‘Physical’ not ‘Social’ distancing — A psychologically informed approach to managing the consequences of COVID-19’*.

20.03.2020: As the Lead for Psychologically Informed Environments (PIE) for Centrepoint, I am pausing to reflect on this week and write this blog in what seems like unprecedented times across the world due to the COVID-19 or Corona Virus ‘pandemic’. Whilst our staff PIE training has been temporarily suspended for the time being, as per current public health advice on social gatherings, my focus this week has been on considering how psychology can continue to support our amazing ‘frontline’ staff who are working tirelessly to support the homeless young people within Centrepoint and keep our services open. Of course, this is naturally a very anxious time for everyone, whether you are continuing to work as a ‘key’ worker outside the home, or are working from home, or self-isolating due to suspected symptoms, underlying physical health vulnerabilities or age.

So what would be a psychologically informed approach to the current situation? Firstly, it is important to highlight that anxiety is a natural (and appropriate) response to the threat that COVD-19 is posing to our ‘normal’ way of life and daily routines, as we all adapt to the current challenges. It is also normal to feel sad, stressed, confused, scared or angry, and that everyone will have different responses at different times. Being kind and compassionate to ourselves and accepting that these emotions are an appropriate response to our current situation, and a flag to ensure we have appropriate self-care and collective-care in place will be critically important.

One of the biggest challenges is ‘social’ distancing and self-isolation, because humans are innately social beings, having lived in groups, villages, communities and families units throughout history. In addition, evidence suggests that social isolation can cause psychological and emotional issues (Umberson & Karas Montez, 2010). As a psychologist, I have concerns about the labelling of these necessary changes to our behaviour to manage our health and the spread of the virus as ‘social’ distancing. In order to build resilience, and cope in challenging times, humans need connections to others. Consequently, I would argue that what we need to be practicing now is not ‘social’ but ‘physical’ distancing. Whilst we may not be physically present with another, we are lucky that technology has advanced significantly that we can be remotely or virtually present with others, in order to maintain that vital social contact. Indeed Centrepoint has this week, induced software (e.g. MS Teams) that will allow us to continue to connect and work together as teams to carry out many of our vital day-to-day business activities even when we cannot physically be present.

Consequently, whilst we are unable to have as many face-to-face interactions with others as we have had previously, we need to think creatively and flexibly how we can connect with others. For example, utilising video calling/conferencing such as Zoom or Google Hangouts, social media connections, e-mail, WHAT’S APP groups and even the old-fashioned telephone (!) will keep us connected with our support network over the coming weeks and months. It will be important to schedule regular meetings and ‘check in’ with our teams and support networks, ideally daily but at least weekly. There are also novel ways to keep connected to others, as resourceful Italians demonstrated recently by their mass communal balcony singing! (c.f. https://twitter.com/leonardocarella/status/1238511612270690305). It can however be hard to stay motivated and connected when working remotely, so some great tips and advice can be found here: https://www.blurtitout.org/2020/03/18/remote-working-definitive-guide/

Our ‘frontline’ staff are also critical at this time, and may feel under particular pressure coping with reduced staffing numbers or our feelings that we will ‘let our colleagues down’ if we cannot attend our usual workplace. It will be important to remember that feeling stressed is by no means a reflection that we cannot do our jobs or that we are ‘weak’. Rather, it is a reflection of being human and compassionate towards others. We all bring our own histories to work, and will be appropriately worried about our own loved ones or personal circumstances (e.g. physical health vulnerabilities, finances, child-care) in addition to our worries about the homeless young people that we are supporting. We will need to ensure all our usual coping strategies are in place, and take time between shifts to prioritise these, after all if we do not look after ourselves; how can we look after others (c.f. https://medium.com/@DrHelenMiles/if-you-are-travelling-with-another-person-who-requires-assistance-secure-your-mask-first-before-a19f112c426)?

Within Centrepoint specifically, we also now have plans in place to offer ad hoc staff support sessions with our PIE psychology team (e.g. via telephone). It will also be key for us to be supportive of each other generally during this time, as well as giving our homeless young people space to discuss the impact on them as and when they need it; in other words to ‘circle the wagons’ around our communities. As an organisation, we are also planning to continue to lobby the government on issues surrounding the increased economic and social inequalities facing homeless young people in the UK because of this crises. Our population remains highly vulnerable not only to COVID-19 but also to the potential consequences and implications even after this ‘pandemic’ is over.

If we have to self-isolate, particularly with children now that the schools will be closing across the UK or with homeless young people in our services, there is some useful advice from the research literature such as the World Health Organisation (c.f. https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf?sfvrsn=6d3578af_8) and a recent review in the Lancet (c.f. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930460-8). In summary, we should try to maintain familiar routines in daily life as much as possible, or create new routines (particularly if we are caring for children at home). Helping children and young people to find positive ways to express their feelings about the current situation is also key, and sometimes engaging in creative activities in a safe and supportive environment can facilitate this process. There are many free online resources to support home learning and keep children engaged. During these stressful times, it will be very important to pay attention to our needs and feelings and to engage in healthy activities that we enjoy and find relaxing. For example, learning daily physical exercises we can do at home to maintain mobility and reduce boredom, as well as keeping regular sleep routines and eating healthily is helpful. In addition, engaging in regular hobbies and activities (e.g. reading, listening to music, watching films, crafting or creative activities, meditation or mindfulness, gardening etc.) or having short period of time outside (within safe distances from others) in the natural world / nature will support our mental well-being.

It is also important to manage our mental health and anxieties, and to seek support and speak to others when at times we might naturally feel overwhelmed by everything that is going on around us, and what the implications of the current situation may be. This is a shared social experience, with an unknown and indeterminate future time period, so whilst those with existing mental health issues are particularly vulnerable and should be identified and offered additional support, we may all experience distress from time to time, regardless of our own personal resilience levels. Something that I have also found helpful this week has been to limit my contact with news and updates, as I am reminded of the saying; ‘my desire to remain informed is at odd with my desire to remain sane!’ The near constant stream of news reports and discussions about COVID-19 can cause anyone to feel anxious or distressed, so it may be helpful to limit this to a set time each day to ‘check out’ the latest updates and facts from appropriate sources (e.g. WHO website, official news channels), and avoid listening to rumours or ‘fake news’ that can make us feel worse!

To end on a positive note, psychologists have known for many years that positive social support and connection increases resilience to stress (e.g. Bailey et al, 1994) and reduces the chance of developing significant mental health issues. Community psychology approaches would suggest that now is the time for positive and regular communication with others, the mobilisation and harnessing of the power of our local communities to look out for the vulnerable in our society and ensure they have basic supplies and emotional support, and the creation of new ways and harnessing of existing strategies to psychologically support each other and create solidary. Keeping our ‘social’ connections to others, albeit from perhaps a ‘physical’ distance to manage the spread of this pandemic, and showing kindness and compassion will not only impact on others, but will also actually increase our own sense of purpose, value and well-being…

*Written by Dr Helen Miles (Consultant Clinical & Forensic Psychologist: Centrepoint PIE Lead) with additional contributions from Dr Natalie Seymour (PIE Clinical Psychologist: London).