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Hello this is Tim Kent from the Tavistock and Portman NHS Foundation Trust. I’m the Director of Adult Forensic Services here and I’m a psychotherapist and a social worker by background. It’s interesting this pandemic crisis that we are in the throes of at the moment, it mostly reminds me of parents and grandparents stories of the Blitz, wartime, rationing, pulling together, and the sense that what was at stake was people’s mental coherence as much as the fear of loss of life and loved ones and of course with that fear comes the sense that we’re not always together and a lot of our work at the moment is remote. I’ve just been on a Skype, sorry, Zoom call, with several colleagues, spending a lot of time on the phone and you know managing a huge array of new experiences and feelings sort of bombarding the mind at any one point and trying to metabolise it like a new medicine so it’s quite bizarre and I think we’re all both sort stimulated and in a way very anxious about the outcome and what’s it’s going to mean.

Of course we all know people who are currently very ill and some who we’ve lost and many thankfully who had mild versions and are either recovering or haven’t yet been unwell so there’s a very strong sense of that kind of spirit of the Blitz, for want of a better description, and I think it’s valuable.

There’s something that’s been on my mind for several years about the experience of a country or nation, that hasn’t in any recent past history been through a considerable period of real adversity and I suppose before COVID-19 we thought that 10 years of austerity and cuts to the NHS was real adversity, which of course it very much is and has been and continues to be and now we are reaping the fallout from that experience.

But more immediately and more personally, my wife’s been unwell so I’ve been advised by our doctors to isolate and it feels as busy working from home as it has been the office, although I miss being around friends and colleagues and within the institutional environment. I’m thinking ahead to whether I could and should be redeployed back into social work and with experience in child protection and adults with mental problems and working the community.

I think for lots of people at the moment there is a sense of wanting to help and wanting to be able to go above and beyond the norm is shared by so many, at the same time that that some of our colleagues are just really frightened and very much wanting to retreat, so a really complex and difficult time and am very very grateful to have so many supportive colleagues.

I know it feels like a difficult thing to come to terms with the moment but it does feel great to be part of the NHS and to see the appreciation of our public for what we do. It’s also extremely worrying to see how austerity has left us unprepared in so many ways and that that ultimately is going to impact on mortality rates.

So in psychological services, just as a final note, for some of our patients if not most of our patients, the psychotherapy that we provide at the Tavistock and Portman, alongside our other services, is a lifeline, literally, for many people. As Donna Winnicott and Albert Einstein wrote to the government during the Second World War, the thing about protecting children and adults from adversity at a time of crisis, and at that point wartime, is not just about a threat to the physical body, the psychological threat to people’s emotional development and mental capacity and ability to keep going and in some cases keep living with the huge threat and therefore the huge anxiety that it causes is paramount.

It’s not really to compare the body and the mind, perhaps better to say that they’re part of the same thing and it’s important to keep going psychologically as it is physically. I think the fact is at the moment that a lot of us are experiencing a very serious traumatic impact to our mental functioning and the bombardment of new experience and change can get through some of the time, so you know you can feel all right one minute and then completely discombobulated the next and unable to think and then them you try and re-gather.

Okay I think that’s enough and I will sign off now. Thanks for listening, take care, keep well and love to you all.

Tim Kent is Director of Adult & Forensic Services, Consultant Psychotherapist and Social Worker at the Tavistock and Portman NHS Foundation Trust. He delivers a rousing commentary for NHS and social care staff about the experience of living through, and working in, the current time of adversity and how the services we provide are a lifeline, literally, for many people.

Key workers across different sectors have some big questions about how to continue to do their work and look after their children in this time of huge upheaval and uncertainty.  

How to explain that you want and need to keep working, managing your worries about the spread of the virus, and how to reassure children that you and they are safe at work and at school.

When the news came a couple of weeks ago that schools would be closing because of COVID-19 the landscape changed for all of us. Without, it seems, even a moment to draw breath, parents and children have had to find a way to trust that continuing to go to work and school is vitally important if collectively we are going to manage this crisis.  Of course there is often huge pride for children in knowing that their parents are part of the helping professions, but at this point it may feel quite difficult to hold onto this.  

Whilst many parents will have had the task of getting used to home working, key workers will have known that this was not going to be an option for many of them. 

The news that key workers’ children would continue to have a place at school came quickly, and with the relief came a number of questions in the minds of adults and children about what being a key worker now meant.  And some of these, for parents, might feel unspeakable.  

How do I keep working in situations that might put me and my family at risk?  

How do I explain that my work commitments will mean that my children have to continue to go to school?  And will they be safe there?

And other questions about what happens for key workers and their children but not for everyone.  Lockdown surely means just that! But of course lockdown means different things for adults and their families in certain professional roles. 

As this pandemic has continued to develop there is a need to keep talking to children about this changing landscape – for some children this may have felt at first like  the beginning of an extended school holiday.  But it is now week two and children of key workers have been attending school as usual, but of course there is nothing usual about school at the moment. So   as the traditional Easter break approaches, how to explain to children that this probably will continue for some time to come and that it won’t end after the holiday – key worker parents will still be working. 

As the reality of this new normal continues, parents will probably be aware of the need to stay alert to the spoken and unspoken worries that their children may have.

How do you have a conversation following the daily briefings which bring news about testing, resources and the numbers of people who are sadly losing their lives.  For those parents who are key workers, and their children, these are uncertain times, feelings of fear, upset and possibly anger are surely somewhere in the minds of your families.  

Thankfully, the thinking and more rational parts of the brain will, with your explanations and reassurances, reason away some of these thoughts, but this may only provide temporary relief for children who because of their age, or their own psychological and emotional needs, find it hard to hold onto these explanations. You may need to explain more than once, to help them regain balance. 

So, how do you manage the emotional roller coaster that you find yourself?

One key task is to find ways to not only remind yourself of the value of your role, but to allow yourself to think about your own worries.  Some of these might take you to places that ordinarily you do not usually have to visit, but by allowing yourself to notice your own ‘not knowing’ you might be able to begin the journey back to what will help you to feel fully equipped, practically and psychologically, for what you are facing.

Speak up and seek reassurance that everything is being done to keep you safe in your job, and ask how your employers will respond when you need a helping hand to get you back to somewhere near your best.  At these times, being in a team and/or finding a colleague to talk to has never been more important – and the difficulties you are facing in relation to your children are very unlikely to be yours alone. 

​ For your children it will be important to talk about your work, perhaps in a bit more detail that you would normally, to let them know that everything possible is being thought about to keep you safe.  And importantly that you would not be sending them to school if you did not trust that they will be safe there too.

Being clear yourself about how the school is operating will help you to have confidence when talking to your child.  Check in with staff about how they are managing the children, and ask them to give you feedback if they have any worries about how your child is coping.

You may also need to give space to allow your child to talk about how upsetting it is to still be going to school when their friends are not.  Whilst they may be proud of your role, they may also resent the fact that this has an impact on them.  Talk about the breaks you plan to take (because your annual leave is still important) and how you and they can spend some different time together.

You will probably be completely worn out due to the mental and physical impact this crisis is having on your well being, so take time to find something relaxing that you can do to recharge your batteries, if only temporarily, but also find short bursts of time (ten to fifteen minutes) to sit with your child doing something that they want to do with you.  The usual rules apply; give them your full attention and that little bit of tlc that you both need.​ As far as you can, it helps if you can keep being  the mum or dad that they know, even though there is so much that is new and uncertain for everybody. 

Laverne Antrobus is a Consultant Child and Educational Psychologist at the Tavistock and Portman. Laverne talks about the challenges for key workers and family life, where children (and parents) may have all sorts of feelings about a situation where work might be felt to be an unsafe place, and where school has suddenly become  a very different place. She talks about the range of feelings that there might be for both parents and children, and has some ideas about how to help children to manage and how to look after yourself as a parent, and a key worker in this difficult and constantly changing situation.

Wellbeing Quiz Profile: #MoreFrantic

Hello, this is Jane O’Rourke. I’m a Child Adolescent and Family Psychotherapist, and yoga and meditation teacher. Today we’re going to do a relaxing, calming breathing exercise, so let’s start by taking a moment to find a comfortable resting position; could belong down or sitting in a chair – whatever feels most comfortable for you.

Let’s start with a few relaxing breaths, inhaling through the nose and out through the mouth, taking deep, relaxing in-breath and slow, relaxing out-breaths, and relaxing out and releasing any tensions of the day with each out-breath, just following your natural breathing pattern: breathing in and breathing out. Breathing out through the mouth helps relax all the tensions that might have built up through the day, almost like a releasing valve.

And now let’s begin our restful breathing pattern. To do this, we’ll be inhaling though the nose, and again, breathing out through the mouth.

So inhale through the nose for a count of 1, 2, 3, 4; holding the breath for 2, 3, 4, 5, 6, 7. Exhale through the mouth: 2, 3, 4, 5, 6, 7, 8.

Inhale through the nose: 2, 3, 4, hold for 2, 3, 4, 5, 6, 7. Exhaling for 3, 4, 5, 6, 7, 8.

Now on your own, inhaling for 4, holding the breath, and then exhaling. Now inhaling 1, 2, 3, 4, holding, now exhaling.

We’re about half way through.

Inhaling, holding, exhaling.

Inhaling, holding the breath, exhaling.

Inhaling, holding the breath, and exhaling.

The last time: inhaling, holding, and exhaling.

And now letting the breath return to its regular rhythm, not trying to change the breath in any way. Breathing in and out through the nose and allowing yourself just to completely relax here, and allowing any tensions in the body to just evaporate with each out breath, Allowing each in-breath to bring strength and courage, a new life; and every out-breath just to allow the tensions of the day that have built up to release and let go. Allow yourself to do nothing.

You can focus now on the breath, wherever it’s most prominent in the body. That may be at the tip of the nose or in the chest or in the belly, but still notice the rise and fall of each in-breath and each out-breath. And of course our minds might wander, so any time you notice your mind has wandered off, just bring it back to the focus of the breath, allowing the whole body to relax and the mind to relax as well. Allowing the mind to slow down.

You can stay here for as long as you like now, just resting, or allowing yourself to fall asleep.

Jane O’Rourke is a Yoga and Meditation Teacher, and a Psychodynamic Psychotherapist with Children, Young People and Families. She teaches Yoga4Trauma within the Trauma Service at the Tavistock and Portman NHS Foundation Trust. Jane guides us through a 5 minute soothing sleep breathing exercise aimed at helping you to get some rest, or to get to sleep.

Wellbeing Quiz Profile: #FeelingHopeless

Hello, my name is Andrew Cooper and I work at the Tavistock and Portman as a Family Therapist and I’m Professor of social work. I’m going to speak about some of the challenges of working with death and with dying people, and some possible ways of helping ourselves with this very demanding task.

In this crisis many more NHS and social care staff find themselves caring for dying patients or are in the situation with unprecedented regularity and intensity. Increasingly, because of isolation procedures, nurses and doctors are alone with people at the moment of their deaths. Families and loved ones are excluded – on the outside looking in. You may be acutely aware of their grief and anguish. Staff are fearful for themselves and for their own families. Professionalism and a sense of duty spurs people on, while the instinct of self-preservation pulls strongly in the opposite direction.

You may want to move towards the dangerous situation and simultaneously flee from it. This conflict can cause huge anxiety, to act on all the other anxieties. Most of you will have suffered the loss of someone close to you at least once in your life. A family member or friend may be very ill right now whether from Covid-19 or another illness. Working in close contact with dying people stirs up these memories even if the pressures of the job mean you hardly have time to think about them – if a patient dies, but you have to move on to the next emergency. Your feelings for the dying person in front of you can become mixed up with your own grief and anxiety about loved ones. This is normal, but immensely stressful. It can feel somehow selfish to be preoccupied with your own losses and fears when you’re supposed to be caring for others. It isn’t selfish, it’s ordinary.

I myself had an uncle I never met because as a young man he was killed in the Second World War, but my mother told me stories about him, while his brother; my father, never spoke of him. Somewhere the grief about his loss passed into me and is still alive. Many of us carry these ghosts inside us and they can come to life in the face of our work with dying people. Will all tend to carry around an idea of what a good death might be like. Whatever that is, your experiences at present will be far removed from this image or ideal. That’s hard to bear in itself and in these pressurised circumstances, when a patient dies you may be left with painful questions: did I do enough? Make the right decisions? Give them enough at the very end of life? Sometimes these thoughts collect in a very difficult way: did I in effect kill this patient? We may know such thoughts are not rational but they can still be very real in our minds.

My colleague Jo Stubley made another podcast in the series about trauma. Most of what she says is completely relevant to you if you’re working with dying people, or people you’re afraid might die. The same situation affects different people differently. You may hardly have had time to get to know many patients, or they are sedated, but something about a particular person can still trigger powerful memories and feelings, and unexpected grief wells up in you when you are working under these exceptional conditions day after day. If you don’t find some release for these feelings they accumulate into what Jo Stubley calls cumulative trauma.

So, what can you do to look after yourself and your colleagues? Letting yourself feel and think when you’re having to work so relentlessly can feel risky. You may worry you’ll fall apart and not be able to function, so you might want to pick your time and place to let yourself slow down and allow some feelings to surface. Most people will find it a relief and feel a bit stronger afterwards.

in some acute assessment wards where patients often die, but the throughput of work is relentless, a team working with the patient who dies do something called ‘the pause’: they stop and take two minutes together to remember this was someone’s daughter, mother, son, partner, friend. But also to remember how hard they themselves worked to try to save the patient. You might try this but if not, you can find a trusted colleague and take some time with them to share your feelings from the shift: fear and anxiety, distress, grief, guilt, anger.

Closeness to death and dying frightens us and makes us want to weep. It’s the most normal reaction in the world but as the saying goes, we need a shoulder to cry on. If you can trust someone else to receive your distress and also offer them some time and understanding, this can be hugely helpful. An honest recognition of what you’re facing together is a bond and to get through this terribly difficult time, strong bonds with colleagues are vital. We are assailed by images of the crisis in the media. I remember one: an exhausted hospital worker sitting on the pavement, head in his hands, being comforted by standing colleague who has her hand on his shoulder. But lastly if these approaches don’t work here or there is just no time, and you feel the pain and distress rising up in you, then a few moments of steady deep breathing will probably settle you, calm your mind and body.

There is no magic solution for the stress of what people are doing when working so close to death and dying. whatever ways you find help yourself, it’s so important to remember that everyone is finding it just as difficult, although each in their own way to some extent. In all this there are moments of hope and success. Some patients recover and can be discharged. You feel you did as good a job as possible in breaking the bad news to a patient’s family. Colleagues thanks you for your support and understanding. It is important to hold onto these moments because they can be wiped out by the overwhelming demands of the art of our task. Everyone in the caring system may be touched by some or all of what I’ve spoken about: porters, cleaners, administrators, managers. Remember one another, everyone has their part to play and is vital to the overall effort. Reaching out to others when you sense distress and being open to others when they offer you something are the best route to getting through and being able to carry on doing your best for the patients and their families.

Andrew Cooper is a Family Therapist and a Professor of Social Work at the Tavistock and Portman NHS Foundation Trust. Andrew talks about one of the most difficult things that any of us face in the current situation, the impact of living and working with death, a particular challenge with COVID-19 even for very experienced NHS and social care staff. He brings some thoughts together about what can make our contact with death in this context so hard, and has some suggestions and practical examples of what can work well in trying to look after ourselves and each other when facing the emotional labour of caring for those at the end of their life.

Wellbeing Quiz Profile: #FeelingHopeless #RelivingTrauma

Hello, my name is Lorna Fortune and I’m the Lead Psychologist for Psychiatric Liaison Services in Barnet, Enfield and Haringey Mental Health NHS Trust and I’ve been working with the acute trust to think about how we support our physical health professionals through this crisis period.

So, I’m going to talk about Psychological First Aid. At the moment our physical health colleagues are working in extreme conditions with very high numbers of very unwell patients, with services and resources stretched in ways we’ve never seen before. So, we’ve looked at what’s helped in other countries who’ve been through similar situations and the evidence suggests that Psychological First Aid is a helpful and useful approach for our frontline staff.

Psychological First Aid or PFA provides a compassionate and supportive presence, designed to help support people in the midst of a crisis situation, by helping to stabilise them and mitigate acute stress and assess if there’s a need for continued mental health care. Psychological First Aid uses quite simple yet powerful principles to help people build support and containment within teams.

It’s worth noting that this model largely uses skills that our health professionals will already have. It’s quite an ordinary way of talking to people that optimises their existing communication and interpersonal skills. However, at times like this, teams can benefit from additional training and support in providing PFA as this will give them an opportunity to think about, practice and build upon their existing communication and interpersonal skills so that they feel more ready and confident in supporting their colleagues.

It’s worth saying that PFA is different to counselling and psychotherapy. The goal of PFA is to help stabilise and mitigate distress, rather than provide long term personal growth. PFA can be provided by almost anyone and it’s usually best provided by people within the existing team as this will help to build on and further develop existing team relationships and support.

So, what does PFA look like? It’s quite a simple model, it can be used quickly to increase connection and reduce stress. There are some basic steps. First of all, it’s noticing when colleagues are struggling or in emotional distress, prioritising them, offering them support. An important part of the support is taking time to listen and to respond, understanding and validating that person’s experiences and reactions. And then its about thinking about how to think through with them what might help and what can be done to help stabilise their emotions in the moment and think together about how they can build their existing coping skills. Also, PFA is not a once only intervention, but it’s an ongoing process that can be bedded into the team culture and structures, helping teams to be mindful of each other, the impact of this situation and feel more confident in supporting each other.

Often in these situations people feel like they’re not doing enough or not making a difference, so I want to remind you that being there for your colleagues, noticing when they are struggling and offering them support by listening and helping them through, can make a very big difference too. It might seem like a small thing, but it can have a significant impact, by helping us work together, connect with each other and look after each other.

Lorna Fortune is the Lead Psychologist for Psychiatric Liaison Services in Barnet, Enfield and Haringey Mental Health NHS Trust. Here Lorna speaks about the value of Psychological First Aid (PFA) in this time of crisis, particularly for those of you working in acute settings providing physical care. A brief introduction to PFA is provided, the goal of which is to help stabilise and mitigate distress by supporting people in the midst of a crisis situation.

Hello there, my name is Nicky Lambert. I’ve been asked to put together a few thoughts for student nurses at this very strange time that we are going through. I think when you start a course as a student nurse you assume that things will smoothly go ahead, you’ll go from module to module, placement to placement, and you’ll come out the end and you’ll have received your goal. One of the really interesting, exciting, scary, fabulous, weird things about nursing is that you can’t predict what will happen. No two days are the same and certainly no nursing journey, no learning journeys, is the same.

I think what I wanted to say to you was a story that I heard when I was a student nurse, and it was something that really stuck with me and it was about the anthropologist Margaret Mead being asked what she thought were the first signs of civilisation in the culture. I think people assume you’re going to talk about wars or axes or clay pots, and what she said was the first sign of civilisation in ancient culture was a broken leg that you could see had healed and she was saying in any situation if an animal breaks its leg, it can’t get food, it can’t hunt and an animal just doesn’t survive a broken leg usually long enough for the bone to heal.

What Margaret Mead was saying was that a broken femur that healed is evidence that somebody was there with that person, somebody stayed with them, somebody picked them up when they fell, carried them to safety, tended them, helped them to get recovered. Helping someone else through difficulties is where civilisation starts, that’s where we are at the moment. We are certainly in a difficult situation, not easy to see how it will turn out at the moment, there will be lots of changes.

The learning journey that we thought we were all on is probably going to be quite different and it’s an opportunity to grow and learn and more importantly it’s an opportunity for us to be together.

So the reason you want to be a nurse, to help other people, to serve the public, to be part of a team, all those things are still same. I think when I first started as a nurse I wanted to learn and grow and be challenged and certainly that’s what these times are bringing us.

So just a few thoughts for you. One is: prioritise your own self-care, make sure you’re rested, make sure you’re eating properly and prioritise your family and your loved ones. You can’t keep drawing on your resources if you don’t have any, so treat yourself with the compassion and respect that you treat the public and that that will help you going through this time.

Also be aware that your colleagues are there for you, your lecturers in college and your peers and even service users and the public will be there to support you. You are doing a really important job, at a very difficult time, people recognise that and I think nurses, your colleagues, really respect you stepping up. If it’s something that you can’t do, if you can’t step up through health issues and through family issues, the other thing I would say is please don’t feel bad. That’s the reason we work as a team, we each have a time and a place to act. This is a long, long game. Do what you can. Support others where you can and step back when you need, to that’s why there’s so many of us and that’s why we stand together. So I hope that’s helped and I would say as well is – thank you.

 

Nicky Lambert is an Associate Professor (Practice) at Middlesex University, where she is Director of Teaching and Learning for Mental Health and Social Work. She is registered as a Specialist Practitioner and is a Senior Teaching Fellow She is also a co-director of the Centre for Coproduction in Mental Health and Social Care. Here Nicky talks directly to student nurses as they navigate their way through their training during the Coronavirus outbreak.

Hi, I’m Rachel Surtees, I’m Director of Strategy and Transformation at the Tavistock and Portman. In my normal job I spend much of my time thinking about and planning for the future, but things don’t feel very normal for any of us right now and I don’t know if it’s the same for you but my concept of time has become pretty distorted so long-term planning right now, feels a bit more like thinking about what might be happening in three hours’ time rather than three months’ time.

But the long-term still matters. We will get through this pandemic and when we do our hospitals and organisations will all need to return to normality so that we can continue to care for our patients and vulnerable adults and children who depend on our services.

One of the really important principles of NCL In Mind is that everybody matters. Our doctors, nurses, receptionists, administrators, cleaners, porters, and everybody else whose roles means that they are really at the face of this thing are doing an incredible job and we are all very grateful. But there are also a huge number of other health and social care staff in more corporate facing roles and your jobs are also still important and your well-being matters and is being thought of too.

Computers still need to be fixed, staff still need to be paid, invoices still need to be raised and all these other hundreds of daily tasks that keep organisations running, still need to happen.

I know from talking to my own teams, who I manage, who are in corporate roles, that this feels like a really complicated and difficult time. They want to help, but just like everybody else fill a bit daunted about stepping into the unknown. They also want to try and keep their day jobs going because they know that is one of the ways to limit the long-term damage of this pandemic, but they are worried about bothering people who are busy dealing with today’s priorities.

There’s no easy answer, but if you’re in a corporate or support service role and have been asked and are able to do other things, that’s great. No-one expects you to be an expert overnight, so do your best, be clear about what is being asked of you and ask for help if you need it. And crucially, stay in regular contact with your core team. Staying connected is one of the very best things that you can be doing right now to look after your wellbeing.

And for those of you who are still plugging away at your day jobs, keep going and thank you. The way that we can help those who are really feeling the heat of this virus is to keep everything else running as smoothly as possible. You may need to adapt how you’re working, I’m sure you already have, but be available, be kind and stay in touch with colleagues.

You can use the NCL In Mind webpage to tell us what you struggling, or what you’d like to hear podcasts on, and we’ll do our best to get helpful content up and online as quickly as we can.

Rachel Surtees is the director of strategy at the Tavistock and Portman NHS Foundation Trust. Rachel speaks to the many health and social care staff who are in corporate or support service roles, who may be finding it difficult to understand their roles during this time of crisis.  

Wellbeing Quiz Profile: #MoreFrantic

My name is Paul Dugmore and I am a Consultant Social Worker at the Tavistock and Portman NHS Foundation Trust. This podcast is about how those of us working in children’s social care can manage and look after ourselves as well as others during these very difficult times. There is rightly lots of focus on the NHS and our colleagues who are really on the front line in tackling the coronavirus pandemic, but it’s also important to recognise the essential and invaluable role that social care plays in helping the hundreds of thousands of children and families affected in different ways or worsened by the current situation.

I want to acknowledge the many challenges you may be facing as a social care worker within the system and the likelihood of you absorbing lots of professional anxiety about issues such as safeguarding, and worries about vulnerable children not being in school, compounded by the global anxiety about COVID-19 in the recent lockdown.

There is to, the added complexity for social care workers in navigating whose needs to prioritise: your own; your children’s; your family and friends; as well as the children and families you work with; the needs of your organisation and colleagues who might be unable to work. Within all of this there will be a mixture of emotions, perhaps conflicting, such as compassion and worry, anger and guilt, which can feel overwhelming at time. There is no right way to deal with the challenges we’re up against, but having time and space to think about how you may be feeling, and what some of these things mean can be helpful.

So, within this context I just want to offer some tips for coping with all of this, and the continuing importance of relationships, which can feel difficult to prioritise especially when our usual opportunities for making connections may not be there. Work meetings may still be an option, face-to-face or via video or telephone conferencing. In the absence of this it’s really important to maintain contact so picking up the phone and checking in on your colleagues is really important. Being able to share experiences and offload and talk about some of your difficult feelings are helpful ways of bearing the load. In the absence of normal working practices, the types of concerns we might have about a child or family don’t diminish, so is more important than ever to connect with colleagues in the wider professional network, to talk things through so you’re not holding onto things and making decisions by yourself.

If you’re needing to stay-at-home because you all your family are self-isolating, this can make you feel more disconnected from others so making the most of social media messaging, phone and video calling are all good ways of keeping connected and you might want to be creative in how you connect online.

If you’re remote working in these strange new times, the importance of keeping a routine and boundaries around work and home life is even more important now in order to look after yourself and those around you.

Checking in and out – consciously identifying a list of who your consistent supports are and planning in a 10 minute check with someone at the beginning of the day to say what you hope to achieve today in terms of work and self-care, and someone at the end of the day to sign up with.

Who’s looking after you – remember the importance of supervision with your manager or supervisor and if their absence someone else with appropriate responsibility in your organisation.

Pace – breaking tasks into smaller chunks so not doing anything for longer than an hour. Taking a five-minute pause at the end of each task and concentrating on your breathing, a ten second meditation when you’re sitting up straight with your feet on the ground, breathing in for four seconds and out for six. Do this every hour and keep hydrated, drinking a glass of water regularly.

Kindness can’t be underestimated – think about how to be kind to yourself and manage your own expectations of what you can achieve in a working day. Recognise that this might be less than usual due to the emotional landscape of the current climate.

Appreciating your colleagues – everyone will be dealing with this in their own way which might be different to yours; showing compassion and empathy to yourself and others and finally ending the day by doing something positive that makes you feel good.

Paul Dugmore, Consultant Social Worker at the Tavistock and Portman NHS Foundation Trust. Paul speaks to those of us working in children’s social care, and how we can manage and look after ourselves as well as others, during these very difficult times.

Wellbeing Quiz Profile: #MoreFrantic

Hello my name is Jo Stubley, I am a Psychiatrist and Psychoanalyst and I run the Tavistock Trauma Service. I am aware in these difficult times that many NHS frontline staff may well be experiencing a number of traumatic events, and I thought it might be helpful to say a little bit about that today.

So what do I mean when I’m talking about this idea of trauma? Well I think at the heart of this is an experience of helplessness, and that can be really difficult for NHS staff who are used to doing the things, not to feeling helpless. I think the other aspect of trauma is that it is often something that is overwhelming, so that our usual ways of coping no longer work. Now that might be a single episode of something terrible happening, either that you witness or that you are involved in, or sometimes it can even just be something that you hear about. Trauma though can also be cumulative, so it may be something that small but significant episodes build up over time. What is traumatic for one person may not be so traumatic for the other, it is often a combination of that particular moment for that person, with their history and if we have a lot of trauma or difficult losses in our background, that may make us somewhat more likely to develop some symptoms after a traumatic event. It might also be that trauma occurring now can link up with these earlier experiences and one might find that earlier losses or traumas get brought to the forefront of one’s mind again.

So, in relation to thinking about the kinds of symptoms that you might have having had something traumatic happen. First of all I want to say that it is very normal after something traumatic occurs to have a number of symptoms that are not part of a mental health issue, they are a normal response to an abnormal event and for the majority of people will settle over time, particularly if one is able to use self-care and the supports that are around. The sorts of things that we find might get activated after a traumatic event come under three main headings:

  1. The first we might call anxiety or hyper-arousal. This is like the fight-flight response; a threat is perceived and one has something activated inside in terms of our body’s response to threat that keeps happening, so you can feel agitated, distressed, find it difficult to sleep, might have moments of real panic. These are the kind of symptoms of anxiety and hyper-arousal.
  2. The second type is those of re-experiencing symptoms, the reliving of the traumatic experience which might be intrusive images that come to mind, it might be intrusive thoughts, it could be nightmares or even flashbacks, where one relives over again what is happening and these things are often triggered by something in the environment that reminds us of the event, quite often it is smells that are particularly powerful for that.
  3. The third type is avoidance and numbing, and it is a way that we kind of shut down a bit, we don’t feel as much, we may not wish to talk to people, we may wish to avoid having interactions or even going back to work, and that is often a way of trying to shut down these symptoms, not get triggered, not feel so over aroused but can be problematic if one feels too much like we want to avoid.

Now all of these symptoms are normal, they are the kinds of things that over time will settle, but it is important to think about what can be done in the meantime. The first thing to say is that all of the evidence suggests that people recover from this much more easily if they feel they have a good social network around them. Now I am aware that that means at the moment we have to work particularly hard to hold on to that because it mainly has to be virtual, but it does stress the importance of keeping our connections in this difficult time. The other thing that is really important is to think about basic areas of self-care; diet, exercise, as much sleep as possible, not using alcohol, prescription or illicit drugs to try and manage these things, the kinds of basics that are really important to come back to.

We will be talking more about how to think about trauma but I hope that this brief start is something that can be helpful for you, thank you.

 

Dr Jo Stubley, Consultant Medical Psychotherapist, Psychoanalyst and Lead Clinician for the Tavistock Trauma Service. Here Jo presents a brief introduction to trauma in relation to the current pandemic.

Wellbeing Quiz Profile: #RelivingTrauma

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