‘Ground Hog Day? … A psychologically informed approach to surviving our different experiences of COVID-19 and thriving in our ‘new’ future’.

12.05.2020: This week, as I write this blog as the Lead for Psychologically Informed Environments (PIE) at Centrepoint, it feels strange that we are now almost two months into this pandemic, and many of the plans I made for this year seem to be just a distant memory. In addition, following the UK Governments apparent relaxing of the COVID-19 lockdown, this week has felt somewhat confusing as we awaited further specific guidance, and again anxiety provoking as the ‘new normal’ for our professional and personal lives was seemingly changing again, perhaps just as we were getting used to a ‘lock-down normal’. However, despite the various announcements this week, for many of us there has been little immediate difference. For our amazing ‘frontline’ staff in our accommodation services, they are continuing to go to work to support the homeless young people within Centrepoint, although perhaps now their journey to work is busier and consequently more risky if on public transport. For our support staff, including the PIE Team, we are continuing to work remotely to deliver the resources and offer the psychological support to those on the ‘Frontline’ as best we can whilst continuing to juggle the work-home balance if caring for, or home-schooling dependents, or managing the social isolation if living alone. I was left feeling this week that this was rather like the film ‘Ground-hog’ day where the main character is reliving the same challenges everyday with no end in sight, and therefore I was reflecting on how we continue our resilience to cope with this and ‘keep going’ right now?

Next week is the UK Mental Health Awareness Week (c.f. https://www.mentalhealth.org.uk/campaigns/mental-health-awareness-week), which is arguably never more critical than at the current time. Speaking to friends, family and professional colleagues this past week, there has definitely been a sense that the current COVID-19 has taken its toll on the mental health and well-being of many people. Whilst it is important not to too quickly medically pathologise what is a shared normal experience to loss and trauma, it will be important to recognise that for many people in our society, COVID-19 has had a significant impact on their mental state over the past weeks and months. For example, those who have sadly experienced the tragic loss of a loved one dying from the disease, who may have not been able to participate in the rituals that enable their loss / grief to begin to be processed. Those who have experienced the disease first hand and have been traumatised by the experience of being admitted to hospital away from loved ones and in a seemingly alien environment surrounded by staff in PPE, or have struggled to manage at home with the breathing complications and associated fatigue having a frightening impact on both them and those around them.

Those who have lost their job and financial security, with perhaps the ongoing fear of losing their home or worries about feeding their family. Those who have kept their job, but perhaps have been furloughed and left at a ‘loss’; missing connection with colleagues and a sense of purpose, or if still working remotely struggling to fulfil their role in their usual way at home whilst juggling caring for or home-schooling their dependents, or whose roles have been even more challenging, risky, anxiety provoking or pressurised if they are working on a ‘frontline’ outside the home. Those who have been isolated from friends and family, and the associated anxiety and sadness that this brings as they cope without the physical touch of a reassuring hug or arm around them. Those who already suffer from mental or physical health problems, but have struggled to receive the care and support they need in a time of crises because our statutory health and social care services have had to change their working practice to manage the risk of the virus and/or focus their energy and resources differently.

Consequently, my head is full of these stories this week from my own experiences as well as personal conversations with others or within professional reflective spaces or video meetings. This virus has affected us all in so many different ways, and continues to do so as we work out what the new ‘normal’ will look like after this, that it can hard to make sense of it all as it is so different to anything that has been experienced before. Only recently, I was trying to explain to my youngest child that this situation was ‘unprecedented’, a concept they struggled with as they asked me with the innocence of a child “so, how often do we have these lockdowns and time off school, will there be another one in a few years?” It is perhaps because this situation was relatively sudden yet ongoing and prolonged as well as so unusual, and that our usual human social mechanisms to cope have been restricted, that it has been perceived as so ‘threatening’ or traumatic to many of us. This in turn has activated our ‘Threat (Protection) System’ (Gilbert, 2009) causing us to ‘fight, flight, or freeze’ and creating the feelings of anxiety, exhaustion, hypervigilance, and distress that we are all experiencing to varying degrees day to day.

Many mental health professionals (e.g. World Health Organisation) have therefore been warning of a potential mental health crisis in the future for many of us, not least those who are most vulnerable. For example, minority groups at a higher risk of living in poverty with low paid / unreliable employment (already a risk for mental and physical ill health), children and young people socially isolated from peers at a critical social developmental stage or at risk of increased domestic violence at home, as well as frontline staff left traumatised after directly dealing with the consequences of the virus whilst not being able to #stayathome to protect themselves (c.f. https://www.telegraph.co.uk/news/2020/05/14/health-experts-warn-covid-19-mentalhealth-crisis/). Others (e.g. https://blogs.bmj.com/bmj/2020/05/01/covid-19-an-opportunity-or-risk-to-addressing-health-inequalities/) have highlighted that COVID-19 has starkly exposed the inequalities that exist in our society, and the consequent impact upon mental and physical well-being.

Because of the focus on our physical health brought about by the recent COVID-19 pandemic, I therefore think it is timely to consider the psychological or emotional well-being consequences of the current situation, especially before Mental Health Awareness Week next week, as well as the future responses to such an issue. A psychologically informed environment (PIE) argues that within the context of homeless services “the definitive marker of a PIE is simply that, if asked why the unit is run in such and such a way, the staff would give an answer couched in terms of the emotional and psychological needs of the service users, rather than giving some more logistical or practical rationale, such as convenience, costs … in that sense ‘psychology’ is an aspect of emotional intelligence or empathy” (c.f. Johnson & Haigh, 2010, cited from Keats et al, 2012, p5). I would argue that what this pandemic has highlighted is that the concept of PIE is actually relevant to many aspects of society more broadly. Should not our society be (re)constructed post COVID-19 in such a way that it benefits of the emotional and psychological needs of those within it, rather than just a focus on the logistics of capitalism such as costs or convenience?

We now have an opportunity to create a ‘new psychologically informed normal’ now, as it is clear that without a COVID-19 vaccine on the near horizon, many aspects of our lives will continue to be changed in the future as this pandemic has ‘been everywhere, effected everyone and effected everything’. Do we even want to go back to life before, when as noted above, COVID-19 has highlighted such inequalities in our society? For example, perhaps our perception of what is normal is impacted by our own power and privilege? Would I want to return to the uncertainty of a zero hour’s contract or low paid work (often by ‘key workers’) or poor accommodation conditions and unstable housing? Can we therefore instead create a values rather than profit led society? Moreover, now that we have seen the flexibility in some roles to work remotely from home or have a different work-life balance, can we accommodate this more, for example for those with caring responsibilities or disabilities? Now that we can action policies more quickly, as demonstrated at the start of this pandemic with changes to UK housing policy to reduce the risks of COVID-19 associated with homelessness (e.g. https://inews.co.uk/opinion/comment/coronavirus-lockdown-renting-housing-policy-2598239), can we do more of this to drive positive social change and #endyouthhomelessness? How can we continue to have the community focus that has sprung up all over the world, as communities offer support and donations to look after the most vulnerable in our society (e.g. homeless young parents in one of our Sunderland Services https://twitter.com/centrepointuk/status/1259806501671231488)?

All of these are key questions that individuals, groups, organisations such as Centrepoint, and governments could consider when thinking about the future. COVID-19 has perhaps created an opportunity to ‘reset’ our society, and being ‘psychologically informed’ in this ‘new normal’ will involve reflection and consideration of the evidence, as well as being prepared to be adopt a community participation model (c.f. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931054-0) and some key principles from community psychology approaches to move forward to a ‘just recovery’ for all (c.f. https://350.org/just-recovery/). These may include more co-production and partnership with those directly affected by the issues (i.e. no longer ‘helper’ and ‘helped’ but ‘mutually helping’), and the recognition that in order to have managed our mental and physical health during COVID-19, we have created and utilised the power of local communities and partnerships in places that perhaps never existed before. In addition, being more creative and adaptable in how we live and work, and using any power or influence that we have to highlight, ‘bear witness’ or ‘give a voice to the voiceless’ to call out the inequalities that impact on our mental (and physical) wellbeing.

Finally, as I have previously argued is the heart or key ‘ingredient’ of any PIE, is the importance of our relationships. Whilst our physical health recently has relied on us ‘physically distancing’ from others to reduce the transmission of the COVID-19 virus, our mental health has relied upon us continuing to ‘socially connect’ with others. Consequently, it will remain vital to manage this ongoing ‘ground hog day’ and create a ‘new normal’ to continue to connect safely with those around us, to form new relationships as well as to gain ongoing support from our existing ones. We are arguably all ‘a traumatised child’ post COVID-19 to some degree right now, and thus this advice from Dan Hughes (2020: https://www.youtube.com/watch?v=2nLF0wdoSJ0&feature=youtu.be) to listen, understand and comfort others; whilst creating new stories, new rituals or new understandings of this recent time within our family relationships as well as within those relationships in our wider communities and workplaces is helpful. We need to share our different experiences of COVID-19 with each other, to create empathy for others by understanding their perspectives and experiences, which may be different from our own, and to help our understanding that we live within a wider ecological system (e.g. Bronfenbrenner, 1977) that impacts and influences us. As a human species, COVID-19 has shown us that we are all interconnected in this globalised world, and our future as well as our current mental health will come from continuing to support each other and work together. Adopting such a ‘psychologically informed approach’ to our current ‘ground hog days’ will not only allow us to cope or mentally ‘survive’ in the present but also to help us to process, heal and perhaps even ‘thrive’ in our ‘new’ future…