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Panos: Hello and welcome to another Keeping Well NCL podcast. My name is Panos Vythoulkas and I’m a clinical psychologist and one of the senior hub practitioners. Keeping Well NCL is a new staff wellbeing service created for NHS and social care employees or for any profession and seniority level with the view to practically and emotionally support staff, teams and organizations during the COVID19 pandemic and its aftermath. Today, we are going to discuss the experiences of men working in caring professions. We will think of the impact on male health care workers emotional wellbeing, gendered stereotypes around mental health and of the importance of seeking help when its needed.  In order to do that, we have invited Alex Tsefos and Titian Tam, both first year Clinical Psychology trainees at Salomons. Titian and Alex are also doing their first year placement in one of the London’s Home Treatment Teams and we will discuss together some of their personal and professional experiences of working in the caring professions and in the end we will share some self-care tips. Before we start our discussion, we want to acknowledge that the use of gender specific language for this discussion is unavoidable, we have made this choice in order to highlight particular difficulties and the harms of gender stereotypes. It is commonly known that the rate of male suicide is higher than women’s – three times more likely in fact. Whilst it’s difficult to pinpoint the exact reason why this is the case, research by Samaritans suggests that societal expectations of the ‘role’ of a male – to be strong, to provide, to support – have a huge impact on mental health. This stigma goes some way in explaining why men are much less likely to reach out for support and access mental health services. Research has shown that only 36% of mental health referrals are for men. These percentages are even higher if specific data are looked into for men belonging in racial minority groups for trans or gay men or non-binary individuals. The statistics also show that 73% of adults who ‘go missing’ are men, 87% of rough sleepers are men and men commit 86% of violent crime. When it comes to mental health, those who identify as men are also so often told to, ‘man up’, ‘grow a pair’, ‘don’t be such a girl’. From childhood, many of us have heard these phrases thrown around, with little or no thought as to the harm this stereotype terminology can cause. So let’s go to Alex and Titian and let’s start with letting people who you are and your relationship with the caring professions. Alex: Hi Panos, thank you for the invite to the podcast today. As you mentioned, my name is Alex and I am currently a first year trainee clinical psychology at Canterbury Christ Church university. Prior to the training, I worked for the NHS for a number of years across various mental health services and I also spent a couple of years working in the third sector. Previously, I worked as a support worker, a psychological wellbeing practitioner in primary care and an assistant psychologist.  I am originally from Greece and I trained there and I moved to the UK 8-9 years ago. Titian: Well thanks Panos for having me here as well, my name is Titian and I’m also a first-year trainee clinical psychologist at Salomons. I would say I have a slightly different background than Alex. I was born and raised on the other side of the world, which is in Hong Kong and I only moved to the UK about four years ago. Yeah, I would say for me it’s quite an interesting journey with the NHS. I started off doing a masters in one of the universities in London about mental health and I had a placement opportunity to work in an inpatient ward specifically for people experiencing psychosis. After that I spent two and a half years working across 2 different inpatient wards, specifically for men before hopping onto the DClinPsych train. It was quite interesting because most of that period of quote “hardship” happened in the midst of Covid-19 Lockdown. And for me it was quite difficult to in a way navigate myself around it, more so when I would consider myself a member of the Black Asian and ethnic minority community. So I think we can have a chat about that in a bit as well. And Well yeah so I am now in the same placement with Alex at a home treatment team in London supporting people going through mental health crisis. Panos: Thank you both you both have a lot of experience in mental health and it is a please having you both here so thank you for accepting and thanks to your university for allowing you to be here. Titian: Thank you for having us here Panos: Let’s make a start. Based on your clinical and personal experiences so far, what do you think can be particularly difficult for male colleagues during this time? Alex do you want to start? Alex: Yes, I guess our male colleagues have experienced a lot of challenges during that period. From my experience working across different services I have kind of noticed how male practitioners are underrepresented in the field of psychology and in the health care professions in general. However, despite the underrepresentation in the field it is quite interesting as you often see men taking more leadership or management roles within the NHS. It is also quite important to highlight how even though I have worked across different services in the NHS I can only speak about my own experiences working for the organisation within psychology services specifically and other people, other male colleagues may have had different experiences depending on their place of work and background as well. So some of the challenges I have noticed that male colleagues have experienced over the past few years is trying to fund a balance between work and responsibilities at home which has become even more difficult during the pandemic. For many male colleagues it was quite hard continuing to work face to face during the national lockdowns so they have faced that fear and increased anxiety of travelling to work and worrying whether they will get ill because of COVID and passing it to other members of their families or their environment once they were leaving work. So for many people that experienced mental health difficulties before the pandemic, going through the COVID-19 pandemic it may have also exacerbated some of these difficulties. Also, from my observations working in a service during the pandemic I noticed how many male colleagues were more reluctant to request flexible working or leave when they needed and my hypothesis was that this may be linked to societies expectations of men during that period to be strong to be not vulnerable and to provide for the family during those difficult times. Titian: I mean that is all really important and I guess from my background as well it is worth mentioning the bits about, some of the thoughts about someone from a black, Asian, minority group background. Particularly on the stand that the term BAME covers a wide range of people with very diverse needs so we are not trying to bring in a term that is one size fits all kind of the thing. The things that I’m talking here I can only represent myself and I am coming much from my own experience but I guess it’s worth thinking why it is particularly difficult for male colleagues and it is worth holding in mind that some individuals experience may be even more difficult than ours. Perception, prejudice and judgement from colleagues or even service users may be at a different level. Particularly as well when we are talking about men, it is worth thinking that some of our colleagues may be identified as part of the LGBTQ+ community and we are aware there are existing discriminations against people’s gender identity, particularly where people are working in healthcare professions so it might have a profoundly negative impact on them as well. I guess we might not have too much to contribute to it but it’s worth holding it in mind. I guess my background, talking about different cultures and why it might have an impact on us. I’d say different cultures and gender have very different interpretations about mental health and thinking about what we have experienced. Men often find it quite difficult to express their feelings and difficulties. This may partly due to the gender role because we always have to, in a way, “pull our socks up” and go. And let’s be honest, when was the last time for the 3 of us talked about our own feelings and difficulties right, rather than sit down with a pint of beer and get on with life? It’s quite difficult. We’re not blaming men for not having that language to talk about it, it’s just sometimes it’s quite difficult. Panos: We’re not used to it. Titian: We’re not used to it, definitely. I guess speaking from my own culture, as an individual from an Asian country, my culture always taught me to just ‘shut up and go’ and to follow what the community think or what our mothers think so it was difficult to include our own thinking or our own feelings in conversation. One of the examples I’ll give is that during the pandemic, when the first Covid cases started, I didn’t know what to do or who to speak to and the last thing I wanted to do is tell my family that I’d been exposed to situations like that because I didn’t want them to worry. So, it has a profound impact on me as someone who came to the UK and tried to start a career here and one of the things I really don’t want to do is worry my loved ones. So yeah, it is quite difficult. Alex: And going back to the fact that male professionals are under-represented in the care professions, I always think how I have in the past been expected to be the male voice on a lot of issues that have come up in the workplace in relation to men’s wellbeing. I remember often being asked in work settings my opinion and expertise on certain issues that some male clients may have experienced which I guess was quite helpful for some people but at the same time it’s quite unfortunate because I have my own perspective based on my own background and my own experiences which may not always be representative of everyone’s experience. So, for example, my perspective into the experience of someone working within the NHS during the pandemic was influenced by the fact I was born and raised in a European country and I’m white and that may mean my experience is different from other people who come from a completely different background. Titian: And I guess it’s super stressful to work in a healthcare profession let alone the chaos of the last two years and a lot of the time, there is a priority on the outcome on the services we’re providing. So, a lot of the time we don’t get to stop and talk about how we’re feeling with the people that we trust. Panos: That’s a very good point. Working in a system where there is a lot of pressure can be quite challenging. It can contribute to feelings of despair or anxiety for all the reasons you’ve just mentioned. So, moving on to our next point of conversation and having thought about what you’ve just said, talking about stigma and shame, for example. What would you say to those male colleagues who might not speak up about their mental health because they’re afraid or ashamed to do so? Alex: I think stigma is quite a powerful force and men in particular experience the pressure to keep quiet about their mental health and to show no vulnerability. The cultural pressure is huge for many men; where the community stigmatises them for talking about their mental health or seeking professional support. Men are often taught from an early age not to cry, to hide their emotions and to be strong otherwise they may be perceived as weak. Many have built their identities on being solid and steady providers for their families, being a ‘rock’ and a protector for their children, their wives and their loved ones and often strength is associated with masculinity. The stronger or tougher they appear, the more masculine they are perceived to be by society or the community. Titian: Sometimes I’d be in fear of being judged by people. I’d want to put on a face in front of people and say ‘I am strong’. Alex: Also, opening up about mental health or showing signs of vulnerability or weakness may trigger a fear of losing that strength and for many people it may be a risk for their masculinity. Then, there is the professional pressure. While many workplaces have made significant progress to support mental health care the recent years, historically opening up about depression or anxiety in the workplace could cost people their jobs. There have been many stereotypes and assumptions that people experiencing mental health difficulties are not productive enough or they are unable to cope with their duties or they are not resilient enough. A lot of these beliefs have been internalised, which makes it difficult for men, in particular, to admit that they are struggling in the fear of losing their jobs and their networks. Titian: I guess for men, working in healthcare professions, they also often feel they have a responsibility to take care of the people in their families or outside of work which is an additional level of pressure. I feel like I have to be strong, like I have to provide. Alex: Yes exactly. I think that’s reflected in the data we have from the NHS which shows us that women are more likely to seek help for mental or physical health problems. Whereas for men, their engagement with services is more sporadic and less frequent than women. As Panos said earlier, the numbers of male suicide are much higher. For the NHS workforce and frontline staff, they face increasing risk in regard to their mental health which accounted for over ¼ of staff sickness absences. We know that over the past few years, male frontline workers often didn’t seek help and they were disproportionately affected by those problems. Titian: Thinking about my own experience, I found it difficult to seek help because firstly, I wasn’t entirely sure where the resources are and also I worried about the consequences of seeking help. Panos: Yes, the worry about how men will be seen when they talk about their vulnerability? Titian: Yes. I guess for me as well, coming from an entirely different cultural background. When I tried to talk about my struggles, I had a certain level of fear that people wouldn’t be able to understand it but if you think about it, it’s more my own worry than the person in front of me not being to understand what I’m going through. Sometimes for me, it’s about taking that first step and talking about what I’m feeling or thinking in order to open up to the conversation about what might be helpful for me. Alex: And I guess those worries may be linked to the stereotypes that we know about the history of male evolution, where men were portrayed as hunters or fighters. However, we live in a modern world and things have significantly changed. So, I think one of the important steps is deconstructing these ideas of masculinity and power and support seeking. For example, men can be given the message that they are taking control by seeking help rather than losing control by doing that. Panos: And this is what we’re trying to say in this podcast, that men need to reach out and seek support when they feel they need it. Alex: Yes, focusing on the idea of emotions and how expressing emotions Is not a bad thing but think about how emotions are a core sign of human existence and survival. By paying attention to our own emotions, it is more likely we will be able to manage. So, opening up and being reflective about our emotions can be scary but it’s one of the first steps we can do to deal with distress. Titian: Yeah and I guess thinking about that, being able to recognise how difficult the situation is, is often a great start. Instead of thinking of it as a way of showing our vulnerability, it’s actually showing how courageous you are being able to accept people’s assistance, support, and all kinds of resources that can help you to move forward. Because when you are going on a lifelong journey of supporting other people’s mental health, or even other people’s health, you have to take care of yourself as well. Along the journey, it is important for us to also have that level of compassion towards our self- being able to open up, being able to recognise it…okay, this is really difficult now. What can I do- shall I speak to somebody? Should I open up to somebody- at least to get some support from there. Just so we are well-rested and recuperated so that we can move on to the next step in our career, in our life- whatever that may be. Panos: Yeah, agreed. And thinking about now the last part of our conversation – what has helped during these difficult last two years, two plus years we have all been through. What has helped you keep going through the pandemic, and now as you learn to live with Covid, any advice or tips you would like to share with our male colleagues that, of course, would be applicable to both male and female colleagues? Titian: Well I mean for me it’s definitely having a good structure for the day. It could be structuring your work day or structuring your weekends as well. Having a good routine of meeting our basic needs … I would 100% make sure that I eat properly, keeping my body healthy. I know a lot of people would struggle with their sleep as well. There are plenty of resources, plenty of ways that you can help with your sleep. It might be something to do with your sleep hygiene, how you can keep well with the way you build a wind-down routine before you go to bed as well. And I guess it’s also important to have regular breaks and finish work on time. I know this is something quite difficult within the NHS, but if it’s some kind of boundaries that we need to try and enforce, anything to keep our self well in that sense. And you know, thinking about workspace as well. It was really helpful for me to connect with other colleagues and actually talk about how bad it might be at work, and how terrible it might be at a certain time of the day, and it’s always good for me to talk to people around me. So my friends, my family, my colleagues…sometimes it’s good to connect with my culture as well. For someone it might be their faith. I always have a really nice meal for my birthdays whenever I feel sad, just to give me that level of satisfaction and connection, and maybe a little bit of nostalgia in there, but it’s also really very important for me to be connected with my roots, knowing that I am not alone. Alex: Of course. And also within the workplace, it can be quite helpful to make use of all the NHS resources on wellbeing that are available. Make sure that we do use all of team opportunities within the teams we are working, and make sure we are using the reflective spaces that are available within teams. Also, using line management supervision can be help us to talk about some of these issues, and problem-solve some of the challenges we may face- so supervision, and line management supervision can really help at times. And of course, joining networks and unions can really help us connect with other people and also, to make some significant kind of systemic change if there’s any need. Panos: Of course, and we have a role as well at the Keeping Well NCL Hub in supporting people who might need to have some kind of signposting opportunities for some psychological therapy or if a line manager is wanting some kind of reflective intervention, reflective space for their team to process difficult things. This is something we can offer and people can get in touch with us, have a look on our website. You mentioned sleep hygiene- mindfulness as well. We have lots of resources that people can use to help themselves, but also to reach out for professional support if needed. Titian: Definitely. Panos: So I want to thank you both for this discussion, I think it’s been very very interesting and helpful. Titian: It’s my pleasure to be here. Alex: Thank you. Panos: Thank you both Titian: Thank you. Panos: Bye.

Panos Vythoulkas, clinical psychologist and KeepingWell NCL Hub Senior Practitioner, talks in-depth with first-year trainee clinical psychologists Alex Tsefos and Titian Tam about how it feels to be a man working in caring professions. They discuss the impact on male healthcare workers’ emotional wellbeing, gendered stereotypes around mental health, and the importance of seeking help when you need it.

Drawing on their first-year placement in a London Home Treatment Team, Titian and Alex also share with Panos some of their personal and professional experiences of working in a caring profession, and some self-care tips.

This podcast runs for 28 minutes. Take a moment for yourself by finding a quiet place to sit and listen, and think about how your feelings and experiences relate to their discussion.

Discover the rest of our staff wellbeing podcasts at keepingwellncl.nhs.uk/podcast/

In the last 2 years, many of us have seen multiple ways of working and changes in practices. Working from home full time, to back into the office and then back to working from home and now many of us doing a form of hybrid working.  The Keeping Well NCL hub is here to support you and encourage you to think about your wellbeing during this period of transition.  I’m Emily a Keeping Well NCL practitioner. This podcast will be thinking of how I and my team have used the idea of the 5 ways to well-being to manage through this period of transition and how we have incorporated some aspects into our weekly routine. The 5 ways of wellbeing have an evidence base and are used to promote health and wellbeing in public health initiatives and as a health promotion tool.

 The first of the ways of wellbeing is being physically active. This was easy for me and has helped me manage working from home and going back into the office. I have always been physically active.  Working from home has helped increase my physical activity- as I have been able to go for walks during the day which has acted as natural stress relief and helps me manage my screen time and sitting position.  If you struggle to be physically active working from home, you can try to do an online workout, seated workout, or book out time in your diary to increase physical activity. Working in the office may bring in some constraints however you can still be physically active for example by taking stairs, walking some of the way to work. The aim would just be to incorporate it into your day.

Getting out in the day has led me to increase the 2nd way of well-being. Paying attention – which can also be understood as mindfulness. Many people feel that mindfulness is meditation and trying to relax and sit still (Something that I struggle with).  But mindfulness is anything that makes you aware of the present moment.  For me going on a mindful walk or taking 5- 10 minutes just looking out of the window, has helped me feel present.  This awareness has made me take notice of the change of seasons more, and walking around my local area I have paid more attention to things that are going on. A cherry blossom tree that hung onto some of its petals throughout the winter. The sound of my steps and my breath has really helped me be in tune with my body and surroundings.  Staying in the moment and trying to avoid my thoughts being distracted has been a helpful addition to my daily routine.

Working from home has been an adjustment and at times was a juggling act between home life and work life, particularly having to be in spaces not meant for work. It also means a loss of connection with others for some people.   Feeling connected is the 3rd way of well-being and something that we all need to a greater or lesser degree.  At the height of the pandemic some people connected through online platforms, zoom quizzes, and online events. Now with more relaxed covid restrictions and things opened up, feeling connected to friends and family maybe easier. However work maybe a different story, working from home and the commitments you may have mean that all interaction with colleagues is solely focused on work, but when in the office it’s a lot easier to feel connected due to all being in the same environment, and the opportunity to have informal chats are easier. There are ways to manage the best of both situations. As a team, we have found it helpful to set up wellness sessions online which has given us space for non-work conversations, but when in the office, we also make sure there are opportunities for connection. 

Learning something new is the fourth way of well-being. It helps increase our self-esteem and build a sense of purpose.  Learning something doesn’t have to be related to your role. It can be a new hobby or something outside work that interests you. For me, this has been a new venture as I was given an embroidery kit for Christmas. This has helped me switch off after work and gives me a natural way to de-stress after the commute if I’ve been in the office. As a team we  are really curious to know what others have done, what new skills and hobbies have been taken up and what you have noticed this has done for you.  For some it may have involved one of the other ways to well-being e.g. starting to go to the gym or taking up cycling and for others it may be that you had more time available to finally start to paint or bake.  And if you started something during lockdown that has now got a bit squeezed as the pace of life increases – try and remember what you enjoyed and perhaps make a bit more space to allow you to continue.   

Giving is the fifth way to well-being.  Working for the NHS and social care, giving to others is a value we live by every day. It gives us a sense of purpose, and we may feel rewarded that we helped someone. But to carry on giving to others on a daily basis we need to think about ourselves. The phrase – help yourself before you help others, reminds us of the importance of looking after ourselves, before doing our job of giving to others.  Working from home, we may have the urge to work through our lunch, work late, try and do all the tasks we need to do, but not take time for ourselves. Working in the office we might do the same, eating lunch at desks, working all hours, looking at emails when we get home.  For me, the importance of setting a routine, making sure that I have a lunch break and take a break from the computer screen regularly, helps me achieve my role and continue giving to others.   Looking at one of the other ways to wellbeing might help you do this.  Reminding yourself of what you do that gives you something in return – satisfaction of your achievement if you’ve run a 5k, baking a great cake, reading a novel – the activities and times that refuel you so that you can continue to keep giving to others.  Without the fifth way – ensuring that you give to yourself – your ability to continue to provide support for others will be decreased. 

Implementing some of these ways to wellbeing may help you as you continue giving to others and also help you navigate and manage changes that are happening. For more information about the 5 ways of wellbeing please visit Nhs.uk and type 5 steps to mental wellbeing in.

 Keeping Well NCL is here to support you and your team to and to help you think about your wellbeing. If you would like more details, please visit our website hs.uk or contact us via email at keepingwellncl@tavi-port.nhs.uk

 

Thank You.  

We know that our social and health care staff have faced a lot of uncertainty during the pandemic, and with rules and workplaces constantly changing, we know that this can impact our wellbeing. In KeepingWell NCL’s latest podcast, Emily Kenworthy, KeepingWell Hub Practioner and Occupational Therapist, draws from her experience and discusses The 5 Ways of Wellbeing and how we can incorporate these into our daily life, to improve physical and emotional health.

My name is Marina Palomo, and I work as a Support Lead in Keeping Well NCL. Prior to taking up this role, I worked as a psychologist supporting older people’s care homes for a local NHS trust. I wanted to talk a little bit about some of my experiences of this work during the pandemic and tell you about how Keeping Well NCL can support social care staff.

Since March 2020, I have witnessed the challenges that my social care colleagues have faced. I have witnessed the fear, as we faced something that we did not understand and were not prepared for. I have witnessed sadness, as teams lost colleagues and residents (who I know staff often see and treat as their own family). I have witnessed the isolation faced by staff and residents alike, as homes had to restrict who could visit in order to keep everyone safe.

I have also witnessed teams pulling together, and staff stepping up to take new roles to make sure that the people they care for were looked after.

My admiration for care home teams can barely be put into words. Their bravery, particularly in the early days when we faced a completely unknown situation, and PPE was sometimes hard to access and their determination to keep going and ensure that residents’ needs were met will stay with me forever.

The impact of these last nearly two years now will be different for different people, and even for the each of us, different at different times. For many of us, a lot of the time, support from family, friends and our teams will have got us through. For some, there may be positives emerging, in terms of what we’ve learnt about ourselves and our teams. New connections, and ways of working together, perhaps. At other times, it will be natural that we may struggle with the impact of the abnormal situation that we have experienced. Perhaps, now that some time has passed you may have a bit more space to reflect on the shock, fear and loss you may have faced. As the situation continues, you may be tired from so many months of uncertainty and going above and beyond. Things may be catching up with you and may feel tough, as you process what you have been through.

One thing that often strikes me when I talk to care home and home care staff, is their dedication to their residents or clients and how little they often think of themselves. It can be really hard for us as health and care workers to ask for support – it is common to feel that our job is to support others and when we see that support is available, we imagine it is there for other people. I really recognise this from my own personal experience. I was glad support was available for my colleagues but I felt that somehow I should manage without; my job was to support others. It took a while for me to spot the fact that I was not practicing what I was preaching – and that I should apply what I knew about the benefits of seeking support to myself. I am only human, and of course I felt worry, sadness and anger too. I wasn’t immune from the effects of the uncertainty in both my work life and my family life.

When I eventually plucked up the courage to speak to someone about my own experiences I was so glad that I did. I can now tell you from my conversations with care home colleagues and teams and also from my own experience, what a big difference it can make to reach out, and have a safe space to talk and think, or to connect with others and feel less alone. Turns out the saying is right ‘you can’t pour from an empty cup’ and looking after ourselves can actually be a way of looking after others by recharging us to keep going.

So if you’re listening to this as a staff member in a care home, home care agency or anywhere else across health and social care in North Central London, firstly, thank you for the skilled work you have done to look after our loved ones during this challenging time. Secondly, my most important message is that it is really crucial to show yourself the care that you have shown the people you look after.

If you are listening, and you think that your team may benefit from the opportunity to come together and reflect on what you’ve been through, what’s kept you going, and how to keep going in the future, or if you are thinking that you as an individual may need some support (as I know I have done at certain points) please get in touch with us at KeepingWell NCL via our website www.keepingwellncl.nhs.uk and we will be really pleased to find a way to support you, as you support others.

We know that our social care staff in North Central London have faced enormous challenges during the pandemic. In KeepingWell NCL’s latest podcast, Marina Palomo, KeepingWell Hub Support Lead, draws from her experience working with staff across social care to acknowledge these challenges and show her admiration and respect for our care colleagues’ skills and continuing dedication.

Marina also reflects on how overcoming these challenges may mean that some of us, or our teams, might need a little extra support, and gives some guidance for taking the first steps to access staff support through the KeepingWell NCL Hub.

Marina is a KeepingWell NCL Hub Support Lead, whose 18 years of experience as a Clinical Psychologist working with families, carers and staff teams has given her a strong appreciation of the importance of supporting those who support others. She is committed to sustaining compassionate cultures of care and work. Marina’s her previous role prior to joining the Hub involved supporting care home teams and residents during the pandemic. 

Hi! my name is Rabeya and I work at Nafsiyat Intercultural Therapy Centre as a bilingual, Bengali psychotherapist. Over the last 18 months many have found Covid-19 difficult because of the many changes that it has brought. For example: • Lockdown itself • Working from home and other work related issues • Social Isolation • Uncertainty and fear with people catching Covid and people dying from Covid. Spare a thought if you can for those people in Black and Minority Ethnic groups (BAME for short) who while dealing with all these issues also have other aspects to face that makes COVID even harder for them. Research tells us that BAME groups are disadvantaged not only because of racism but also by such aspects as poor health and housing, difficult where there are many generations living in the same household – all before COVID was even heard of. The same research sources tell us that many people with BAME backgrounds have pre-existing health conditions as a result of both health and social inequalities with some studies showing that as much as 34% of critically ill COVID-19 patients are from BAME communities. I would like to mention some possible reasons that we could consider: • Experience of individual and institutional racism make BAME groups suspicious of authorities including health care – particularly when information might not be available in a language they can understand. Without accurate information it might lead to people accepting wrong information from different sources – family, community or religious figures for example • Where community and family ideas are seen as important then misleading information based on hearsay can be shared and persuade a person to avoid medical or psychological help. The power of the community often has more impact than a room full of scientists. • BAME can have higher death rates as a result of inequalities – and are potentially more likely to be infected when living in overcrowded poor housing conditions. • Psychologically mental health might not even be accepted by many cultures making it harder to find ways of reaching out to BAME cultures to offer assistance. Even if people are willing to try therapy, with lockdown there can often be no space to have private therapy in busy crowded homes • Not everyone works in jobs that includes the potential for financial help with lockdown – many people in BAME cultures are more likely to work in lower paid employment that might in turn expose them to more chances of becoming impacted by COVID, either because they could not work from home or simply because their jobs cannot be done from home. • With lockdown there has been a huge increase in technology to provide vital services – yet many older generations struggle with technology – so even if they are considering therapy, it might only be available in ways they cannot use or do not have access to. Faced with these extra difficulties BAME patients would welcome professional help that can give them even better support, and there are some ideas here that you might find useful. • Be as aware as you can be of the impact of your culture on the person you are with. Acknowledge your differences and recognise that in doing this it might make it easier for the patients to open up and learn to trust. • Being able to communicate in their own language also brings out many aspects that otherwise might not emerge – so look to either involve interpreters or bilingual staff. • Although you may not be able to help personally, at least be able to point to where they can get reliable information to deal with COVID issues • In terms of projects it would be helpful as groups of professionals to work with community and or religious leaders to find culturally acceptable ways in which the best kind of support can be offered both in terms of psychoeducation and ways of getting practical help. COVID-19 has affected so many people worldwide – but the additional challenges faced by people in BAME cultures can be greatly helped by any professional working alongside them, particularly if we are aspiring to provide the best kind of service to the many cultures we work with.

In this podcast, listen to Rabeya, a bilingual psychotherapist who works at Nafsiyat Intercultural Therapy centre, explore the impact COVID-19 continues to have on people from black and minority ethic groups and how we can contribute to help those facing extra difficulties.

Nafsiyat are a charity who offer intercultural therapy in over 20 languages to people from diverse cultural communities. To find out more about the work Nafsiyat do, click here.

Ola 0:07 When we discussed previously in our planning, we thought first about what our intentions were because I think for me it was really important to be really clear about what’s our intention here, and I guess you know what we talked about, the intention being to enable to encourage people to have these conversations about race and about difference and what it means to each other. To encourage curiosity about the other I guess, were some of the things that we talked about. And so we had a little plan about some of the things we would cover in our conversation. But since then, I suddenly started to really worry about being recorded, talking about race and I struggled with that because I wasn’t sure what it was I was really worried about, especially because conversations about race is something I’m so passionate about. And I’m very comfortable talking about it with people that I’m close to people that know me, but I suddenly realised that, actually, I don’t want to be sort of like the voice of black people because I suddenly started to think that some of my views around race might be offensive to other black people. And I wasn’t sure. I mean I don’t know that that’s what we were going to do in our conversation, but with that in the back of my mind, it worried me. And you know since then I’ve had a few conversations about it and thought ok, I’m definitely going to have a sort of thing at the beginning of our conversation whereby I’m making it really clear that you know, my views in no way represent the views of black people on race, they’re just my ideas and my views, and they might not extend much further than that you know, For other people it might not represent them. But then I realised that actually, this issue of race is such a sensitive and emotive topic. And if me, as a black person, is this worried and anxious about talking about it and being heard and sharing some of my ideas and about race, you know what does that feel like for other races, who aren’t black for example. And I just thought that that was really interesting thing to think about and I wondered if actually us having a conversation about that, in this podcast might be something that we could use and people could listen to and maybe get something from. What do you think about what I’ve said so far? Jocelyn 2:53 It’s triggered, lots of thoughts in my mind, and I suppose the first thing I thought was, you know, what we’d said initially about, what I’d said about my experiences of having these conversations with black colleagues, and then feeling, you know that sometimes they would be comfortable to talk about their feelings, and at other times they’d feel like they were a token black person. They’d feel like perhaps people might ask them questions from a good place, from a compassionate place, from a curious place, but that the issues that they might be talking about – and I guess I’m thinking back to George Floyd’s murder – was so emotionally triggering for them, that they didn’t want to have those conversations with a colleague, which sometimes they did and sometimes they didn’t. And I also really relate to what you’re saying, as a white person because you know what this conversation, potentially does is it puts both of us out there in the public domain. And I similarly to you can’t assume that my views represent every white person’s view. All we can do is speak for ourselves. With regard to how we feel right now at this moment in time knowing what we know. And I suppose the other thing I was going to say was we make; I think this also just speaks to the idea that we shouldn’t make assumptions about people, as a black person, you might, you might be experiencing certain things or you may come from a certain background or you may come from a particular position or emotion on something, you know, and, and similarly, you might make the assumption that, I’m a privileged white South African and therefore, I am potentially racist. And I would have a whole lot to say about that. Yes, I am a privileged white South African, and I did benefit from apartheid. But does that make me, you know someone who was pro that regime for example. And there’s so many layers, and it’s so uncomfortable to talk about, but actually if we don’t have the conversation. Then we risk silence. Ola 5:47 And nothing changes and nothing moves. And I think, you know, when I started to have these worries, you know, someone said to me well don’t do it, and I thought well no I don’t not want to do it. I just want to be careful about the way that I do it. And I don’t want to shy away from these conversations because I think they’re so important, you know, and when you was talking about that token thing, I actually wasn’t sure what that meant I had to kind of have a conversation to get an understanding of well what does being a token mean. But prior to that, I was thinking in my mind that I don’t want to be the token black person who comes and talks about race in this podcast. And what meaning people might take from me, if they view me that way – to be the token black person coming to speak, because I’m very aware that, you know, whilst the black experience is a collective thing, on some level, but it’s actually a very personal thing and it’s very individual. My position as a black woman in London today, I mean, whilst I don’t see myself as British, I’m not British by birth. I’m very British in my upbringing, and I have been here since a very young age. So, for example, even in this job role that I’m in now. I know nurses that I met, as a newly qualified nurse working on a ward, who are still band six on that ward, I don’t know what their experience of that is. That’s not been my experience; I have been able to progress and I think it’s something that’s very known in the NHS that you don’t find so many black colleagues at senior levels, the higher up you go the less black faces you’re going to see. And so I think that was very much on my mind when I’m coming into here; thinking that I’m going to be talking about race, but other people might not share my experience of race. So for me, I can say things that for someone else may think: Actually, no, that’s not their experience and they might be very angry, they might have experienced very blatant, very overt racism. That might mean that the way they relate to having conversations like this, with their white colleagues isn’t such an easy thing to do and is far more difficult to do. But I do think these are the things that we need to talk about and we need to think about. I think these are the things that matter. I think its understanding or trying to, being curious enough, and being patient as well, because actually it’s not an easy thing to talk about, and people are going to get it wrong. People are going to say the wrong thing, or they might ask the wrong question. But that patience will enable us to actually be able to break down those barriers really slowly and start to ask the questions and start to understand why something might be a trigger for this person, but not a trigger for another person, because experiences are very different in this regard or they can be. Jocelyn 9:21 I was thinking about what you were saying about patience and patience takes generosity of spirit. In order for you to, let’s say be patient with me about a mistake, mistake in inverted commas that I might make. You have to be coming from quite a compassionate place and not from a threatened vulnerable or angry place. I think that’s important to hold in mind because a lot of times people who are feeling threatened or feeling really marginalised and disadvantaged and angry because of bullying, or because of racist comments and treatment and so on, may not have that generosity and why should they actually? And then I was thinking about something else when we were having a previous conversation about this and I said that sometimes I get into such a tangle. I’m so scared to make mistakes, and I talked about the white South African feelings of shame and guilt that leads to avoidance, because I think there’s so much shame and guilt that I carry coming from that position and that sometimes it can be extremely silencing. And that that’s a problem. But then you said to me, shame and guilt is a luxury. Ola 11:01 Well it is in comparison, I mean that’s the thing I have a lot of compassion for my white friends and colleagues, who you know, carry this guilt and shame. Sometimes I think about it in terms of: ‘well it’s not your fault that you was born in a white body, the same as it’s not my fault that I was born in a black body, but at the same time, I would much rather feel guilt and shame, than the feelings that come with racism, experiencing racism, being a victim of racism, so it’s still a privileged position to be in. Jocelyn 11:37 100% And I totally get that, and that comment really landed with me and I really thought absolutely just get over yourself. And I feel like that kind of conversation where you can kindly but firmly, you know, make a comment like that is really good. And I suppose, that’s why it’s worth having this kind of dialogue. We’re doing this because the conversation, the idea sprang from this idea of black history month. And I wanted to ask you, what does that mean to you, Black History month? Ola 12:36 This is one of the reasons why I got scared because what I don’t want to do, is say things for the sake of it because I think they sound good. I’m somebody that really likes to stay true to myself. My mum always said, if you don’t have anything good to say, don’t say anything at all. I actually don’t subscribe to the idea of black history month. Whilst I get it, I get that black people are the one race that, the experience, the black experience is very different. Everybody has experienced some kind of prejudice, I think, and there’s different degrees to it. You can’t compare it, and that’s why I think that I understand that Black History Month is there to pay attention to the fact that black people have had this horrendous experience throughout history. For example, I had a colleague once say to me that, being a Polish woman she’s experienced racism, because when she came to this country, and went in to a shop and they heard her voice, they started to treat her differently or whatever her experience was. I thought, yes, whilst I agree that that is prejudice, the black experience is different to that, and racism is for me anyway, it’s about the colour of your skin. The difference there is, that when I walk into a shop, they see, I’d have to put a bag or where a Burka or something to cover in order for them to not see that I am black. Whereas she could just go into a shop and maybe not really talk and nobody would really know and it would be fine, that’s the difference, that’s a big difference. The difference in terms of our history, it’s so different. There’s a psychiatrist that I’m really fond of; almost see her like an idol; Dr Francis Cress Welsing I think her name is, and she talks about this generational trauma or PTSD that black people are affected by, and till this day you see the impact of it and whilst I don’t think it’s an excuse, because I’ve heard that argument that oh you know it’s an excuse, it’s actually the reality and I think you have to understand the implications that does pass through in that way, but for me the reason why I don’t subscribe to Black History Month is because I don’t like this idea that history is thought about in a month. Black history is a part of history, you don’t have a Chinese history month or an Indian history month or a white history month. So why have a black history month? I mean, I get the why and I get that’s important for a lot of people, but for me personally, it’s a no. Black history is history and the history is just history, and so therefore history should just be a part of history. It’s just a part of history, and I would prefer if it was thought about as such, so we pay attention to it throughout the year like with any other type of history. Jocelyn 15:50 And I absolutely agree with you. Because, of course, black history is history, and therefore making it a month means that you just think about black history for October and then you don’t need to worry about it again, it’s really colluding with that. But it’s difficult for me as a white person to say that isn’t it. And I think that’s interesting. And if it means that it does get people having difficult conversations or maybe get my kids learning something in school, which is outside of the main stream. Then I guess it’s also got to be a good thing to get to a point where we don’t need black history month. Ola 16:50 I grew up learning about King Henry the eighth and the Victorians, I had to go and learn for myself about black history, not slavery, I’m talking about black history -the kings and the queens and the Warriors. The richest man in Africa that travelled around flinging gold everywhere; Mansa Musa, but I had to go and learn those things for myself. Those things wasn’t taught to me as a child, it was in my adult years I had to go and learn it because I was interested to know. Suddenly I thought ‘what we doing before slavery?’ You know, and I asked myself what was colonisation, what did that actually look like, what was that experience, did nobody fight against it. And I got to learn that actually there was a lot of fights, and some people were successful in their fights to protect their land and all the rest of it so you know I think that needs to be the black history that that people learn about not just the horrendous horrors of slavery, because I’m not even sure how helpful that is actually. It pushes one narrative, it pushes one narrative that you know black people were slaves. But actually, you know they weren’t, they weren’t only slaves, they were kings and queens and they did great things. Jocelyn 18:18 And so, it’s a sort of narrative of disempowerment rather than one of empowerment and that’s not helpful. Ola 18:29 But this is good. I feel so much better about this conversation than the fear that I had before about coming to talk about something that is so, because you know, I feel like we’ve raised, it’s something you can talk about for days even, and you’re still, you know, for me, it’s a constant learning, I don’t know all there is to know. I’m still learning as a black person, I’m still learning. And so some of the ideas and thoughts I have today might change tomorrow and I think that was part of my worry; that we’re going to have a 5-10 minute conversation that people will hear. And I don’t know what people might take from it, but it’s just such a small snippet of some of the things we think and I don’t know for me some of my thoughts and ideas are still being formed and shaped you know by my experiences and experiences of other people who I talk to and learn about theirs. So, yeah it was really worrying. You know, I think one of the things I worried about is that I might say something and it might get taken out of context, or there’s no opportunity for the person who’s offended to ask me a question, to check what I meant or, you know. I hope that some of the things that we’ve talked about resonates with some people at least, I hope that, you know, if there is anything that’s not understood, people can reach out because they have our contact address, and our email address; they’ve got contact details, so I hope they can reach out to check it. And I hope that going forward. This encourages people to have the difficult conversations because I think this was a difficult conversation for us. I mean for me at least coming into this. But I think, you know, what you said about compassion and kindness and patience, you know, all of that stuff. I think we have that between us so we’ve been able to have a conversation, even what you said about me being able to say to you about, you know, well it’s still a position of privilege, that’s because we’ve created a sort of space, there’s a safety for me to be able to say that to you. And I hope that people are able to kind of go forth and have some of these difficult conversations and, and find ways to have them. Jocelyn 20:48 And I suppose, I think this might be for some people listening to this, I think it could be quite triggering. And I suppose it’s important that people are aware that we we’re available as a service to signpost people to spaces where they can talk about this, if they feel like they need to. I think it’s also important to highlight how these conversations are particularly important in health and social care. At the moment, because of people’s experiences, because of the way in which people have really experienced racism and marginalisation. And, you know, being disadvantaged from many years in services. And yes, the pandemic has just, you know, has highlighted this more. The inequities, a light has been shone on them. But it’s really important that we go on to sort of promote a culture where these sorts of conversations can happen in safe spaces within our organisations. And that if someone listening to this feels prompted to think about how they’re going to do that with their colleagues and their team or within their organisation, then I feel that even though this was a hard conversation to have. And I think these conversations make one uncomfortable. They should make us uncomfortable right, if we’re kind of glibly having these conversations, then I think we’re not being self-aware or self-critical or kind of, not that we should be criticising ourselves but we need to be, we need to be thinking about our assumptions I suppose, if that means that, you know, people do get to feel uncomfortable initially but then go on to have those conversations then that’s got to be a good thing. Ola 23:16 Yeah and it’s growth, I think you know, as you were talking I was thinking growth, because you know, I really believe or subscribe to that idea that, you know, in order to progress or to change, or to grow, you’ve got to get a bit uncomfortable. I think for me that’s when I know something’s happening. You know, when things just are just fine, I’m not really growing.

In this podcast to mark Black History month,  listen in on Keeping Well NCL Hub colleagues’ Ola Ajala (black Nigerian born, British mental health nurse and family therapist)  and Jocelyn Blumberg  (White South African born, Clinical Psychologist)  conversation about race, privilege, Black History Month and why uncomfortable conversations are important for growth.

Hello my name is Kulbir and l’m the Communications Lead for the Keeping Well NCL Hub and in this podcast I want to talk about the importance of building connections and seeking help. We know that men have traditionally found it harder to seek help compared to women – a claim that’s backed up by leading mental charities including Mind and the Mental Health Foundation. Although the causes are complicated, the consequences of not reaching out, or reaching out sooner rather are very real – death by suicide being the single biggest killer of men under 45 for example speaks to that. I also wanted to share my own story about my mental health – how I’ve struggled and also some snippets of what’s worked for me over the past 18 months. Covid clearly has a lot to answer ! I’d like to say that I’ve been fortunate too – fortunate that I haven’t lost any loved ones to Covid, unlike so many others. So, the onset of the first lockdown coincided with my decision to work for myself and become self- employed, figuring as I did that the freedom and control would be right up my street. It turns out that my timing couldn’t have worse! The work contracts that I had lined up at that point had all been postponed – I went from having 3 clients who had promised to work with me to precisely non…literally overnight! Not only was I pivoting to a new life, I then had to pivot again… an exhausting and daunting process. I clearly had to get comfortable with the idea of change! My work situation recovered in time (healthcare communications unsurprisingly being a growth area!) however it wasn’t long before familiar feelings of anxiety and loneliness kicked in. Spending long, uncertain days at my work desk felt awful and isolating (and still do). By 3pm it feels as though the walls have crept in. I missed the little interactions the most, the daily walks to the canteen, a lunchtime browse in the shops, small talk with the canteen and security staff, afternoon cups of tea. Most PR and comms folks tend to be people people…– so human stories, asking questions, being inquisitive is what we do best – take away people and you take away the fuel by which we work. SO in no particular order, this is what I learned about my mental health over the past 18 months since the first lockdown and also what I did to improve it: The first thing I did was accepted that I felt bad and sought support. Personally, therapy has been brilliant and professional mentors have been a godsend. Although I come from a background where we don’t really share, this process has encouraged me to open up a bit. I’ve kind of had to share – not being seen or heard is literally the worse feeling for me! I’ve found the regular weekly times gave me something to look forward to and has kept me accountable for what I want to achieve in the weeks and months ahead. Secondly, I Changed things up. I’m proud to co-run two support groups – one for LGBTQ+ Sikhs and one for Punjabi males focusing on their mental health. I found that they became my support networks and turning up and organising these sessions gave me a renewed sense of purpose. Being accountable to these groups also gave me a sense of belonging. I’d found my tribes and connected deeply with the online space we had fostered. Joining my first ever book club has been a revelation too allowing as it did a level of intimacy I hadn’t imagined was possible online. And thirdly, Focused on the things I’m good at. One of the joys of working for myself is that I can work on projects that bring out the best in me and let me focus on my skills. So for me that means collaboration, working to solve challenges and writing and I actively sought out projects that I thought I could make a difference on. So, over lockdown, it’s been a real pleasure working on the communications for the vaccine rollout in London and also for a mental health start up and for the keeping Well NCL Hub. As a parting thought, I want to say that if you are struggling with your mental health, please remember, there’s always someone there to help – be it a GP or friend or family member, so do reach out. And for those of us who think someone needs help or you sense they may be struggling, a useful tip I’ve found online is to ask twice: asking “How are you?” Followed up closely with “how are you, really?” For me, that that seems like a really powerful way of taking that extra step.

Kulbir Sandhu, Communications Lead for the Keeping Well NCL Hub, shares his thoughts as part of World Mental Health Day, which takes place on Sunday 10 October. He talks about his lockdown experience over the past year and how he’s navigated this testing time.

Melissa: Hello, my name is Melissa and I am a clinical psychologist working with Camden and Islington NHS Foundation Trust, and I am here today to talk with Jenny, who is a clinical nurse specialist in Multiple Sclerosis.

Welcome Jenny.

Jenny: Heya.

Melissa: So tell me, how was your job impacted by the pandemic?

Jenny: I was redeployed twice. I was redeployed during the first wave for just over three months and then went back to my MS role for, I’m not even sure how long, 6 months? And then in January of this year I was redeployed again for three months, and I’m just about to go back. So over the last year I have been redeployed for 6 months. Which I know a lot of people, it’s that experience of being redeployed for a long time, but I had two sort of experiences of being redeployed. Once right at the beginning of the pandemic when no one had an idea about what was going on, and then once during the second wave when there was a sort of much more controlled effort I guess.

So during the first wave I was literally just put on the ward and just said ‘you are doing family liaison. We don’t really know what that is, we don’t really know what your ward is. Go, here’s a phone, see what needs doing.’ So that was quite hard. It was just, there was no real job plan or description other than they knew that families were not allowed to visit because of the pandemic and there were lots of patients who were very very sick and dying, and families were constantly calling the wards, I mean, understandably very upset. And staff were so busy there weren’t having the time to phone the families back to let them know what was going on, so they needed someone to fill that gap, to find out what was going on with the patients and answer that phone and phone the families back and let them know what was going on.

Melissa: It’s a very emotionally heavy role.

Jenny: Yeah, and especially right at the beginning of the first wave you know, no one knew what was going on with COVID, there were not really established treatment protocols, all the patients were on different treatments and there were a lot of patients dying really quickly. And we weren’t having any visitors so there were families where we were setting up for them to watch their families dying over Zoom videos, and it was very hard to be there for that.

Melissa: Yeah.

Jenny: I guess the other real struggle for everyone is being in the huge amount of PPE that we have all been in, being completely covered from head to toe, where you can’t even recognise each other. You don’t know who is under that. So having patients who are very very unwell and incredibly, you know a lot of them are delirious, so we had people waking up thinking we were spacemen, or thinking we were aliens, and it is, it’s one how to cope with it ourselves but how to explain that to families as well. But then also you have patients who are dying and we are the only people who can be with them because their families aren’t allowed to come in and we are holding their hand, but holding their hand through two pairs of gloves. And it’s just, as a nurse it just doesn’t feel the same as actually, you know we can’t actually touch them. I guess as well, part of being a nurse, there is that, you know there are loads of aspects to being a nurse but part of it is that touchy feely, you know you want to be there with your patient, you want to be able to hold their hand a be able to touch them, and them not being able to see your face and not be able to see you smile at them, or hold their hand properly. I have looked after patients for three months now and they have never seen my face and it just feels like you know they might see me in the street and they wouldn’t recognise me.

Melissa: You know just listening to you speak I’m just thinking about actually about the incredible amount of care you have managed to deliver under these crazy circumstances actually.

Jenny: Yeah. You know it’s such a, I think the Family Liaison is such an important role at the moment because we have such limited visiting. But what it has highlighted to me is that it could be such an important role going forward, even outside of COVID or outside of the pandemic because it really does bridge a gap in terms of communication and enabling people who aren’t able to make those communications themselves. So we have been doing things for, yeah for the really sick patients to end of life, who are less conscious, but also for you know patients with dementia or elderly patients who don’t know how to use their phone or don’t have a phone. At our hospital there was one Family Liaison Officer who worked on the dementia ward pre-pandemic, so I say it was a completely new role, it was in the way I was doing it, but there was someone who worked with dementia patients to try and help with communication pre-pandemic. And I think it is something that, you know, even with visiting is really important in terms of bridging that gap in communication. I hope that it is something that can be taken from the pandemic and taken forward.

Melissa: I wonder like, how did you cope with this, what helped you cope in these moments?

Jenny: Lots of different things. I think one of the biggest things that helped me cope was the team, so the team again because it was a completely newly built ward, was a completely new team. So during the first wave were all completely from different wards but a lot of them knew each other, and the team were absolutely fantastic, really supportive and worked together really well, and were all learning new things. And the management of that team, we were headed up by a really excellent consultant, there was nursing management as well. So having such a supportive team around who just, sort of, accepted everyone was really really helpful. We had, as you know, some psychological supports, we had support groups coming in several times a week, which was good so that the team could just sit down and talk about anything, whether it was work related or not, to have that supportive environment. And then at home I’ve got my mum who is a retired nurse, so she’s always there to talk to about nursing stuff and is happy for me to offload onto, and then just doing non-work related things, so going out for walks and… you know I think it is hard for everyone during the pandemic when everything is shut, but doing other things. So, crafting, and cooking, and walking, so just trying to, you know, get my mind off things, and then, as everyone has been doing, Zoom calls with my family.

Melissa: It’s not quite the same but it’s there.

Jenny: No.

Melissa: I can definitely vouch for your team. When I visited your ward, when everyone was being given those packs that had lipstick in, it was really lovely to see.

Jenny: Yeah, we were all wearing lipstick under our masks and no one could see it!

Melissa: Get some self-care at work, I love that, it’s brilliant.

Jenny: And then I have also stayed really close in contact with my MS team, so they have been really supportive even though I haven’t seen them in three months. My manager and all of my colleagues there have stayed in contact and that’s really good, so I’m looking forward to seeing them next week.

Melissa: Thank you so much for joining me to speak today. I know it was quite brief but just hearing about what you have been up to for the past twelve months has been really interesting and illuminating for me and I’m sure there are lots of people listening who can really relate to it as well.

Jenny: I hope so.

Melissa: So really thank you for your time.

Jenny: You are very welcome.

A conversation between Melissa Hoban, Clinical Psychologist at Camden and Islington NHS Foundation Trust and the NCL Wellbeing Hub, and Jenny Slough, a Clinical Nurse Specialist in Multiple Sclerosis working at University College London Hospitals (UCLH), talking about Jenny’s experience of having been redeployed into a family liaison role– the challenges this brought and the learnings for future work that were possible.

From Jenny: I’m Jenny, a Clinical Nurse Specialist in Multiple Sclerosis. During the COVID pandemic I was redeployed to HDU twice for over six months total to work as a Family Liaison Nurse. This was very different from my normal role and enormously challenging, but I also learnt a lot and met a lot of amazing people while I was there.  Melissa Hoban is a clinical psychologist who, during the pandemic, provides frontline staff support in the form of individual sessions, training and wellbeing groups. She also works for a mental health charity supporting the mental health and wellbeing of 18-25 year olds’ in the transitional age group.  Having worked in a specialist trauma service and substance misuse service, Melissa is interested in a trauma informed approach to mental health care. She also creates accessible mental health resources in the form of illustrations and animated videos that you can find on her Instagram platform @myndoodles

In recent history, NHS staff have never seen such public support and affirmation. In the first wave of the pandemic, the Thursday clap was a marker in the week; NHS charities were overwhelmed with donations, staff were fed by restaurant chefs and children painted rainbows for us. Or was it for us, colleagues in cancer care, maternity, paediatric and mental health services (where I work as a psychologist) were wondering ….. ? “Were these gestures for us too?”  Because when we think about NHS ‘heroes’, somehow we weren’t feeling like those were us – and frankly if one asks most people what comes to mind when they think of NHS heroes , its inevitably first those images of PPE clad staff in the acute hospitals working frantically to treat patients with Covid-19. 

I’m Jocelyn Blumberg, a clinical psychologist working at the Traumatic Stress Clinic in Camden and Islington Foundation Trust, as well as with the Keeping Well NCL Hub supporting health and social care staff across North Central London. In this role, although I have done a lot of work with staff working on Covid wards, I have also had lots of conversations with colleagues who had to continue providing treatment as usual to non-Covid patients – people with cancer; very ill children; pregnant women and people in mental health crisis. And from those conversations it has become clear that Covid-19 and the unhelpful rhetoric about “NHS heroes” have really polarised the NHS.

Many NHS staff who were not called upon to do Covid-19 ‘frontline’ work, did not stay away from the frontline out of choice. The capacity to be on the frontline or indeed to be redeployed onto the frontline was largely determined by skill set and role; often hurried organisational decisions about who was best placed to do what; people’s own health and individual circumstances such as pregnancy and underlying health conditions, or the need to comply with national guidance around ‘lockdown’ and social distancing for so called non-essential or routine work.

However from those ‘left behind’ – not on the frontline – it is not this that is held in mind. Rather I have consistently heard about feelings of survivor guilt (while colleagues on the Covid-wards were exhausted; traumatised; getting ill and dying), shame and a sense of being undeserving. Maybe this is because NHS staff are a self-selecting bunch – people who chose their line of work to feel busy; useful and potent; and whose identity is defined by working to help others. So when talking to these staff from a wide range of backgrounds, there was always a common theme, this experience of guilt – of feeling bad that they were  ‘just’ seeing to ‘treatment as usual’ or in some cases were underoccupied, because their normal roles were not possible.

If one asks the right questions, professionals providing treatment as usual in their services went on to describe how this really wasn’t treatment as usual at all. They spoke about increased caseloads with other services shut and colleagues redeployed or shielding, patients much sicker on admission, as well as very angry and anxious patients, upset because of long waits. They have borne the brunt of this.

Learning new ways of working online and over the phone has caused massive stress  – feelings of loss of control; worry about what might be missed and about patient safety, as well as difficulties caused by being stuck at home and separated from colleagues on whom we all rely for support and guidance. Despite these challenges, as well as the threats and losses we have all faced during the pandemic, people I have been speaking to still describe at times feeling like frauds or imposters, blaming themselves for somehow not helping more, despite having made every effort to volunteer their services where they might be useful.

There is no doubt that the division between those who have been working in active frontline Covid work on the Covid wards and those who had to continue with providing crucial treatment as usual for the patients in their care, has caused distress: feelings of frustration, anger, guilt, shame, helplessness and worthlessness. Especially, because at times this care and incredibly hard work, which many have felt was unseen, was made increasingly demanding, stressful and complex because of Covid.

These splits and hurts will take work and time to heal. So what might help?

It is important to remember that we are all cogs in the bigger NHS and social care machine, and the nature of this crisis has meant that some of us have had roles in active ‘Covid work’ – whilst for others our duty and contribution, if not ‘frontline’ and centre stage, has been to be working incredibly hard keeping our patients as safe and well as possible and to limit virus spread. So please do remember that as a non-frontline NHS professional you too were doing your duty, just as much as anyone else. ‘Duty’ just looks different for different groups.

So as you reflect on your experience of working “off the frontline” during the pandemic, be self-compassionate. Think about what you know you’ve done well. Can you write down some things that you feel you can be proud of?

Can you also think about what you need to do to look after yourself? Have you taken leave? Or are you overworking, to compensate for working from home or indeed for not being on that Covid ward? Remember that you cannot pour from an empty cup – you have to be well-resourced and rested to be effective and efficient in caring for your patients.

And I know that for many of us, while not being on the frontline was profoundly difficult in many ways, we have also developed creative and effective strategies to help us in our work. My sense is that this has led to systemic advances, which will sustain after the pandemic has passed and about which we can be really proud.

I hope that when the dust settles, we will all come to the realisation that each one of us in the NHS, in all our different roles has something important to contribute; that everyone adds expertise and contributes to the equation, even if we were not caring for patients with Covid.

However, in order for this to be really felt, senior leadership and managers at all levels need to recognise and reinforce this and to make sure that all staff feel valued for their contributions.

And at a team level, reflective practice groups for staff teams can really help us to really listen to others experiences and to share our own.

With the clapping a distant memory and no pay rise to speak of ,we will need to rebuild the brilliant team cohesion, sustaining collegiate relationships and mutual support if we are to move forward together and continue to provide the best possible care for all patients, which we aspire to.

Jocelyn Blumberg is a Chartered Clinical Psychologist at the Traumatic Stress Clinic at Camden & Islington NHS Foundation Trust and also works for the Keeping Well NCL Hub. This podcast focusses on the experiences of people working in roles that are not defined by some as the ‘frontline’, those who had to continue providing treatment as usual to non-Covid patients. Jocelyn recognises and reinforces this important role and the need for all staff to feel valued for their contributions.

Hello I’m Angela Bagum, Mental health nurse and Clinical Work Focused Practitioner at the Tavistock and Portman NHS Trust. I’d like to talk with you about my experience of Mindful walking in nature, along with a quick outline on how you might do this yourself.

For the last six years, I have been engaging in mindful walking. This is something I did initially as part of a Mindfulness course, but I did not integrate it into my daily life until much later. I found myself changing my commute to work, so that I would have to walk through a park on the way there and back. At first, I changed my route because I enjoyed the park, but I started to notice that I felt a deep sense of satisfaction and less stress while walking through that space –almost intuitive response to my own health and wellbeing.

My interpretation of mindful walking has meant being open to what is around me, noticing my breath in the moment, making a conscious effort to feel my stride, and focusing on the colours, feelings, textures and scents in my environment. Sometimes, just being aware of different trees – knowing they’re alive – makes me smile, aware that underneath the ground, their deep roots are supporting other trees like a community network, helping each other out. At times, wind sweeping across me can feel like I’m bathing in water, in tune with the elements of the earth. In summer I can feel the fire. Marked by Gaelic Pagan ritual of Beltane, introducing the birth of summer and the fertility of land. What is, a hopeful exchange between seasons. These patterns of nature remind me that situations and feelings of difficulty, can and do, move on.

Mindful walking can feel like a type of cleansing or restoring of vitality. I later learnt about the Japanese concept of “Shinrin-Yoku”, meaning “forest bath” or forest bathing:  this practice is about taking in the forest, or trees and immersing ourselves in its atmosphere, using the five senses. Of course, there are times when it feels impossible to do any mindful walking or forest bathing…. But just being in the presence of nature is where it starts.

Some tips for Mindful Walking:

  • Firstly, you can practice mindful walking wherever you are, preferably in presence of nature – a park, on a quiet tree lined street, a wood, a river or on a beach… Just start walking!
  • Look out to your surroundings and what are you seeing in this conscious and present moment. What can you smell, feel and taste? How does your body feel as you move? A little heavier than usual. We are just noticing.
  • Bring attention to your breathing – you could try taking longer breaths than usual or slowing your stride, and you could even pause for a few moments in a particular spot. Perhaps resist the urge to check your phone, and instead focus on the here and now, engaging all your senses.
  • Check in with yourself and how you are feeling, are other thoughts  coming into your mind – it’s ok to notice them allow them to come and go, knowing that you will come back to them later. Focusing on your breath can help here, as well as the feeling of your feet as they touch the ground – a literal ‘grounding experience’.

Angela Bagum, Mental Health Nurse and Clinical Work Focused Practitioner at the Tavistock and Portman NHS Trust looks at mindful walking and forest bathing, linked with the theme for Mental Health Awareness Week this year, which is nature, and it is about a way of gathering oneself, looking after the mind and body, and finding ways to allow nature, wherever you find it, to offer some roots and solidity.

What are podcasts?

Podcasts are regular, short messages from wellbeing and mental health practitioners within this network. They will be directly responding to what we are hearing from you through both the Wellbeing Quiz and the ‘How Are You Today’ survey, as well as offering more specific presentations for targeted staff groups, for example social workers.

Once you have completed the Wellbeing Quiz, keep an eye on the hashtags underneath each of podcasts to help identify those which might be most helpful for you.