Recovery, Renewal, Resilience

The pandemic has highlighted the multitude of ways that community action has supported resilience (see TMB Issue 30). The British Psychological Society (BPS) recognises that although this is very much the case, it is critical that we don’t overlook those communities who have “long faced and struggled to overcome adversity”. As with many other impacts of the pandemic, the psychological impacts vary significantly in “scale and social distribution”. Those who have limited local/neighbourhood connections have been found to be more socially, economically and clinically vulnerable to psychological strain and distress. The BPS have provided guidance on the potential benefits and possibilities of appointing a Neighbourhood Community Psychologist which may be of use to local government teams, civil society organisations/other community workers. Consider embedding psychologists in local authorities to:

• Improve community engagement and prevent distress by co-creating with local communities, and to research and provide the evidence base for preventative interventions to improve community health
• Bring distinct knowledge, skills, and capabilities, such as:
  • Extensive theoretical and evidence-based knowledge and understanding with regards to behaviour and experiences in various contexts e.g. social, cultural, policy and politics
  • Understanding of important forms of capital (social, economic, cultural) and factors of place that affect people’s lives
  • Experience of directly working with individuals, groups and across organisational boundaries, with abilities to work with and balance power, conflict and diversity
  • Co-designing research that tackles complex societal challenges and places reflection and learning at the heart of practice

The guidance helpfully offers a job description which could be used in full to create a new post within a local authority or could be used in part to align with another role.

Case study example from the pandemic:

• MAC-UK, a group of community psychologists, have been working in communities with vulnerable young people during COVID-19. Some of their activities include:
  • Investigating the ‘underground economy’ where many excluded young people work to identify ways in which they can be supported in the event of income loss due to the economic impacts of the pandemic
  • Developing strategies on ‘what next’ in the aftermath of COVID by exploring the potential role of community psychologists in creating social change in communities

TMB Issue 36 mentioned the need to identify and address the impacts of ‘Long COVID’ on people who receive and provide care and support in local communities (e.g. social care services/unpaid carers). The most recent Office for National Statistics (ONS) figures (July 2021) report that just under one million people in the UK have self-reported symptoms of Long COVID. The symptoms associated with ‘Long COVID’ (e.g. fatigue, shortness of breath, joint pain, cognitive dysfunction) have the potential to impact people’s ability to work, and their physical and mental health. The impacts of Long COVID have the potential to increase long-term demand on local health and social care services. Consider:

• How a rise in demand will impact current capacities and resources in local health and social care services
• Where re-deployment (e.g. of volunteers) may be possible to alleviate pressure on health and social care workers and meet the needs of people who might require continuous support e.g. with transport/shopping
• What training and safeguards would need to be put in place to ensure any additional support provided by volunteers is done safely
• The impacts of Long COVID on other services such as housing, transport, welfare and employment
• Conduct a review to:
  • assess current resources and surge capacities
  • understand who in the community does and might need additional support and estimate the length of time this might be for (using information such as people who have underlying health conditions)
  • estimate what funding might be required to meet a rise in demand and how this potential rise can be forecasted, budgeted, and planned for

COVID-19’s prolonged nature, and the intensity of measures taken to respond to it, have brought major disruptions with lasting consequences. Our relationship to mortality and death has been redefined, not least by disruption to traditional rituals that enable societies to cope with and overcome major trauma. A recent webinar, organised as part of the Manchester Webinar Series, considered how we might collectively remember the COVID-19 pandemic. Our speakers reviewed lessons from the past on building resilience through coproduced commemoration and discussed key considerations for policy makers and communities in planning to recognise and remember the huge losses caused by COVID-19. Consider the key lessons offered by our speakers:

• There is no one way to remember. Unlike most disasters, each individual’s experience of COVID-19 is a personal one and commemoration activities will require careful consideration around ways to bring people together to collectively to remember while also recognising the uniqueness of everyone’s experience
• The co-production of activities can provide a way to ensure commemoration is inclusive of all of those who would like to be involved, to create a collaborative and bottom-up as well as top-down delivery of remembrance, and enable communities to take ownership of their remembrance
• Consideration for who will lead and be involved in these conversation will be really important, to mediate, and to support communities to find ways to compromise on differing views and perspectives on commemoration
• The timing of commemoration is a challenge, considering that COVID-19 is now a long-term chronic problem and we are not at the end of the disaster. The pandemic has seen commemoration since the beginning, demonstrating how communities can begin to create spaces of remembrance even while the crisis persists. Some examples of these commemoration activities can be found in TMB Issue 34 and Issue 29
• Memorials can be political, and grand gestures such as monuments can fade, or be contested. This reinforces the need for co-produced commemoration, enabling the voices of those who will benefit most from commemoration activities to be heard and actively participate
• Education is a good form of remembering, through storytellers or creating spaces (online or in local newspapers) where people can share their individual experiences of the pandemic. Recording those memories now will enable authentic materials to support education in years to come
• Think about how those who have lower agency in communities will remember (e.g. children who have lost grandparents). Commemoration could be done by creating spaces in schools/community youth groups for teachers/youth volunteers to support children

Social innovations in health and care are “inclusive solutions that meet the needs of end users through a multi-stakeholder, community-engaged process to address the healthcare delivery gap”. They concentrate on local community needs and priorities, strive to establish “low-cost solutions” and build upon the pre-existing strengths in a community. This paper produced by the LSHTM demonstrates how social innovation during COVID-19 has mobilised local communities, adapted existing health services at rapid pace and developed partnerships between local government and civil society. Consider the following international examples of social innovations in health during the pandemic:

• Peru mobilised communities by adapting their ‘Mamás Del Río’ programme which “selects and trains local people as community health workers”. This project adapted during COVID to both ensure the “continuity of maternal and neonatal health services” while also educating and training local people on COVID-19 prevention
• Malawi’s existing free hotline created by local people to provide health advice was scaled up nationally during the pandemic. The government then capitalised on the capabilities of this local service to “triage people with COVID-19 symptoms, identify and refer people at risk of domestic violence, provide health information to the public and gain a greater understanding of local needs”
• The Philippine’s multi-sectoral partnership brings together the “strengths and resources from the private sector, academia, local government and communities”. COVID-19 response was strengthened by these partnerships which enabled rapid deployment of a “hunger management campaign, the establishment of a call centre to manage returning resident’s and a role out of local testing teams”

Social innovation initiatives have proven a “powerful means of mobilising communities to respond to emergencies that can complement and extend government and private sector responses, and in turn build more resilient communities”.

London School of Hygiene and Tropical Medicine (LSHTM)

Public health has taken centre stage throughout the pandemic. Pre-existing fragilities have been exposed, but opportunities for reform and renewal have also presented. The White Paper ‘Integration and innovation: working together to improve health and social care for all’, recently presented legislative proposals for a health and care Bill in the UK. A recent briefing by the NHS recognises an opportunity for change, which lies in reform of “how population health is prioritised and resourced in the future”, to not only recover from the pandemic, but to renew systems so that they prepare for (and protect against) future public health risks by building resilience.

The White Paper is a complex and intricate document which is hard to summarise. Discussions of it with a health professional may help to illuminate its main implications for civil resilience. We identify a few lessons from it, but there are others that you may find. We focus on the challenges that lie ahead as part of a restructure of public health functions. Some challenges include:

• How to retain existing expertise:
  • Taking into consideration that responsibilities will change hands, such as those for health improvement functions, those which Public Health England are currently responsible
  • Continuing to fulfil local and national leadership responsibilities
  • Investment to “make up significant shortfalls over recent years”
  • Ensure effectiveness in health improvement functions moving forward
• The sustainability of public health services given budgetary pressures:
  • “Robust and long-term investments in public health services”
  • Acknowledging the critical role they play in building resilience to crises is crucial
• The potentially reduced agency and disempowerment of local government and local partners:
  • By considering that they are positioned most effectively to tailor services and communications to the needs and priorities of the communities they serve
  • Strategic partnership working between NHS organisations, local government and the voluntary sector is essential to promote empowered and flexible working at the local level
• Ensuring that local authorities are involved in resource discussions to locally distribute health improvement responsibilities
• Improving the commissioning arrangements for public health services to address the vulnerabilities exposed by funding cuts and resource shortages

The health and social care system is complex, spanning a broad range of services delivered by both statutory and third sector organisations. COVID-19 has had a significant impact on society and on health and social care services. A recent impact assessment ‘Health and Social Care in Wales COVID-19: Looking Froward’ presents “high level expectations” for NHS and social care recovery. It also identifies the challenges and constraints ahead, and priorities for each part of the system. Social care services are one of the key priorities, recognising the critical role that social care workers (including unpaid carers) have played in frontline responses to COVID. Consider:

• Learn lessons from the pandemic. Assess and identify the “hidden harms” caused by COVID-19 and implement services that can mitigate the longer term impacts of COVID on communities and individuals
• Facilitate opportunities for families to “identify and own solutions to challenges brought about or exacerbated by COVID”, to support families to remain together
• Identify and address the impacts of ‘Long COVID’, work to understand the effect of this on people who receive care and support, including unpaid carers and the social care workforce
• Introduce strategies that tackle the disproportionate impacts of COVID-19 on unpaid carers, focusing particularly on challenges related to “respite and support for carers”
• Recognise that the Local Authority Hardship Fund has been central to the continuity of many critical social care organisations during the pandemic. “Ensure that commissioners of care and support services, in local authorities and health boards, use this financial support in ways that enable them to match the provision of services to changing population need” as the full impacts of the pandemic play out
• Introduce the ‘Real Living Wage’ across the social care sector, to support wellbeing and mental health
• “Build on and improve the collaborative working that has been evident across the health and social care sector throughout the pandemic”

In health systems across the world, screening programmes and non-emergency surgical operations have been postponed and cancelled to reduce transmission and free up capacity to treat Covid-19 patients. The USA, UK and Canada have been working to re-start non-COVID related healthcare since the first wave of COVID-19, with subsequent COVID-19 surges creating further challenges, particularly for those countries who are yet to tackle healthcare waiting lists. Those working to reduce the backlog report that some patients continue to defer seeking care so not to increase pressure on services, or because they fear catching the virus. Continued delays will decrease quality of life, increase treatment costs, and worsen outcomes, as the conditions individuals are suffering from deteriorate. There may also be knock-on effects on social care. Consider the measures explored by the UK, USA and Canada:

• Proactively engage the public (e.g. through local communications) to instill confidence in the safety and continued functioning of healthcare systems and encourage them to seek care if they need it
• Ensure ample PPE is available to prevent unnecessary challenges in the delivery of health and social care
• Inform plans by developing rigorous forecasts of future patient demand and service pressures
• Enhance national and local partnerships developed during the pandemic to address the backlog of people needing care. For example:
  • Begin to increase resource capacity through recruitment now to ensure sufficient capacity is available in the future
  • Extend surgical operating hours, including at weekends
  • Draw on volunteers to support vaccination programmes to enable trained healthcare staff to focus on elective care
  • Pool resources between local hospitals and centralize waiting lists so that patients can be treated wherever there is capacity
  • Make greater use of virtual care to increase outpatient access
  • Pilot alternative health care testing programmes (e.g.home testing kits for HPV)

Lockdowns, shielding and school closures have significantly reduced social contact for many people, including older people, children, people with underlying health conditions and those with disabilities. Prolonged isolation from family, friends and social activities poses significant risks to mental health and well-being. To address the impacts of this, consider:

• Establish a community-led mental health and well-being initiative, to support those who may be at risk of more serious distress, to keep people in the community connected and enable socialisation for those who are isolated
• Provide Psychological Frist Aid (PFA) training for those involved in the initiative (see TMB 17)
• Involve local voluntary organisations and groups, and local businesses in establishing and funding the initiative
• Develop a 'check-in' system to build relationships with people in the community and develop an understanding of needs and concerns of those shielding or isolating
• Establish a buddying or be-friending programme to enable local volunteers to support the needs of people in the community by shopping for food, picking up prescriptions or simply just calling virtually/popping by for a chat from the garden:
  • Match a volunteer buddy with up to 10 vulnerable adults/families
  • Buddies can link those who are isolating into existing groups and social activities in the community
• Set up online social activities:
  • Virtual story-telling for children by senior citizens, and vice versa
  • Weekly bingo, book club, quiz night, coffee mornings and kids discos
  • Add humour and prizes for all, such as drawings made by children, to mitigate competitive behaviour in games
  • Online home exercise classes or gardening tutorials
• Recognise that vulnerable people who are isolating may not have access to the internet for virtual activities so also run non-online events:
  • 'Door-step book club', where buddies call to those shielding and discuss books from the person's garden, ensuring they are socially distanced
  • Encourage community donations from businesses/households of unused computers/tablets
  • Develop and deliver local newsletters to include activities such as crosswords/puzzles, and stories written by community members

Important parts of recovery are mourning the loss of loved ones, and remembering those who have tragically lost their lives through the pandemic. Consider opportunities to memorialise, including:

• Develop a website dedicated to those who have died during the pandemic, allowing families to create obituaries, find a network of support, and help those who may feel alone in their grief
• Hold online memorial services to enable people to come together and remember loved ones
• Build and dedicate a memorial to those who have died, e.g. St Paul's Cathedral will build an inner portico at the North Transept and dedicate it as a physical memorial to those who have died due to COVID-19
• Invite those of all faiths and none to join in remembering loved ones to offer a safe and inclusive space of refuge, solace and hope

To ensure appropriate memorialisation, consider:

• coproduction of memorialisation options with communities
• collaboration with partners that specialise in supporting those who have been affected by bereavement
• whether the memorial is to those who have died, those who have been otherwise affected by the crisis, and/or those who have helped in the response to the crisis

Period poverty has increased sharply in the UK since the COVID-19 pandemic. Period poverty is defined as the struggle to pay for basic sanitary products on a monthly basis. Reports from one charity state they have supplied almost six times as many menstrual products compared with before the pandemic started. Around one in five people have experienced period poverty in the UK which has a significant impact on hygiene, health and wellbeing. Period poverty has risen as result of self-isolation, loss of income, and loss of access to services which may have provided free sanitary products. Scotland has become the first country in the world to provide free and universal access to period products, and places a legal duty on local authorities to make period products available for all those who need them. Consider how to:

• Encourage schools, colleges and universities to provide sanitary products for free
• Encourage businesses and places of work to provide sanitary products
• Establish programmes where sanitary products are distributed to low-income households
• Partner with pharmacies to offer free sanitary products to those eligible for free prescriptions
• Raise awareness of trans, non-binary, and genderqueer people's rights to access sanitary products and ensure provision to them

Well-being hubs strategically placed across a location could build on successful initiatives already delivered by the voluntary sector. Such hubs can be used to tackle health inequalities, and help reduce the rise in mental health issues due to the COVID-19 pandemic. Hubs would ideally offer face-to-face support, and would have to ensure COVID-19 safety measures. Hubs may support:

• Health services during the COVID-19 pandemic and relieve pressures on the system through partnership working between healthcare providers, local councils, housing and the voluntary sector e.g. The Hubs in Wakefield, West Yorkshire, relieve pressure on primary care - in six months The Hubs have seen almost 2,000 people including 636 urgent referrals
• Preventative health and wellbeing policies that protect people and reduce potential strains on health and social care services
• Social prescribing, whereby local agencies can refer people to a Link Worker who support people in focusing on 'what matters to me' and taking a holistic approach to health and wellbeing. They connect people to community groups and statutory services for practical and emotional support

Many people may be concerned about the rising cases in some areas and the risks of returning to work. So, the return to workplaces, including the risks this may pose to people’s health, may cause anxiety due to a heightened sense of risk of COVID-19 infection and uncertainty. Consider how new routines may be developed to avoid people becoming overwhelmed. Consider:

• Regular team meetings and debriefs to discuss anxieties about returning to work and any concerns or learning that may arise
• Allocating dedicated ‘buddies’ to support colleagues at work. These people could be from other departments to support confidentiality, and have specific training on helping people to manage their anxieties, on the organisations’ process and plans for safe working, and additional services staff may want to access
• Clear and simple protocols that outline how workplaces will keep employees safe and any workplace adaptations that have taken place
• Accessible ‘Frequently Asked Questions’ sections on organisations’ websites to provide answers to the most common concerns, including signposting to other relevant services such as health and wellbeing support at work
• Providing opportunities for e-learning or training on managing anxiety about returning to work and COVID-safe practices in the workplace
• Surveying staff to understand their enthusiasm for returning to work and addressing concerns raised

University students are beginning to return to communal housing located in residential areas. This, alongside rising COVID-19 infections in younger people and fatigue for COVID-19 restrictions, requires consideration of student welfare, and the management of potential transmission. Consider:

• Who should lead the management of a new community of students in cities (e.g. voluntary sector, universities, local authority) including responsibilities for welfare checks, test and trace, GP registration, and food distribution to student households if they are required to isolate
• Providing a point of local support for students, outside of their academic institution, for students who may have moved away from home. Consider partnership with local voluntary sector to coordinate with the local authority such as the OneSlough project which uses 'Community Champions' to provide information and resources to residents
• How the potential movement of students will be managed e.g. if they become ill and decide to go back home, and the impacts of this on potential transmission in two communities i.e. where they reside as students, and their home
• Targeting local online social media influencers to reach younger audiences to communicate COVID-19 messaging and promote track and trace

Test and trace systems have been implemented worldwide to try to track and contain the transmission of COVID-19. While these efforts have been broadly successful, there are some communities in which the test and trace process is inefficient due to limited uptake[1]. This has been particularly relevant in communities where there are language barriers[2], and in work environments in which sharing colleague’s information may be difficult because a positive result could mean unpaid sick days[3]. Commonly, such occupations include those with a large number of migrant workers, or where workers are employed through agencies and staff members are inconsistent or turnover is high[4]. In these cases alternative mechanisms such as mass swabbing through mobile testing units have been employed to try to boost the number of people tested, including those who may be asymptomatic[5]. Taking swabs can be unpleasant, however, using saliva samples can be less invasive, more reliable than nasal swabs, and can be done more frequently, even once a week which would help mitigate the false negatives swabs can produce[6].

Targeted mass swabbing is currently being undertaken in some countries such as Canada, where there have been outbreaks and deaths of those working in agriculture due to poor living and working conditions5. The vulnerability of these groups to COVID-19 was addressed in The Manchester Briefing 13 where it addressed localised spikes in COVID-19 transmission as a result of poor working conditions in food and garment industries.

Mass swabbing could help to mitigate the lack of reporting to contact tracers, improve the transparency of information within the health system, and improve the efficiency of testing[7]. Efficient mass testing should consider:

• Effectively mapping all existing testing and laboratories capabilities including those in health services, research centres[8], and scientific institutes to reduce the risk of running parallel systems with the private sectors which may encourage competition for supplies and potentially reduce the capacity of existing systems13
• Use existing capacities to help develop important localised approaches to improve the coordination of mass testing through involvement with local authorities and industries13
• Develop partnerships with life science industries to build resources and capacity for mass testing14 that should account for, and complement, existing local capacity
• Be mindful of how targeted mass testing may (further) stigmatise certain communities. Careful consideration should be given to the location of testing centres so not to create an association between a particular community and the virus
• Ensure there is clear and simple dissemination of public information in areas in which mass testing takes place. This should include sensitivity to the local conditions including languages, culture and the level of community (dis)harmony

Increasing effective capacity for mass testing, especially in high risk populations, is central to limiting the spread of COVID-19. Developing an integrated localised system that is capable of regular, repeat testing may not only help stem the spread of the virus, it may also help support other sectors adversely affected by COVID-19. For example, this type of testing may help mitigate the issue of quarantine after travel as the virus can be more closely monitored, even in asymptomatic patients. In addition, particularly vulnerable groups may be protected through close observation, including those who work in jobs where there is a high risk of infection, and those who may feel forced to go to go to work due to financial insecurity.

[1] https://www.theguardian.com/world/2020/aug/04/four-key-failings-of-england-covid-19-test-and-trace-system

[2] https://www.theguardian.com/world/2020/aug/04/four-key-failings-of-england-covid-19-test-and-trace-system

[3] https://www.theglobeandmail.com/canada/article-ontario-pivots-on-testing-strategy-for-migrant-workers-to-contain/

[4] https://www.iheartradio.ca/am800/news/mass-testing-planned-after-24-year-old-migrant-worker-dies-of-covid-19-1.12612356

[5] https://windsor.ctvnews.ca/mass-testing-for-migrant-workers-planned-following-death-of-24-year-old-man-1.4972533?cache

[6] https://www.newscientist.com/article/2246880-city-in-uk-takes-steps-to-test-entire-population-for-coronavirus/

[7] https://www.bma.org.uk/news-and-opinion/a-hidden-threat-test-and-trace-failure-edges-closer

[8]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878121/coronavirus-covid-19-testing-strategy.pdf

To read this case study in its original format, follow the source link below to TMB Issue 20 (p.22-23).

The health impacts of COVID-19 such as organ scarring, and long-term lung problems are gradually coming to light. However, wider implications from lockdown on working socialising and living in small spaces is less understood. Consider the impacts of this and the steps that can be taken to address them:

• Eye strain. Consider the amount of time being spent on online calls e.g. on Zoom or Skype:
  • Where possible replace Zoom with phone calls
  • Make meetings shorter and limit them to 40 minutes
  • Use the 20/20/20 rule. In a 40 minute meeting, take a mid-time break to rest your eyes and look at something 20 feet away for 20 second
• Back pain. Consider impacts of home working environments on back pain such as working from the sofa:
  • Ensure employees have a set-up that's fit for purpose like they do at their office
  • Do not stay seated all day as the spine is out of alignment - set reminders to walk every hour for a few minutes or do simple stretches
• Circulation. Improve awareness of the risk from poor circulation as a result of moving less:
  • Look for signs of varicose veins such as aching legs, swollen ankles, and red or brown stains around the ankles
  • Keep hydrated and mobile to decrease the risk of deep vein thrombosis (DVT), or clotting in the deep veins of the legs
• Maintain contact with your doctor as DVT is associated with underlying health issues that may go undiagnosed

With social distancing, limited public transport, and advice on safe working practices, some employers have closed work sites and have required staff to work from home. Many staff report that they work from home diligently, often putting in extra time to support their employer. However, some staff report suspicion that colleagues who are being paid to work from home are not working diligently; for example, logging onto work but not working, failing to attend meetings or provide agreed deliverables, enjoying alternative activities when they should be working, or working reduced hours. In recognition of the disparity between peoples' approaches to working from home, consider:

• how perceived disparity of effort may build resentment across the workforce
• how resentment may manifest itself, create difficult interpersonal working environments, and when intervention from senior staff is needed
• whether this perceived disparity will change work cultures and expectations beyond COVID-19

To address any resentment, consider:

• keeping an open mind on why resentment has developed
• addressing resentment by talking with staff regularly and when resentment is first detected
• identifying how different staff contribute to the organisation in different ways and why these may not always be visible to other colleagues
• communicating justification for work allocation across staff, ensuring fairness at work
• how the organisations may support staff to improve arrangements for working from home
• when conversations are needed to address performance concerns

Extreme fatigue, nausea, chest tightness, severe headaches, "brain fog" and limb pains are among the recurring symptoms described by some sufferers of COVID-19 for weeks/months after their diagnosis. NHS England has developed an online portal for people in England to access tutorials, contact healthcare workers and track their progress called "Your COVID Recovery". Consider development of similar services that include:

• Access to a clinical team including nurses and physiotherapists who can respond online or over the phone to any enquiries from patients
• An online peer-support community for survivors - particularly helpful to those who may be recovering alone
• Exercise tutorials that people can do from home to help them regain muscle strength, and lung function in particular
• Mental health support, which may include a psychologist within the service or referral into other mental health services along with information on what to expect post-COVID
• Face-to-face provision for physical rehabilitation where possible, ensuring the safety of staff and patients
• Support from professionals such as dieticians, speech and language therapists, occupational therapists
• Cultural practices and relationships with rehabilitation needs

There is also an ongoing need for data collection about a nation's health to understand the long-term effects of this disease.

Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. People may feel ill, nervous, embarrassed or fearful in public places. With self-isolation and social distancing being a core component of 'living with COVID-19', people may feel trapped or particularly concerned about contamination and infection. Consider the provisions required to support people including:

• Helplines for those wanting to talk over the phone and support lines via live chat, text or email for those who don't wish to call or are unable to
• Webinars for the general public such as: how to be kind & compassionate to yourself', and 'dealing with COVID-19 negative thoughts when you already have anxiety'
• Access to approved therapists able to offer 1:1 support through therapies such as Cognitive Behavioural Therapy (CBT) and counselling

Signposting to supportive apps such as Headspace (www.headspace.com) or Calm (www.calm.com)

Public Health England have adopted a place-based, whole system approach to improving the health of the poorest. This strategy aims to build healthy, resilient, connected and empowered communities on mental health - and sits alongside wider strategies on "Place-Based Approaches for Reducing Health Inequalities". This involves scaling a range of community-centred approaches, addressing community level determinants. Consider addressing the following principles:

1. Scaling: Rolling out a flexible approach rather than applying a standard model using integrated community-centred approaches e.g. integrated wellness services at the local neighbourhood level. Utilise local resources and expertise
2. Involving: Gather community insights and encourage participation to better understand people's health needs
3. Strengthening: Grow local capacity and knowledge through workforce development to build core skills in the community. Encourage a thriving voluntary, community and social enterprise sector
4. Sustaining: Address social determinants of health, as they directly impact on people's resilience and ability to participate. Develop short, medium and long-term indicators about what matters to communities and share between agencies and communities

COVID-19 has had widespread consequences on all aspects of health and wellbeing. In particular, it has taken a toll on emotional health and wellbeing as a result of remaining isolated or physically distant from friends, family and normal support structures. Additionally, the effects of COVID-19 on risk factors including socioeconomic inequalities, poverty, debt, unemployment, food insecurity, and physical inactivity have had significant impacts on the emotional health and well-being of many

These impacts can be understood on a continuum, from those experiencing some effects on their emotional health and wellbeing, perhaps for the first time, such as intermittent loneliness; to those suffering from more serious mental health disorders such as anxiety, depression or post-traumatic stress disorder; and those who require medical intervention and psychiatric care. This presents three core challenges for mental health provision:

1. Prevent an associated increase in mental health disorders and a reduction in mental health wellbeing across populations
2. Protect people with a mental disorders from COVID-19, and the associated consequences, such as increased risk of COVID-19 infection and mortality due to increased vulnerability
3. Provide appropriate public mental health interventions including for health professionals and carers

The challenges of understanding how emotional health and wellbeing have been affected is complex as many people may develop negative psychological responses after an event, so, even as the threat of the pandemic lessens, more people may reach out for support. This is a particular concern for frontline medical staff, many of whom have not had time or space to process their experiences and may suffer from mental and physical fatigue.

The challenges faced in providing adequate care and support are not just related to the increasing numbers of people who require mental health services. Mental health services claim historically under-funding , and the expected compounding of the impacts of a global recession on the resources available; further stretching the sector. Across the UK, the voluntary sector has played a key role in service provision and developing innovative and flexible care models. Voluntary sector support ranges from helplines to peer support, and alternatives to inpatient care. They may be large national charities delivering a range of responses in different localities or smaller local social enterprises providing a specific service, such as a crisis cafe.

To meet the expected demand for mental health support, the Voluntary, Community and Social Enterprise (VCSE) sector organisations are working with their NHS and local government partners to respond to the pressing needs of the communities they serve and come from. Key priorities have been identified to maintain these services

• Rising service demands - there is a significant rises in helpline usage which has led to concerns about the provision of effective support to every caller; especially those in crisis
• Workforce - consideration of: reductions in personnel due to isolation or secondments to statutory services; gaining key worker status and recognition for voluntary mental health providers, and testing
• Loss of access to care coordinators - a care coordinator plays a key role in helping people to manage and monitor their care, including support with medication, physical health, housing, employment, finances and home care. Support service users who have not been able to contact their care coordinators due to their redeployment to COVID-19 response teams, and/or sickness, self-isolation, etc
• Infection control - PPE and clear guidance on its use is needed for regulated and unregulated services. A considerable number of staff are also working on the frontline with service users, and require protection
• Collaboration with statutory services - VCSE organisations have extensive experience of working alongside statutory bodies in the provision of mental health services. In many areas, partnership working between the VCSE sector, NHS and local government is well-established but, in other areas, it has not always been easy to form effective working relationships
• Advocacy services - appropriate access to advocacy services is important for people with mental health conditions. During COVID-19, some people who have been sectioned need more contact with others. While some people have been provided with mobile phones by hospitals, other people need more support to make contact with others to avoid isolation
• Adapting service delivery - with social distancing policies in place, many services are being moved online or to telephone. Provision for anxiety and crisis support have reported an increase in calls to helplines. Some have reconfigured services but consideration needs to be given to the sustainability of this
• Changes to legislation - emergency legislation (Coronavirus Act 2020) includes temporary changes to the Mental Health Act and local authorities Care Act. Consideration of the effects of this on the availability, accessibility, commissioning and provision of mental health care and support services is needed
• Sustainability of the VCSE sector - concerns about funding streams, cash flow, and long-term sustainability of service providers has been raised. While the Government have provided financial support, the long-term sustainability of the mental health sector at a time when services are needed should be considered

Follow the source link below to read this case study in its orgininal format, including references and source links.

[2] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30240-6/fulltext

[3] https://www.hrw.org/news/2020/06/08/mental-health-support-necessary-during-covid-19-pandemic

[4] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30240-6/fulltext

[5] https://scienmag.com/global-study-launched-to-examine-impact-of-covid-19-on-health-and-wellbeing/

[6] https://www.theguardian.com/world/2020/jun/07/health-experts-on-the-psychological-cost-of-covid-19

[7] https://www.tuc.org.uk/sites/default/files/Mentalhealthfundingreport2_0.pdf

[8]https://www.theguardian.com/world/2020/jun/07/health-experts-on-the-psychological-cost-of-covid-19

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695387/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695387/

This week in the UK is Carers Week. Carers Week aims to raise awareness of caring and the challenges carers face. It is also a time to help people who may not identify as having caring responsibilities and to help them recognize this so they can access much-needed support[1]. This is particularly important as an estimated 4.5 million people in the UK have become unpaid carers for elderly, disabled or physically or mentally ill relatives since the COVID-19 pandemic[2]. This is on top of the existing 9.1 million unpaid carers that already provide support in the UK[3].

Around 2.7 million women and 1.8 million men have become new carers, typically helping with food shopping, finances, collecting medication and providing emotional support2. Others may be taking on more intense roles that include helping people with personal hygiene, movement around the home and meal preparation. 62% who have started caring since the outbreak are also juggling paid work alongside their caring responsibilities[4].

Unpaid carers in the UK have described facing mounting anxiety and frustration regarding getting access to vital medication from pharmacies and time spent queuing for medication or food shopping due to social distancing rules[5]. As a result, the following advice has been provided to improve carers’ experiences and ability to access the medicines they need. These include:

• Allowing two people into store when the carer has no choice but to take the person being cared for to the pharmacy with them
• Considering prioritising un-paid carers of vulnerable/shielding people for medicine delivery slots
• Recognising that, for some families, young carers are the only people able to collect medicines in the household

Recognising the role of young carers is extremely important. Of the 13 and a half million unpaid carers in the UK, an estimated 700,000 are children[6]. Evidence suggests that young carers and young adult carers are being disproportionately impacted by COVID-19 and are experiencing high levels of anxiety and isolation as a result of lockdown[7]. Many young carers are under increasing strain while schools remain closed as caring responsibilities increase and time away from these at school decreases[8].

Additionally, other systems used to support and safeguard young carers such as health and social care systems, are struggling under the pressure from COVID-19 impacts[9] as they continue to make changes to accommodate the needs of disabled and vulnerable people[10]. While this is vital, it may draw attention away from the often hidden and marginalised needs of young carers[11], and may miss many new young carers[12]. Where young carers are in contact with local authorities, they are encouraged to discuss with what support or services they need by[13]:

• Thinking about good and bad days being a carer
• Making notes about a typical day helping the person they care for, including their own needs and concerns
• Thinking about things which would help them cope, their aims, hopes, and what is important to them

Although there a huge challenges for unpaid carers, the issue is gaining visibility as a result of the rising numbers of people providing care and has led to calls to government to deliver social care reforms that detail long-term investment into care and support services[14]. This is increasingly important as the timeframes of the pandemic are unknown, and more people may be required to provide care for longer periods of time. Charities supporting carers have called for4:

• An increase in Carer’s Allowance – currently £67.25 a week
• A “one-off coronavirus supplement” in recognition of the role unpaid carers have played in the pandemic and the significant costs associated with caring
• Increased recognition of the vital work unpaid carers provide and the limited support they can currently receive due to COVID-19 restrictions
• Physical and mental support for carers and increased investment in support services
• Carers must be a priority for regular testing and PPE, particularly where they care for the most vulnerable

The government recommends that all carers create an emergency plan with the person they care for to use in circumstances where help from other people to deliver care is needed. This may be from family, friends or another care provider[15]. They advise the following details are provided:

• The name and address and any other contact details of the person you look after
• Who you and the person you look after would like to be contacted in an emergency
• Details of any medication the person you look after is taking

Details of any ongoing treatment they need and any medical appointments they need to take

References:

[1] https://www.carersweek.org/about-us

[2] https://www.carersweek.org/media-and-updates/item/493439-covid-19-pandemic-4-5-million-become-unpaid-carers-in-a-matter-of-weeks

[3] https://www.carersweek.org/media-and-updates/item/493439-covid-19-pandemic-4-5-million-become-unpaid-carers-in-a-matter-of-weeks

[4] https://www.carersweek.org/media-and-updates/item/493439-covid-19-pandemic-4-5-million-become-unpaid-carers-in-a-matter-of-weeks

[5] https://carers.org/news-and-media/news/post/42-organisations-work-together-to-improve-unpaid-carersa-access-to-medicines-during-the-covid-19-pandemic

[6] https://www.bbc.co.uk/news/av/uk-52948236/coronavirus-life-as-a-young-carer-under-lockdown

[7]https://carers.org/what-we-do/our-survey-on-the-impact-of-coronavirus-on-young-carers-and-young-adult-carers-

[8] https://www.bbc.co.uk/news/av/uk-52948236/coronavirus-life-as-a-young-carer-under-lockdown

[9] https://www.uea.ac.uk/about/-/new-project-examines-impact-of-covid-19-on-young-carers

[10] https://www.uea.ac.uk/about/-/new-project-examines-impact-of-covid-19-on-young-carers

[11] https://www.uea.ac.uk/about/-/new-project-examines-impact-of-covid-19-on-young-carers

[12] https://carers.org/what-we-do/our-survey-on-the-impact-of-coronavirus-on-young-carers-and-young-adult-carers-

[13] https://www.southlanarkshire.gov.uk/info/200220/carers_and_caring/505/carers/11

[14] https://www.itv.com/news/2020-06-08/millions-have-become-carers-due-to-covid-crisis-new-research-finds/

[15] https://www.gov.uk/government/publications/coronavirus-covid-19-providing-unpaid-care/guidance-for-those-who-provide-unpaid-care-to-friends-or-family

Councils maintain crucial services, have set up community hubs, and established local teams for tracing and tracking. Councils provide food and shelter to people at risk, help local businesses stay afloat and have mobilised volunteers and therefore know their communities in depth which can support trace and track. Councils:

• Are naturally placed to respond quickly to the distinct needs, challenges and infection rates of their own area
• Are equipped with their own teams of public health professionals

For example:

• Collect data on the mental health effects of COVID-19 across the population and vulnerable groups
• Monitor and report the rates of anxiety, depression, self-harm, suicide, and other mental health issues
• Determine what psychological support is available to front-line medical/health-care staff and their families
• Determine the best ways to signpost and deliver mental health services for vulnerable groups, including online clinics and community support
• Use health messages to optimise behaviour change and reduce unintended mental health issues
• Design longer-term strategies to address an increased volume of mental health issues and their impacts on service demand
• Target population-level interventions to prevent and treat mental health symptoms (e.g. anxiety) and boost coping and resilience (e.g. exercise)
• Synthesise an evidence base of lessons learned for future pandemics, tailored to specific groups, to motivate and enable people to prepare psychologically and plan for future scenarios

This response can include having the flexibility to create new capacity in the health system perhaps by creating new 'field' hospitals or by creating more space in existing hospitals.

For example, in the UK, capacity in the health system is being created by moving patients that are not at risk into hotels and similar facilities to free up health services for at-risk patients. Hotels in Dorset UK, with support from the local council, have offered rooms to "free up urgent bed space in the NHS by taking low risk patients and carers and being part of the solution... 230 hotels prepared to reopen their door". Developing a roster of hotels and similar spaces that can be used in case of resurgence would support emergency planning.

Consider:

• How prayer spaces will be managed for keyworkers- allocate suitable spaces with social distancing requirements in mind, provide adequate notice should a prayer space be closed for cleaning
• Public information regarding Iftar and Eid; the breaking of fasting each day (Iftar) is usually a sociable even. Remind the public that despite its personal religious importance, social distancing measures need to be observed. The same measures also apply to the end of Ramadan (Eid). Eid is on Saturday, 23 May 2020, and even if some lockdown restrictions have been eased, it is important to remind the public that social distancing is still required. Consider working through local leaders, community members and where appropriate the police, to ensure public safety
• These lessons are applicable to other major religious events, or holidays - consider processes to manage events such as Diwali, etc. While later on in the year, it is likely social distancing measures will still need to be observed

Material for those supporting frontline workers has been developed using the latest evidence and drawing on expertise from across the world.

One-page resources are available on issues including: readiness, team dynamics, decision making, leadership, post-traumatic stress disorder (PTSD), resilience. This resource is continually being added to.

Training in psychosocial first aid can help here to increase the network of people who can provide psychosocial support. This can facilitate the population's recovery. This acknowledges that some will need help at a professional level.

Reference: UK County Council

For example: age, gender, and race. In the UK of 2,250 adults surveyed 49% said they had felt more anxious and depressed than normal, 38% said they were having trouble sleeping and, 22% said they were concerned about significant money problems. If current measures are to persist, these figures are likely to rise.

For example, a study in the UK showed that among 24% of 16-24-year-olds said they were finding it extremely difficult to cope with the lockdown. Only 11% of those aged 45 to 75 said they were struggling. While older populations may be more susceptible to the physical impacts of COVID-19, younger people may be impacted more psychologically.