your healthy habits by:

  • Keeping up a healthy sleep pattern
  • Making an effort to exercise outdoors
  • Eating a good diet
  • Minding your alcohol intake

Reflect on all that you have achieved this year - This year has been particularly stressful and overwhelming for us all, so please try and not become fixated on some goals that you may have not achieved in the past twelve months. Take time to reflect on how far you have come and all you have achieved! Writing down a list of your achievements and reading over them will help with this. Remember to be kind to yourself!

Festive Spirit - Helping others has been recognized as a contributing factor to well-being. While aware of the COVID-19 rules.  Neighbor’s and communities can play a special part this year. Neighborhoods can come together to add some sparkle by lighting up, checking in on others or supporting local charities and businesses.

Here is a two minute face scan exercise which focuses on bringing one’s attention to the here and now:
https://hse.drsteevenslibrary.ie/Covid19PsychSupport/Face_scan

Here is a link to the HSE Staff and Wellbeing countdown to Christmas with some nice tips to stay connected and keep focused:
https://www.hse.ie/eng/about/who/healthwellbeing/healthy-ireland/national-policy-priority-programmes/staff-health-and-wellbeing-countdown-to-christmas-2020.pdf

Here are the remaining countdown day’s pointers to Christmas from the HSE Staff Health and Wellbeing.

Day 18 - Celebrating at Christmas may mean drinking more than usual. For tips on drinking less and tools to track your drinking visit www.askaboutalcohol.ie

Day 19/20 - If you’d like 2021 to be the year when you, a friend or a loved one becomes an ex-smoker, visit www.Quit.ie Today and sign up for a Quit Plan to help you stop smoking in January. 

Day 21 - Our friendships play a critical role in our happiness. Schedule a virtual dinner date or set a time to talk with a friend you may not see over Christmas this year.

Day 22 - Bring back the nostalgia Christmas Movie Night. Make a list of movies that can be watched such as Home Alone, Fred Claus, and Jingle All The Way with some popcorn and Christmas goodies. 

Day 23 - Working over Christmas? Take time to relax, this can help with difficult emotions or worries, and improve you wellbeing. Try some relaxation by Practicing Self-Care you deserve it.

Day 24 - It’s going to be different this year but follow the guidelines we will get through this together. We know we’re stronger together. 

Day 25 - You made it Happy Christmas have a wonderful time!

Introduction

Throughout the COVID-19 outbreak there has been a wealth of information available online about how to cope and thrive during the pandemic. However, we, the Psychological Support Team, understand that, given many peoples’ busy schedules, people may not have had the time to read through the many articles, watch all the YouTube clips or listen to the endless supply of Podcasts. Therefore, we have decided to distil some of the available resources for your interest.

National Health Library & Knowledge Service. Health Service Executive. Dr. Steevens' Hospital, Dublin 8. Tel: 01-6352555/8. Email: hselibrary@hse.ie

Disclaimer