‘What now? … Is there a space for acknowledging the positives and considering a psychologically informed impact on our future as a result of COVID-19?’
03.04.2020: This week I am writing my blog as Centrepoint’s Lead for Psychologically Informed Environments (PIE) half way through my own 14-day self-isolation due to a household member displaying symptoms. It has been a worrying week, due to some underlying health conditions, although as I am reflecting today, we have been lucky and COVID-19 has seemingly swept through our household with relatively minor impact. This has made me reflect on many things this week, but not least how focused our current media is on a narrative of death rates and not on ‘recovery rates’. Whilst this is understandable to highlight the importance of adhering the current ‘lock-down’ or ‘physical distancing’ measures, it does nothing to alleviate individual anxiety or highlight that many individuals are surviving this virus, even if being admitted to hospital (c.f. https://www.worldometers.info/coronavirus/coronavirus-cases/). Even my youngest child noted this week when watching the T.V. headlines; ‘Why is it all bad news?’, which has made me think about how can we find positives in these challenging and unprecedented times?
As a psychologist, I know that if we do not see the balance or the positives as well as the negatives, it can be so easy to become overwhelmed by the negatives. For example, the anxiety about our physical, mental and financial health, the grief at what we have lost during the ‘lock-down’ and the stress of uncertainty as to ‘when will this all be over?’ Within a psychologically informed environment (PIE), appropriate and positive supportive relationships are critical and are incredibly powerful in supporting the recovery from past traumatic experiences. I would argue that what we are all experiencing right now is a ‘trauma’; everything has changed so dramatically and so quickly, and is out of our control. We are experiencing a ‘threat’ to our sense of self, our communities and even our ‘normal way of life’, and we need to find meaning in this situation and consider how we can respond to this threat in a manner that does not cause more issues in the future. It continues to be key for example, as Dr Lucy Johnstone (Consultant Clinical Psychologist) explains in this video clip (c.f. https://www.youtube.com/watch?v=raD9OBNmHh8&d=n&app=desktop) not to pathologise our natural responses to the pandemic. There are also some helpful ideas (from those with lived experience) about how to cope with anxiety and panic here: https://dulwichcentre.com.au/wp-content/uploads/2020/03/Lived-wisdom-on-panic.pdf
So how can we remain positive at the moment, when we are perhaps working in personally risky situations on the ‘frontline’ or being isolated from family, friends and work colleagues whilst working remotely? I have highlighted in a previous blog (c.f. https://medium.com/@DrHelenMiles/physical-not-social-distancing-a-psychologically-informed-approach-to-managing-the-445dacb675d1) the critical importance of ‘relationships’ and staying connected to others (albeit virtually or remotely in most cases). Humans are extremely social creatures and we spend much of our lives in the company of others. In fact, social connections are one of the greatest sources of human well-being (Lyubomirsky et al, 2005). Positively, although I have missed seeing friends, family and work colleagues face to face, during these ‘remote’ social connections, I have connected with people in ways I may not normally do in terms of sharing thoughts, feelings and/or the frequency of remote contact. There has also been the sharing of daily creative challenges, and humorous memes and videos that are building relationships in new ways that will, hopefully, outlast the current ‘lock-down’.
Positively, it has also been shown worldwide, just how quickly humans have begun to adapt to this current pandemic threat already. Luckily we now have the technology to do so, that may not have been possible even a decade or so ago. Firstly, within our own organisation in Centrepoint, I am impressed with the adaptation that occurred to our new environmental conditions. Our ‘front-line staff’ working tirelessly and ‘often going above and beyond’ for our homeless young people have been amazing in ensuring that all of our services remain open to support this vulnerable population. There have been changes to their ways to working to keep the homeless young people safe and supported, and they have risen to the challenge. Again when I ‘clapped for the NHS staff’ last night at 8pm, I also specifically clapped for the other ‘front-lines’ across the country. These are often some of the lowest paid and previously undervalued individuals in our society. Even our own government has redefined in the past few weeks what it means to be a ‘key-worker’ and who is therefore of ‘value’ in our society, and therefore I hope the renewed respect, admiration or indeed rewards for such ‘key-workers’ doesn’t end when this period is over.
Secondly, our ‘back-line’ or ‘support’ teams have shown great adaptation too. Our offices are closed and all staff that can work remotely for the majority of their time are doing so. This has been a particular challenge to ensure all staff have the resources they need to do so, but has also been a personal challenge for me, as I have spent my entire professional career being physically present with those I am supporting or assisting. Whilst there is useful guidance about how to undertake therapeutic work remotely (e.g. https://acpuk.org.uk/remote_working/), as someone who has always ‘been in the room’ with others throughout my professional career, it has been a learning curve! For example, I have had to adapt how I build a therapeutic relationship with another person, when I am relying only on verbal and not visual listening cues. It has been positive to see that I, as with many of our staff, have found different skills and abilities within us, that perhaps we didn’t know we had, in order to react to the changing landscape that our organisation is operating in.
This adaptation and flexibility will be key over the coming weeks and months. As an organisation we are vast and there are many varied roles, all operating as different pieces within of the ‘wider jigsaw puzzle’ that is needed to #changethestory for homeless young people. Never before has our business empathy with others in the organisation been so critical. This is an opportunity for us all to understand the different parts we play within the charity, and a time to us all to try to ‘pull together’. Whilst, it can be so easy to divide or feel critical or negative about day-to-day things at work, holding onto the ‘bigger picture’ will be key. Critical now is good communication with each other, and allowing our creativity as human beings to respond to local needs in a localised manner. As a national charity, our priority is to keep our front-line services open, but this ‘looks’ different in the different places we operate. Creating spaces to reflect, learn and change or adapt to local pressures as this pandemic continues is key. We will make mistakes, but we may also learn some new ways of doing things that ultimately are to the benefit of the homeless young people that we support, and this will be positive for the future.
This may also be a time to learn from the homeless young people that we support even more than usual, reversing the usual ‘helper’ and ‘helping role’ that may be empowering and positive for both sides. For example, young people can teach us a lot about technology. As someone who never even saw a computer until I was in my twenties and still has a paper diary (!), I am constantly amazed by how quickly my children or the young people I have worked with can engage with this new way of working. Perhaps we can use this time to ‘ask them for help’ and let us know more about how they communicate and use the best of technology? Excluded young people often have a fragmented relationship to help with professionals (Fredman & Reder, 1996) because of previous less positive experiences of ‘support’ or ‘help’ (from parents, carers, professionals, peers or otherwise). By asking for a young person’s help, or giving them the opportunity to teach us something, we are ‘flipping’ the help seeking relationship on its head, and acknowledging the strengths and resources of our young people.
It has also been positive and inspiring to witness the power of the ‘community’ of late. This is no surprise to psychologists due to the amazing resilience that humans beings can evidence following a disaster (e.g. https://www.researchgate.net/publication/258125338_Rising_to_the_Challenges_of_a_Catastrophe_The_Emergent_and_Prosocial_Behavior_Following_Hurricane_Katrina) but it has still been heart-warming to see the sheer numbers of individuals who are volunteering to support the most vulnerable in their communities, to deliver food or medical supplies or to provide support to those living locally to them (c.f. https://www.theguardian.com/commentisfree/2020/mar/27/the-guardian-view-on-covid-19-volunteers-the-kindness-of-neighbours). Even in my own street in London, we now have a What’s APP group sharing support, jokes, and offers to get shopping for the elderly or vulnerable residents. This has provided new communication between neighbours, developing relationships and connections that I can see outlasting the impact of the COVID-19 and the current ‘lock-down’. Community psychologists would argue (e.g. Wolff, 2001; Speer et al, 2003) that a guiding principle of collective community organisation and activism is the focus on building relationships with others that can then facilitate actions and positive change. If nothing else, COVID-19 has been a stark reminder of what is important in life, and perhaps these newly formed community connections to others can be a powerful catalyst to ensure that this is not forgotten in the future.
Of note within the homeless sector specifically, it has been interesting to see when a coordinated response to ending street homelessness or ‘rough sleeping’ has the impetus and resources provided (c.f. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30160-0/fulltext/), how much of an impact this can have. Whilst not all homeless young people have been found secure accommodation (c.f. https://www.standard.co.uk/news/uk/centrepoint-charity-hidden-homeless-warning-coronavirus-a4403231.html), there is certainly an marked reduction in street homelessness, with some data suggesting an 80% reduction in just a couple of weeks (e.g. https://www.onlondon.co.uk/coronavirus-london-street-homeless-charities-report-unprecedented-effort-to-get-rough-sleepers-off-streets/). However to keep supporting homeless young people, Centrepoint along with many other charities, faces significant challenges as many of our usual fundraising events and activities have had to be curtailed or cancelled resulting in a significant loss of revenue this financial year. Therefore, today we have launched our emergency appeal to ensure that homeless young people in the UK will get the support they need. You can donate here: https://coronavirus.centrepoint.org.uk/, and do one incredibly important and positive thing to help those most vulnerable in our community from the comfort of your own home!
Moreover, in the academic research sector, I have been impressed with the speed of collaboration and resources that made available to use science and engineering to provide solutions to our emergent medical needs. In my previous role, as a Clinical Research Lead for a large NHS Trust for many years, it was often painstakingly slow to develop research ideas, acquire funding, seek collaborators, undertake research and then disseminate positive outcomes into practice. However, just this week remarkable stories of academic and industry research collaboration, in a matter of little more than days, are surfacing to find solutions to current needs and problems in creative ways (e.g. https://www.ucl.ac.uk/news/2020/mar/ucl-uclh-and-formula-one-develop-life-saving-breathing-aids-nhs). COVID-19 has therefore shown us that challenges we might have previously thought ‘can’t be changed overnight’ can, if the will and resources of the community are empowered to do so. Money and resources have materialised to do things that previously would have been considered impossible or implausible (e.g. https://www.gov.uk/government/news/nhs-to-benefit-from-13-4-billion-debt-write-off) as our priorities have changed.
Each day of the current ‘lock-down’, even when I have had my own moments of anxiety and sadness, it has been helpful to try to remain grateful daily of the positive things that are occurring, both personally and in the wider world. Sometimes it has been harder to look for these in the narrative of negativity that pervades our rolling news feeds, but it has been worth it to remember the incredible human capabilities we have as a species when we work together as a community. In addition, I have tried to end each day remembering what I do have or I have achieved, however small, and not just focusing on what I have not done or what I have ‘lost’ temporarily. We are all hearing about individuals taking up new hobbies, reading books that they have been meaning to for ages, doing gardening or DIY projects, spending more time with children, speaking to their neighbours and even doing regular exercise! I hope these positive things will continue when the ‘lock-down’ eventually ends. Even in the midst of all this negativity, it is not too soon to hold on to hope. In fact, it will be important that we do. This is the start of a new decade and a time for reflection, even in crises, as to what is important or a priority. Crucially, now we know this within our personal lives and our wider communities, it must also be a time for hope and positive change. Our lives will never the same again after COVID-19; I hope we do not forget all the positives we have learnt during these unprecedented times, when they are finally over…
*Written by Dr Helen Miles (Consultant Clinical & Forensic Psychologist: Centrepoint PIE Lead) with additional contributions from Dr Natalie Seymour (PIE Clinical Psychologist: London)
