‘Resilience: A psychologically informed approach to ‘keeping going’ during COVID-19’…

24.04.2020: As I am writing the blog this week, I cannot help but reflect that it has now been one year since I left the UK National Health Service: NHS (after two decades service) to join the national youth homeless charity Centrepoint as their Lead for Psychologically Informed Environments (PIE). And what an extraordinary year it has been! It was a big step, both personally and professionally, to move away from what was my ‘normal’ day-to-day life, leaving my brilliant team in the NHS behind to apply my psychological skills and knowledge in a different setting. However, I have not regretted that decision for a single moment. Over the past year, I have had the pleasure of meeting and working with some amazing individuals’ and team(s) across the whole organisation who are united in their dedication to #changethestory and ensure the homeless young people referred to Centrepoint can achieve a ‘home and a job’. This has never been more apparent than recently, during the COVID-19 pandemic, wherein staff are regularly going ‘above and beyond’ for some of the most vulnerable young people in the UK, and displaying tremendous resilience and adaptability in these unprecedented and anxiety provoking times. Throughout this past year, I have also been impressed by Centrepoint’s commitment, throughout the organisation, to the strategic priority of becoming more psychologically informed. Whilst Centrepoint’s journey, as I have blogged about before (c.f. https://medium.com/@DrHelenMiles/an-evolution-not-a-revolution-59da12f0447d), is more of ‘evolution’ than a ‘revolution’; building on the existing skills and knowledge of 50 years of supporting homeless young people, there have also been lots of new positive PIE related initiatives and changes across the organisation.

For example, the development and initial roll-out of staff PIE training; which in the first six weeks before the COVID-19 lock-down delivered sessions to over 100 staff from across the whole organisation, resulting in significantly positive changes to their PIE knowledge and attitudes post-training. Staff reflective practice sessions have also commenced although these have moved online to remote ‘reflective spaces’ during the current COVID-19 lock-down. We have also provided over £20,000 of funding direct to services to make simple but effective co-produced improvements to the physical environment in some of our services, and have plans underway for further funding and PIE informed refurbishment projects in the future. Our PIE research evaluation is underway, and we have begun to review some of our policies and procedures to ensure that they are PIE informed. I have also been closely linking with our policy and communications team, to support and supervise research and data analysis relevant to issues pertaining to homeless young people. Finally, I am most proud that all of our PIE journey so far has been co-produced with our group of ‘PIEineers’ (current and ex-homeless young people), who have been advising upon and promoting our PIE locally and nationally. I look forward to continuing the co-production with them and our staff team(s) on all aspects of the Centrepoint PIE over the next year and beyond!

However, one of the qualities that I have personally found that I have needed over the past year has been that of ‘resilience’. It is very hard to leave what you know, or have known for a long time and do something ‘new’ or ‘different’. Whilst I am still a Clinical (and Forensic) Psychologist, and have been applying my skills and knowledge in a similar way to previously, the charity environment that I am operating within is very different from the NHS. I have had to learn new systems, new ways of delivering things, and work with a wider variety of individuals from different backgrounds and areas of expertise. This has been exciting and I have learnt a lot, but of course, I have not always ‘got it right’ sometimes(!), and particularly recently with COVID-19, I have had to adapt and be ‘resilient’ in the face of new challenges (e.g. moving psychological sessions from ‘in the room’ to ‘online’.) The importance of this ‘resilience’ has also been something that has been touched upon during some of the ‘reflective spaces’ I have facilitated this week, as staff have talked about the need to ‘keep going’ or ‘just getting on with it’, even when feeling exhausted and overwhelmed at times with the different challenges that they are facing. Therefore, I wanted to reflect more on the concept of ‘resilience’ in this week’s blog, particularly as it seems relevant to the ongoing ‘lock-down’ in the UK consequent of the COVID-19 pandemic as we all continue to try to cope with the change to our ‘normal life’. How can we remain resilient in the face on the ongoing threat of COVID-19 to our ways of working, our financial situation, our family or home life, our physical or mental health, the education of our children or even our social interactions with each other?

‘Resilience’ is broadly defined as; ‘the capacity to recover quickly from difficulties: toughness’ (c.f. Oxford English Dictionary, 2020) whilst McAllister & McKinnon (2009) describe it as: ‘a dynamic process encompassing adaptation within the context of significant adversity, if often considered an antidote to poor well-being, offsetting work-place stressor, setbacks and traumas, and buffering against adverse events’. Consequently, resilience is often conceptualised as something that lies within an individual and encouraged as something that can be developed through ‘training’. However, I would argue that ‘resilience’ is broader than an individual construct; instead it also refers to and can be impacted upon by the wider systems we operate within. After all, what is the use of an individual being resilient if they are operating in a work or home environment that does not support them or undermines their attempts to undertake their role? Moreover, within wider society, how can we expect a vulnerable individual or homeless young person to be ‘resilient’ in the face of ongoing trauma or difficulties, without adequate support from others, and a societal system that may seek to exclude rather than assist them? A psychologically informed approach (PIE), would argue that organisations should therefore create an environment that allows those within it to have the resources they need, the support and capacity to meet challenges (e.g. staff training/reflective practice), and recovers or adapts quickly when difficulties are faced with reflective evidence based decision making.

Nevertheless, wider systemic challenges notwithstanding, resilience is something we can individually cultivate to some degree. Right now, the current COVID-19 situation is probably challenging most of our personal coping strategies and our ‘resilience’ levels more than ever. Whether this is the risks or anxiety inherent within our frontline or ‘keyworker’ roles, or the challenges of remaining physically distant from loved ones, or working remotely from our colleagues; we are all drawing on our personal resilience levels to cope with the changes to our ‘normal’ lives and freedoms. Even the ‘war’ language being used currently of a ‘battle against the virus’ or ‘frontline’ can feel exhausting at times, and lead us to question what we are doing, or to lose hope, as there is seemingly no clear or quick exit from the current lock-down situation and we face an ‘invisible enemy’ that can be hard to ‘fight’.

Psychological studies on resilience (e.g Coutu, 2017) have however identified three (overlapping) characteristics of ‘resilient’ individuals or organisations. The first is that they ‘accept the current reality’. This is not about being defeatist, but realistic, and focusing on what we can manage in terms of the current threat (e.g. through risk minimisation). This can lead us to focus on remaining calm and in the present moment as much as possible, in order to problem solve or address any issues as they arise. Secondly, they focus on how their work may be meaningful to others; whether that be the direct work we undertake with homeless young people in the frontline services or our remote support teams that ensure the resources and processes are in place to deliver this. During this time, it can therefore be helpful to share examples of successes, hope and/or good practice, which can overcome the often negative messaging that commonly surrounds the current challenges, as well as build our motivation or resilience to continue as we are reminded of the purpose of and positive outcomes resulting from our role(s). Finally, resilient individuals or organisations have an ability to improvise. Utilising what we have to devise a solution to a problem, or just seeing the possibilities as well as the challenges, demonstrates resilience.

So how can we build individual resilience to our current challenges, so we can ‘keep going’ through this period? This helpful summary highlights some key ways to develop our resilience; https://positivepsychology.com/wp-content/uploads/2017/06/10-ways-to-develop-resilience.pdf some ideas of which have been themes within our ‘reflective spaces’ with staff this week at Centrepoint. For example, accepting that change is a natural and unavoidable part of life, keeping things in perspective and in context, and avoiding the tendency to view crises as insurmountable challenges can create a positive or resilient outlook. It can also allow us space to maintain our hope, and look for opportunities that can create actions to help face these challenges. This has certainly been critical over the past year, as I have focused on the not insignificant task of being responsible for developing a PIE across a national charity (as well as over recent weeks since the COVID-19 lock-down)! Keeping our goals realistic and knowing ‘we are one person doing all we can’ is also helpful at times when we feel overwhelmed. Spending time at the end of each day to consider ‘Three Good Things’ that have happened, however small, can lift our mood and build our motivation and resilience to carry on the next day. Sometimes reflecting on examples where we may have actually succeeded ‘against the odds’ to achieve something, or we have been able to use our positive skills or qualities also builds resilience to face future challenges. Finally, remembering the importance of keeping our sense of humour is key, as laughter has been shown to boost resilience in the face of difficulties (e.g. Wellenzohn et al, 2016; https://twitter.com/centrepointuk/status/1252619151602077698), as well as ensuring we are practicing appropriate self-care and self-compassion (Trompetter et al, 2017).

Moreover, making connections or building relationships, as per PIE, with others in our teams or wider social network to share the ‘load’ and ‘stand together’ will not only build our own individual resilience and well-being but can build the resilience of those around us too. Being part of a community can make us feel stronger, braver, happier, and more able to confront difficulties, as we know we are ‘not alone’ and have the support of others to face a particular challenge. Community psychology approaches in particular, have noted the positive impact of building community spaces through mutually supportive relationships (c.f. Walker et al, 2017), sometimes against a shared ‘enemy’ or challenge. Of note, this week I have been hearing lots of accounts from frontline staff in our ‘reflective spaces’, of how both staff and homeless young people have been working together more than they ever have previously. Perhaps this is because they are developing a common identity (e.g. Tierney, 2003) together to ‘defeat coronavirus’, rather than the dynamic of ‘us and them’ that can often pervade such settings? I hope that perhaps one of the long-term consequences of COVID-19 may be this recognition of the importance of ‘community-led’ approaches to well-being and resilience. In addition, that the future role of the psychologist may perhaps be to work less with the micro level ‘individual distress’ and more at a systemic or macro level, using our psychological skills and knowledge to address, challenge or prevent the structural inequalities in society that so often creates the individual distress in the first place.

Lastly, as I reflected on the topic of resilience this week, I remembered something that my now deceased Grandmother said to me as a teenager, when I felt overwhelmed. Given that she lived through an actual war and overcame great odds personally as a working class woman, living well into her nineties, I paid attention at the time to her sage advice that “life is often hard … the secret is to get up each morning and just keep putting one foot in front of other”. This also reminded me of the amazing resilience of some of our homeless young people, who have overcome significant trauma and challenges already in their relatively short lives, but are still trying, and still striving to achieve ‘a home and a job’. As a human species we have shown great resilience to many things, COVID-19 is just one challenge we are facing right now and we are likely to face more in the future, whether that be another viral (or bacterial) pandemic and/or the impacts of other global issues such as climate change. We can make the choice as a species to work together to ‘keep going … hold on … bounce back’, and I hope we do, whether that is together within our individual households, our teams at work, our local communities or even nationally/internationally. What is certain is that the next year is certainly going to challenge all of our capacity for resilience. I remain extremely grateful for those who have helped and supported my personal and professional resilience levels over the past year, and I look forward to continuing this journey with them, wherever it may take us….