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In Conversation with Jenny – Family liaison

 
 

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

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Off the frontline? Experiences of NHS staff not working on the Covid wards

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.

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Mindful Walking in Nature

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.

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In Conversation with Katy

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 Katy, who is a women’s health physiotherapist.

Melissa: So welcome Katy.

Katy: Thanks so much for having me.

Melissa: Maybe it would be helpful at first to hear how your job was impacted by the pandemic?

Katy: So I’m a women’s health physio that mostly works in outpatients at UCLH, and in the first surge our whole team was redeployed over to Westmoreland Street which was set up as a cancer hub. We were redeployed as a team and then formed a bigger team, so we were quite close knit over there. It was kind of a nice opportunity to focus on some different skills.

In the second surge it was a little bit different. We had all come back to our normal service in between but as we all came back from Christmas in January, we were all redeployed again, but this time we all went to different places. So some of the team stayed here to continue our urgent services, some of our team went back to Westmoreland Street, and I went up to the COVID wards which is where I met you. So it was a very different experience with the two surges, especially being up on the COVID wards I felt like a lot of my colleagues there had seen the COVID patients before and been in that environment before whereas it was all really new for me in the second surge, so that first week I was just emotionally and physically exhausted because it was all just a really new environment and treating patients I had never really come across before. And what was different the second time round, there was a constantly changing team, so you never really knew who you would be working with until you were up on the ward in the morning, which is in some ways really nice because you got to work with lots of different people with different skill sets, but it was actually something I found quite stressful because I realise how much I depend on the people around me and that identity within a team and it was something that was changing on a daily basis at the time.

Melissa: I wonder if it can make a person feel like it is hard to find their footing when there’s that not stable or secure foundation that a team can provide.

Katy: Absolutely, I mean there were some really nice things in there as well, so one of the physios I was working with was initially someone that I was their educator when they were a student a few years ago, and then all of a sudden she was the respiratory expert and I had no idea what I was doing, I was like ‘teach me everything’. So it was really nice having a bit of a role reversal and experience that as well.

Melissa: I wonder are there any other difficulties or challenges that you really felt being redeployed, particularly in your second role, posed.

Katy: I think the second time round we were all probably quite fatigued with the change over the past year, and I think there was a real sense of loss in terms of career progressions. I mean we all specialise for a reason and we are all really passionate about those areas that we specialise in, and I think that for me I had this concern about my normal caseload that had had appointments missed, we weren’t even able to properly catch up from the first surge, so there was that anxiety of how are we even going to restart our service when we come back. So I feel there was more of that in the second surge and colleagues at every level had had their career pathway changed or things delayed and so it was obviously frustrating for myself but to see others as well have to wait to get to those milestones as well.

Melissa: Yeah, and you mention that word loss there and I can really hear that coming through. It’s the loss of the patients you are working with and your role that is all waiting there in the background and worrying about them, but it is also the loss of your identity where you are at on your training pathway and how you specialise, all this stuff you have been working towards and the uncertainty about what is going to happen there.

Katy: Yeah, no, absolutely. I was having those experiences in work but also outside of work. I mean in some ways it is good to talk about something different when you are outside of work and have a different environment, and I know we were very lucky with that in terms of getting to leave the house every day and having a change of environment. Particularly in that first lockdown we had such beautiful weather and just cycling to work every day, coming back in the sunshine was such an important thing.

Melissa: It’s funny you mention that because that was literally going to be my next question of what helped you cope with that, and I can hear cycling might have been part of it.

Katy: Yes, definitely being outdoors was really important. In the first surge we were really lucky, we had a little courtyard and just having that time together outside to have lunch as a team was really important. And I think it was just you know having that recognition that you could only do your best and you’re part of this wider team that are all experiencing the same challenges and frustrations and we were all working towards the same goals. And then I think in the second surge I think it was really important for our team that had been redeployed to different places to come together and the sessions that you facilitated were so helpful to have that opportunity to reflect together, because everyone had such a different experience, even when we were in the same environments. And I think you can think that someone is finding something difficult but you never really understand it until you hear it from their perspective, so that was really important. And then I guess personally just having time out, having annual leave, I don’t think any of us took annual leave for months in that first lockdown and that is definitely something I have learnt, take your leave and have that time out.

Melissa: So we are coming to the end of our chat today, but before we go I really wanted to ask you what do you think is something, if you had to name one thing, that you are proud of that you have done during this time? It can be something at work, outside of work, big or small.

Katy: Oh, that’s so difficult! I guess I am proud as a whole of our team and kind of the fact that we have gone through those two different redeployments and we are back in clinic and we are seeing our face to face patients now slowly which is really nice. So I guess just that ability to bounce back from all of the change and almost come together stronger, and there are things we have done as a team that have happened quicker because of the fact we have had to change to virtual or develop new services which is really good. And then yeah I guess personally I am proud of recognising the importance of work life balance and trying to get that better and I think that is a lesson to take on longer after the pandemic.

Melissa: Oh Katy, it has been such a pleasure to speak to you, I wish we had longer. I could sit here and talk for ages, but it has been so good to hear about how it has been for you over these past twelve months and I think there is a lot of what you have said that people are going to really relate to so thank you so much for sharing it today and speaking with me.

Katy: Not at all, and thanks for all of your help. Thanks for giving me the opportunity to reflect.

A conversation between Melissa Hoban, Clinical Psychologist at Camden and Islington NHS Foundation Trust and the NCL Wellbeing Hub, and Katy Megson, women’s and pelvic health physiotherapist working at University College London Hospitals (UCLH), talking about Katy’s experience of having been redeployed – the challenges and the learning that were possible. It is a conversation about having to readjust, about not being able to inhabit a familiar working identity, having to learn to be with different people in a different environment in a different way.

Katy is a women’s and pelvic health physiotherapist working at UCLH and privately in Southwest London. She enjoys working with women throughout the various life stages to treat symptoms of pelvic floor muscle dysfunction and pregnancy related musculoskeletal conditions. Katy enjoys working as part of an multi-disciplinary team which aim to improve the quality of lives of women suffering with these conditions.

Melissa is a clinical psychologist who is working part-time for the NCL Wellbeing Hub, supporting staff wellbeing through the pandemic. She also works for a mental health charity supporting 18-25 year olds mental wellbeing.

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Mind The Gap – How Are We Supporting Supportive Staff In Health Care

Hello my name is Trish McEvoy. And I am an Operations Manager for the Adult complex needs service at the Tavistock and Portman NHS Foundation Trust.

I want to talk about what it’s been like working in a supportive capacity to clinical services during this pandemic, and the experiences of many of my colleagues and I working in these roles.

Of course it’s been an incredibly challenging time for all in health care, more so for our colleagues in acute Trusts dealing hands on with patient care.

However, supportive services have also experienced challenges, seeing an increase in email traffic, workloads, working hours, technical hitches with remote working, as well as an increase in clinical governance issues and along with that; growing anxiety and frustration with the uncertainty the situation fosters. And this without the usual outlets to relieve those emotions, such as networking with colleagues in the office, going for a drink and a meal with friends, or that quick chat in the kitchen and coffee break. Or even that much deserved weekend away to see family.

Staff supporting clinical services in an administrative way have seen their workloads increase to include adding clinical notes to patients’ records, sending Zoom links to patients, and explaining some of the nuances of the technology to both patients and clinical staff. They have been the lynch pin to ensuring that trainees and honorary clinicians have what is needed to start their training and clinical work, repeatedly providing instruction, guidance and signposting to those needing it.

We have found ourselves getting more involved with some of the health records tasks that would normally fall within the remit of clinical responsibility, with clinical staff not being present in clinic for various reasons over long periods. While also taking on new admin tasks like Covid-19 screening calls to patients attending for face to face appointments to help protect the clinic and staff members.

Added to that, having to sensitively respond to patients who had naturally become more anxious due to lockdown, as well as handling distressing duty calls from patients, sometimes from home, without the support of colleagues readily available.

So it’s felt even more important to provide something for this group of staff, to help manage the increased stress levels that many had reported feeling, in the same way as had been provided to clinical staff.

In talking to staff, it was clear that they had not accessed the resources provided, to help with their wellbeing, with some stating that they had not been able to find the time to read anything, as it would take away time they needed to just get through requests, or emails. They just felt that they couldn’t spare the time to stop and think about themselves.

I’ve found it useful to increase contact, adding regular 1:1s and weekly group meetings or informal check-ins; just to create opportunities to talk to colleagues and find out how they are doing, even beyond the world of work. And thinking about the time pressures many have mentioned, sharing links to infographics on wellbeing that are generally quicker and easier to engage with.

But I found myself thinking ‘what else can we tangibly do to fill the gap for this staff group?’. Perhaps replacing a little of what has been lost; as well as what positive learning we can take from these experiences to add to working practices beyond the pandemic. 

Firstly, I would say it’s really important to listen to this staff group and find out what they are feeling, and what the barriers are for them accessing support for their mental health.  And then to involve them in conversations about what is needed in terms of support for their wellbeing.

Keeping Well NCL have gone some way to doing that in planning a webinar and panel discussion, set to be held in early summer to better understand the experiences of this staff group across NCL. So I do hope you can join us for that once the date is set.

I’ve also been thinking about what we can learn from what private industry is doing in this space for their workforce and make it ‘the norm’ for the supportive workforce post the pandemic. We’ve likely heard of ‘duvet days’, ‘dress down Fridays’, and flexible working, and huge organizations like Citi Bank have introduced ‘no Zoom Fridays’, to help relieve some of the pressures. 

Granted not all of these can be easily adopted into the public sector healthcare workforce.  But can we promote initiatives on an organizational level that specifically target challenges this staff group face, like ‘no email Mondays’ and continued flexible working from home options across all pay Bands? These could be in addition to tangible efforts like lunch time yoga sessions, Zoom common rooms for chats and coffee breaks, or regular wellbeing infographic circulars that encourage staff to be mindful of taking their breaks.

Trish McEvoy is an Operations Manager for the Adult Complex Needs Service at the Tavistock and Portman NHS Foundation Trust. In this podcast she talks about what it’s been like working in a supportive capacity to clinical services during the pandemic, and the experiences of herself and many of her colleagues working in these roles.

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Breaking Unhealthy Habits

Hello, I’m Dr Emily Shaw, a Clinical Psychologist working with Camden and Islington NHS Foundation Trust. I want to talk to you about breaking unhealthy habits.

The coronavirus pandemic has forced us to drastically change how we go about our everyday lives and continues to present significant uncertainty. At times like this, you might be experiencing difficult feelings more often and more intensely, whether it’s stress, anxiety, loneliness or boredom to name just a few. It’s not pleasant to feel this way, so we’re inclined to search for something that is going to give us some immediate relief and this is just when old familiar habits start to return. Those things that give us a momentary pick me up, a feel good boost or help us to temporarily block out uncomfortable feelings. But they’re also the things we wish we didn’t need to rely on because we know they come with a cost; to our health, our relationships or even waste our valuable time. It may even be habits that you’ve previously been able to overcome that you’ve noticed creeping back in. It might be smoking, drinking too much alcohol, biting your nails, eating junk food, going to bed too late, spending too much time on your screens or maybe avoiding exercise. There’s a whole host of habits we can easily pick up during difficult times.

One of the biggest obstacles to breaking these habits and forming new healthier habits is the mind itself. Habits are formed when we do something enough times it becomes automatic. These behavioural patterns are imprinted in our neural pathways, so it can take a lot of effort and repetition to create new pathways. Particularly during more challenging times, our minds prefer the path of least resistance, seeking out the habitual behavioural patterns that have already been formed. So the mind has all manner of tricks to talk us into returning to our old habits and avoiding any new ones: ‘There’s no point in trying’, ‘Just one chocolate won’t hurt’, ‘You can start again on Monday’, ‘Go on, you deserve it’, ‘Don’t bother, you’re going to fail anyway’.

So if we want to make a change in our life, we have to be aware of our habitual responses.

One way to help you take a new direction is through slowing down and being BOLD.

BOLD is a series of steps that will help you to reprogram your behavioural patterns and create new directions in your life.

Let’s go through each one now. You may want to write them down on a card that you carry around in your purse or wallet, or have stuck on your fridge to remind you of the steps.

B stands for breathe.

By becoming aware that you’re breathing and taking a slower and deeper breath the parasympathetic nervous system will become activated, which is responsible for creating a sense of calm in the body. By consciously breathing you’re also pausing whatever else you’re doing, putting the brakes on your usual automatic habitual behaviours. This small moment of pause can be enough to help break the habit.

O which reminds you to observe.

Here we take another moment or two to simply observe what is happening. Notice what thoughts are here, perhaps some unhelpful ones that try to bring us back to our familiar behaviours. Notice what feelings have shown up that could be important to listen to, and really observe what you’re doing in this moment.

L stands for listen.

Listen to yourself. What do you most want for yourself in this moment? Instead of listening to your thoughts and feelings that don’t always have our best interests at heart, get in touch with what’s important to you right now.

D stands for Do what matters.

Commit to what YOU really want to do and follow through with it.

By slowing down and running through the BOLD steps, you’ll find you’re able to experience a greater sense of ease and respond more effectively when we are drawn towards an unhealthy habit.

Go through these BOLD steps over and over. It takes time for new behaviours to become more automatic. And be kind to yourself along the way. You’re bound to slip back to old patterns from time to time, gently return back to the BOLD steps and try again.

Emily Shaw is a Clinical Psychologist working at Camden and Islington NHS Foundation Trust. Here she speaks about the unhealthy habits we may have turned to during the pandemic to give us immediate relief and how we can reprogram our behavioural patterns by practicing being BOLD.

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Everyone Needs Support

Hi, my name is Abi Concannon and I’m a new (part time) member of staff working within the Mental Health and Wellbeing Hub for NCL, now known as Keeping Well NCL.  Elsewhere I work as senior lecturer/cohort director for the NHS Leadership Academy’s Elizabeth Garret Anderson programme and have also been working at the Tavi as a 1-1 facilitator on the Practice Supervisor Development Programme.  And I have a small private practice.  So I wear lots of different hats. 

I’m very conscious of the impending string of anniversaries about to cascade – a whole year of not being able to see my clients face to face in my consulting room, a year since the EGA programme was suspended/restarted/suspended to release everyone back into frontline work where necessary, a year since my 20th wedding anniversary trip to Italy got cancelled, a year since we all had to change the way we work and socialise.  A year since the world changed irrecoverably.  A year that has been tougher than many people realised it would be and yet……. A year when many, many people rolled up their sleeves and got down to the  business of supporting each other, thinking together, making decisions in record time, finding creative solutions to previously unimaginable dilemmas.  Everyone’s experience has been simultaneously similar and different – overarchingly similar because everyone has been affected by the pandemic one way or another and massively different because we are unique as individuals, are differently privileged and marginalised, seen or unseen, heard or ignored.  But there is a thread as well, that I’ve seen running through all the different accounts of experiences that I have witnessed which is about support.

Supporting others – to stay well, to make informed decisions, to remain independent, to understand and accept, to let go, to recover, to learn – this is what many of us were engaged in this time last year – supporting the work of others.  And all those people engaged in providing those services, the nurses, therapists, medics, social workers, carers, educators knew that they came to work for a specific purpose which fulfilled the need of the service user/patient/client/student and which also was meaningful for them as an individual – most people having made an active decision to work in their chosen field as a means to enact their desire to support the wellbeing and development of others.  What this year has shown, certainly to me and I think to many others is that while we might be quite good at supporting others, and really engaged throughout the pandemic and thinking together with others about how THEY might adapt behaviours to meet unexpected challenges – turning that attention inwards has not been so good or consistent.

So, for example, I remember having 1-1s with some senior social workers at the beginning of the first lockdown and discussing with them in detail the ways in which they might think about how on earth they and their teams were going to keep a separation between their work and home life now that they were effectively living at work, often homeschooling simultaneously and had completely lost the compression/decompression time that a commute provided.  We co-devised individual responses that included going out the front door turning around three times and entering back into the home to start work.  Sometimes this might include a walk at the beginning or end of the day.  Or for healthcare workers they would take their lanyard on and off to signify their being at work – and this became more elaborate to include specific items of clothing.  Tiny but symbolic acts that signified to the brain that something of the old routine might still be alive and serving a purpose.  We devised ways of managing the tyranny of the online meeting invites inserted into calendars.  We talked about  how colleagues could be drawn into service in terms of accountability for taking a lunch break or finishing work at a certain time.  Really basic stuff.  And all the time that I was doing this work, encouraging managers and leaders to model behaviours to their teams and reports, I was sitting eating breakfast and lunch at my desk, sometimes not going outside all day, taking on more and more work whilst simultaneously trying to ensure my teenage children were engaged with online education – you get the picture?  I definitely wasn’t practising what I was preaching in those early days and it made me very conscious of the need that propelled me originally into this field of work – the desire to help – and that this had gone into a kind of overdrive.  This sense of desperation that there was always someone who needed more and the pull to try and meet that need. 

And so discussions with colleagues began to emerge – about how as professionals we were used to providing support and of course making use of the systems of support in place e.g. supervision and peer engagement that contained and challenged our experiences of undertaking that work but that the pattern had changed.  Whereas a more linear experience existed prior to the pandemic, where a person with a need was matched to a suitably experienced/qualifed professional who could lean into their system (more or less) in order to meet that need , the blurring of the personal /professional boundary when WFH/LAW and the many harrowing stories of those having to leave home to go and work in unimaginable scenarios created a new and different pattern.  More like concentric circles of support – with those in the middle working at the front line and those in subsequent circles providing increasing layers of scaffolding to hold everything in place.  But what happens to the outer circle – where is the support for the people who occupy that space?  The circular model is flawed.  If we work on the premise that everyone, everywhere needs support in some form or other, that the most experienced clinician and the newly qualified social worker both need support, that the carers need support.  That I need support and you need support – if we can accept and embrace that then I wonder what more we might be able to provide for each other.  A network rather than a circle or a line.  In the Keeping Well NCL Hub, this is what I hope to be part of – a network of Keeping Well groups and resources where we can take care of each other and provide spaces for resting and thinking together, reflecting on the past, present and future, providing support and receiving support so that rather than a scaffold, we create an architecture that looks more like a network of fungi which flowers and migrates to where there is a source of, in our scenario, need.   one that can adapt and respond in real time to all the challenges we are able to imagine.  And some that we can’t. 

In the meantime, I go for a walk before starting work.  I take a lunch break.  I put do not disturb on my calendar.  I try really hard to practice what I preach.  I feel better.  I am better at my work and feel less overwhelmed.  I check in with my colleagues.  You get the picture?

Abi Concannon is a new member of staff working within Keeping Well NCL. Elsewhere she works as senior lecturer/cohort director for the NHS Leadership Academy’s Elizabeth Garret Anderson programme and as a 1-1 facilitator on the Practice Supervisor Development Programme at the Tavistock and Portman. Abi’s podcast emphasises the importance of everybody, recognising and accessing support in very ordinary ways, either self-care or through the support of others. It is really about our need to not just be thinking about how we give to others, but also being ready to notice when we ourselves might need support, ask for support or be ready to accept it when it is offered.

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Celebrating the social care workforce

Hello, my name is Andrew Cooper. I work as a social worker and Professor of Social Work at the Tavistock Centre in London, where I also practise as a Family Therapist.

During the pandemic I’ve been facilitating reflective groups for frontline social care workers and managers, and meeting with experienced social workers every day as part of the training programmes I work on.

This is an unbelievably hard time. One thing that social care workers say a lot is how unrecognised they feel their contribution is at the moment. All the media and public attention is on the nurses and doctors, the crises inside the hospitals. It’s as though social care in all its forms is invisible, out of mind, and I sense this is damaging people’s morale, at a time when they are working so hard, taking risks with their own lives, putting their own families at risk and coping with death on a daily basis.

At worst it seems to be true that social care staff, post discharge facilities, and residential homes are once again a kind of dumping ground for the hospital system as it rushes frantically to create capacity for the inflow of terribly ill people. The inter-dependence of the two systems of care is forgotten, expelled from mind; discharged patients are often scattered far and wide as capacity in the care system itself is overwhelmed. I’ve heard social workers describe how they can’t keep track of patients and service users’ movements, and so it’s impossible to do a good job. The hospitals need social care and can’t function without you, but at present there are so many critically ill people that all attention is turned on them.

Those of you working with children at risk and vulnerable adults often can’t come close enough to them to know how things really are inside the home or placement. This is leaving people with a burden of worry and anxiety. Referrals are on the rise everywhere. I heard a CAMHs manager speak about the huge increase in eating disorders among young women, the lack of options for treatment, but also how children’s wards have been taken over to accommodate Covid patients. Again all this is somehow ‘out of mind’ in the public domain.

People everywhere are angrier at the moment I think. Anxious, worried and bereaved families of service users will often project their feelings at people like you. They often feel helpless, and may leave you feeling the same.

Our own managers and organisations are struggling too. Everywhere, I pick up a feeling that staff don’t feel ‘held in mind’ in the way they might have been a few months ago; under intense pressure we can all close down, shut off from the needs of others around us, depleted as we are by our work which ironically is all about giving out to others, listening, understanding, working in their interests. Many people are describing symptoms of burnout, and the most distressing of these is when they realise with a kind of horror that they’ve stopped feeling as though they care any more. ‘But that’s not me’ they say, and of course it isn’t because we all came into this work because we find fulfilment in the task of caring. It’s just the place our minds and bodies end up in when we’ve been overextended for too long and need some care ourselves.

Through all this I see and hear social care staff showing amazing resilience, determination, commitment, loyalty, dedication. There isn’t enough recognition or appreciation of your essential contribution, but everyone should remember to feel proud, and to help one another hang onto the fact that you are continuing to behave professionally and compassionately in the face of it all. If there are heroes in this terrible time, there are so many more unsung heroes.

So what can you do to help yourself, and others, as we wait and hope for relief? This series of podcasts provides all sorts of good ideas for looking after yourself individually. But you can also join together with your colleagues. A group of home working social care staff I was supporting, who were finding the isolation, the lack of anyone to share anxieties with or get advice from about the constant policy changes very difficult, decided to organise their own weekly check in online for an hour. In the office environment we rely on each other all the time for ideas, support, thinking, and comfort. The workers approached their manager for permission to meet within working hours and she readily agreed.

We can hold each other in mind in an active way in our teams and groups. This is happening in all sorts of ways all over the country in communities, workplaces, streets. Mutual aid is springing up to fill the gap left by our struggling professional and organisational systems. People are organising themselves rather than waiting for a response from further up their hierarchies.

And we can remember to say thank you to one another, as often as possible. It’s a way of making other people’s small acts of giving and compassion meaningful, recognising one another’s achievements and each others’ distress, appreciating one another. These are some small, everyday gestures that can make all the difference in this horrible period.

I wish you all well. I’m proud to be a social care worker, and proud and moved by so much of what I’ve witnessed lately.

Thank you for listening.

Andrew Cooper is a social worker and Professor of Social Work at the Tavistock Centre in London. He reflects on the experience of social care workers and managers during the pandemic, informed by his work facilitating reflective groups for frontline social care workers and managers, and meeting with experienced social workers as part of the training programmes he works on.

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Henry Smith – Supporting Social Work Students During COVID-19: Stories from (the) Frontline

Hello, my name is Henry Smith, and I’m a Principal Practice Tutor for an organisation called Frontline. Frontline is a social work charity that trains students in social work practice a qualified route into social work. We mainly focus on children and family social work. And I support units of students based in children’s services departments.

So the changes that came as a result of COVID-19 happened very quickly for our students and for me. When Boris Johnson announced a lockdown, we suddenly went from seeing families face to face, and me meeting them face to face, to everything being remote. We had to adapt very quickly to a lot of new technology, and suddenly I was meeting participants via apps like Zoom and Skype. And a lot of our participants, the students on the programme would be, would have relocated for the programme and many were living in shared houses, and would be really working from their bedrooms, particularly a small number of participants who were isolating and wanted to continue with the programme. So we felt enormous duty of care in terms of supporting them through this very difficult time and, and helping them progress with the course that they wished to continue.

So I think for the participants on the programme, there was a sort of, lots of mixed emotions, there was a kind of fear for themselves due to the impact of COVID and that they might catch it, for the families that they were supporting and for their own families, but also a fear of what might happen to the programme, would they be able to complete their social work programme. They were nine months through their qualifying year when this struck, and there were lots of uncertainties, uncertainties that we couldn’t initially provide solutions for and we had to have a number of conversations around trying to sit with this anxiety of not knowing while we worked with social work England and the local authorities they were placed in to work out how we could get them to qualify.

And a couple of practitioners, the practice educators who worked with the students reflected to me that it was actually very hard for them in terms of they were worried about families and their, they would want to help families and that’s a lot of their professional self as a family, as a social worker would be to help families and to support them, but they could no longer do this because of being isolated in the lockdown. And they were reduced to contacting families via phone and feeling a little bit inept, and I think they found this very difficult and big challenge to their professional selves.

So how do we react to this, both me as a practice tutor, tutoring the students, and as an organisation? Well, very much the attitude was the show must go on. We are the largest qualifying routing to social work and to reduce that flow of social workers into the system at such a crucial time, when we are probably going to need more social workers, would have been very counterproductive. And the participants were very keen to proceed as well. So I had weekly meetings with my participants, particularly as some were so isolated, and were really, as I say, in bedrooms and in shared houses with people they didn’t know that well, unable to see the families. We made some social events, we did quizzes, I upped my pastoral support, we did some extra teaching, sticky stuff around the Black Lives Matter movement that was happening at the same time. We took time to share the technology we were using with families, programmes like Jamboard and TikTok, my participants were doing some fantastic work with families around that and making sure we weren’t breaching any data protection.

So what we saw was some great creative work and actually many of the families that had been due to close to the children and family social work teams actually requested that they, their families were kept open in order to provide extra support through COVID, and what I saw was social work students helping families make sense of some of the confusion and advice around COVID-19, supporting families with routines now that school is not in place, and particularly for parents who hadn’t had a good experience at school and didn’t feel very comfortable teaching their children, helping them, sending them educational resources and supporting them with how to manage that.

As well, these families who were still open, there were risks involved and there were concerns about the family’s welfare and just making sure we weren’t getting false positives from online visits and talking with children over digital platforms in terms of their wellbeing. But happy to say that the programme is close to completing and all the participants have passed the programme and I’ve seen some great social work along the way. Thanks for listening.

Henry Smith is a Principle Practice Tutor with Frontline. Henry discusses how Frontline have supported social work students during the pandemic, and the way students and colleagues creatively adapted to new ways of working.

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Jane O’Rourke – Box Breathing Exercise for Sweet Dreams or Relaxation

Hello, my name is Jane O’Rourke. I’m a Child, Adolescent and Family Psychotherapist, and a yoga and mindfulness teacher. This exercise called the Box Exercise is really good for helping you steady and ground, and also to do before you go to sleep.

So I’m inviting you to either lie down if you’re preparing to go to sleep, or you really need to rest, or to find a comfortable seated posture. If you’re lying down, get yourself nice and comfortable, perhaps by putting a cushion underneath your head and allowing the body to settle. And if you’re sitting up, then finding a posture where you can let your spine rise nice and tall.

And then I’m inviting you next to put a hand on your heart and a hand on your belly. And just start to engage with the steady rhythm of your breath. Perhaps notice in your hands rise on the in breath, as your belly rises and your chest rises. And then on the outbreath, the belly releasing and the chest releasing, so tuning into the rhythm of your breath. Feeling the steadiness of the floor, if you’re sitting up, that’s beneath your feet, or if you’re laying down feeling the whole body underneath you, being supported by the earth, feeling the steadiness of the earth, connecting with that, so that you can feel your whole body starting to relax. The breath starting to deepen and soften.

So in your mind’s eye we’re going to imagine the breath going around like a box shape. So, breathing in for a count of four and then we’re going to be holding it for a count of four, breathing out for a count of four and then pausing for a count of four before we begin again. So on your next in breath, breathing in for a count of 4, 3, 2, 1, holding the breath for 4, 3, 2, 1. And then breathing out 4, 3, 2, 1, and holding the breath for 4, 3, 2, 1. Breathing in 4, 3, 2, 1, holding 4, 3, 2, 1, breathing out 4, 3, 2, 1, holding 4, 3, 2, 1.

Breathing in… Holding… Breathing out… Breathing in… Holding… Breathing out… Holding… Breathing in 4, 3, 2, 1. Holding… Breathing out… And holding… Breathing in… Holding… Breathing out… Holding… Breathing in… Holding… Breathing out… Holding…

Last round, breathing in… Holding… Breathing out… Holding… And then just allowing the breath to move in and out at its own pace, not controlling it in any way. Feeling the steady rhythm of your own breath…

And you can stay here longer if you’re now going to sleep. Or in your own time allowing yourself to gently come back into the room in your own time.

Perhaps taking some time to look around, to centre yourself, taking in the room around you and gently coming back. Perhaps stretching, giving yourself perhaps a little shake if you need to re-energise before you can go on with the rest of your day.

Box breathing is a practice that has been taught all around the world to people working in frontline jobs.

Jane O’Rourke takes us through this practice as a way of helping the body and mind to calm at times of stress or to help us sleep. Jane is a yoga and mindfulness teacher and a psychodynamic psychotherapist with children young people and families. She teaches yoga for trauma within the trauma service at the Tavistock and Portman NHS Foundation Trust.

Wellbeing Quiz Profile: #MoreFrantic #RelivingTrauma

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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.

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Keeping Well NCL is a wellbeing and mental health project that connects and supports the North Central London health and social care workforce during the Coronavirus outbreak.

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