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How colleges are supporting mental health in lockdown

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How colleges are supporting mental health in lockdown

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Stuart Rimmer in TES on 7.5.20 :

The mental health of staff and students is one of the top priorities for the Association of Colleges

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How colleges are supporting mental health in lockdown

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The mental health and wellbeing of staff and students in the coronavirus lockdown is one of the top priorities for the Association of Colleges, writes Stuart Rimmer

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Starting 12 May AoC and NAMSS are offering a series of webinars on mental health and the response to coronavirus

12.5.20 at 2pm
Good practice in the here and now

19.5.20 at 11 am
Young people's mental health with expert input  by Young Minds

4.6.20 at 2pm
Staff mental health with the Education Support Partnership & Charlie Waller Foundation

Dates to be confirmed for further sessions on:

bereavement

transitioning into college /what might colleges do in summer

transitioning out of college

AoC  will try to avoid webinars with a mental health focus clashing with the dates and times of other core AoC sessions that are related to mental health, for example a session on 21.5.20 on home working

Link will be added here as soon as we get it.

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Mental Health in Crisis

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Managing Mental Health Crisis Webinar - CfE in SEND Weston College

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Agylia Care for Care Sector Employers enhances care services by helping private care providers, charities, NHS Trusts, local authorities and other care sector employers to improve the training and knowledge they provide their employees.

As a care sector employer, when you sponsor Agylia Care, your employees are able to access over 1,000 guides and reference resources. You can also add unlimited amounts of your own internally or third-party produced content.

With full support for the Care Certificate, you can build training pathways for employees to renew or achieve certification.

[ Find out more about Agylia Care for Care Sector Employers ]

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Agylia Care for Care Sector Employers enhances care services by helping private care providers, charities, NHS Trusts, local authorities and other care sector employers to improve the training and knowledge they provide their employees. As a care sector employer, when you sponsor Agylia Care, your employees are able to access over 1,000 guides and reference resources.

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Katrina Thomas Countdown
https://www.aelp.org.uk/covid-19-coronavirus-guidance-and-patron-support/

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Are some ethnic groups more vulnerable to COVID-19 than others?

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Are some ethnic groups more vulnerable to COVID-19 than others?

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Institute for Fiscal Studies Report published 1.5.20

Key findings
'The impacts of the COVID-19 crisis are not uniform across ethnic groups, and aggregating all minorities together misses important differences. Understanding why these differences exist is crucial for thinking about the role policy can play in addressing inequalities.

Per-capita COVID-19 hospital deaths are highest among the black Caribbean population and three times those of the white British majority. Some minority groups – including Pakistanis and black Africans – have seen similar numbers of hospital deaths per capita to the population average, while Bangladeshi fatalities are lower.

Once you take account of age and geography, most minority groups ‘should’ have fewer deaths per capita than the white British majority. While many minority groups live disproportionately in areas such as London and Birmingham, which have more COVID-19 deaths, most minorities are also younger on average than the population as a whole, which should make them less vulnerable.

After accounting for the age, gender and geographic profiles of ethnic groups, inequalities in mortality relative to the white British majority are therefore more stark for most minority groups than they first appear. Black Africans and Pakistanis would be expected to have fewer fatalities per capita than white British but at present they are comparable. ...

Men from minority groups are more likely to be affected by the shutdown. While in the population as a whole women are more likely to work in shut-down sectors, this is only the case for the white ethnic groups. Bangladeshi men are four times as likely as white British men to have jobs in shut-down industries, due in large part to their concentration in the restaurant sector, and Pakistani men are nearly three times as likely, partly due to their concentration in taxi driving. Black African and black Caribbean men are both 50% more likely than white British men to be in shut-down sectors.'

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The COVID-19 pandemic has affected some sections of the population more than others, and there are growing concerns that the UK's minority ethnic groups are being disproportionately affected. Following evidence that minority groups are over-represented in hospitalisations and deaths from the virus, Public Health England has launched an inquiry into the issue.

In the short term, ethnic inequalities are likely to manifest from the COVID-19 crisis in two main ways:

through exposure to infection and health risks, including mortality;

through exposure to loss of income.

Analysis of ethnic disproportionalities in health outcomes that aggregates groups together masks much of the story with regards to ethnic inequalities, and limits the scope for understanding why they have come about. Moreover, simply comparing mortalities with overall populations fails to take account of key characteristics of different groups that we would expect to lead to different outcomes in the aggregate, such as demographics and place of residence. Accounting for these factors is necessary to understand the true scale of disproportionalities as a starting point for thinking about policy responses.

In addition, given the varied profiles of different ethnic groups, some are more likely to be economically vulnerable under current restrictions than others, and this dimension is crucial for painting a full picture of ethnic inequalities arising from COVID-19. Household structures, occupational profiles and levels of savings are all important to consider in identifying in which groups the greatest economic vulnerabilities lie.

This report brings together evidence on the unequal health and economic impacts of COVID-19 on the UK's minority ethnic groups, presenting information on risk factors for each of the largest minority groups in England and Wales: white other, Indian, Pakistani, Bangladeshi, black African and black Caribbean. For the most part, we focus on these six groups (and the white British majority) for which there is reliable information across different data sources.

The analysis focuses on a limited but crucial set of risk factors in terms of both infection risk and economic vulnerability in the short term. Beyond the scope of this report are a range of other factors which may prove to be important as more research is undertaken, as well as the longer-term consequences of widespread societal disruption for the outcomes of different groups.

Key findings

The impacts of the COVID-19 crisis are not uniform across ethnic groups, and aggregating all minorities together misses important differences. Understanding why these differences exist is crucial for thinking about the role policy can play in addressing inequalities.

Per-capita COVID-19 hospital deaths are highest among the black Caribbean population and three times those of the white British majority. Some minority groups - including Pakistanis and black Africans - have seen similar numbers of hospital deaths per capita to the population average, while Bangladeshi fatalities are lower.

Once you take account of age and geography, most minority groups 'should' have fewer deaths per capita than the white British majority. While many minority groups live disproportionately in areas such as London and Birmingham, which have more COVID-19 deaths, most minorities are also younger on average than the population as a whole, which should make them less vulnerable.

After accounting for the age, gender and geographic profiles of ethnic groups, inequalities in mortality relative to the white British majority are therefore more stark for most minority groups than they first appear. Black Africans and Pakistanis would be expected to have fewer fatalities per capita than white British but at present they are comparable.

After stripping out the role of age and geography, Bangladeshi hospital fatalities are twice those of the white British group, Pakistani deaths are 2.9 times as high and black African deaths 3.7 times as high. The Indian, black Caribbean and 'other white' ethnic groups also have excess fatalities, with the white Irish group the only one to have fewer fatalities than white British.

These disparities cannot currently be accounted for by non-hospital deaths. Official deaths in care homes - for which the ethnicity of victims is not currently available but where over 95% of residents are white - could only explain a small part of estimated excess fatalities recorded in hospitals for minority groups. The ethnic composition of additional deaths directly or indirectly caused by the virus but not officially attributed to it is unclear at this time.

Occupational exposure may partially explain disproportionate deaths for some groups. Key workers are at higher risk of infection through the jobs they do. More than two in ten black African women of working age are employed in health and social care roles. Indian men are 150% more likely to work in health or social care roles than their white British counterparts. While the Indian ethnic group makes up 3% of the working-age population of England and Wales, they account for 14% of doctors.

At-risk underlying health conditions are especially prevalent among older Bangladeshis, Pakistanis and black Caribbeans. Compared with white British individuals over 60 years of age, Bangladeshis are more than 60% more likely to have a long-term health condition that makes them particularly vulnerable to infection, which may explain excess fatalities in this group.

Many ethnic minorities are also more economically vulnerable to the current crisis than are white ethnic groups. The fact that larger shares of many minority groups are of working age means that these populations are more exposed to labour market conditions as a whole, but even amongst working-age populations there are clear inequalities in vulnerability to the current crisis.

Men from minority groups are more likely to be affected by the shutdown. While in the population as a whole women are more likely to work in shut-down sectors, this is only the case for the white ethnic groups. Bangladeshi men are four times as likely as white British men to have jobs in shut-down industries, due in large part to their concentration in the restaurant sector, and Pakistani men are nearly three times as likely, partly due to their concentration in taxi driving. Black African and black Caribbean men are both 50% more likely than white British men to be in shut-down sectors.

Self-employment - where incomes may currently be especially uncertain - is especially prevalent amongst Pakistanis and Bangladeshis. Pakistani men are over 70% more likely to be self-employed than the white British majority.

While in the population as a whole young people are more likely to be affected by the shutdown, the reverse is true among Pakistanis and Bangladeshis. While 24% of young white British and 29% of young Bangladeshis work in shut-down sectors, the figure is 14% for 30- to 44-year-old white British but 40% for 30- to 44-year-old Bangladeshis. This also means that the family circumstances of those affected by shutdown differ by ethnicity, with older workers more likely to be living in couples.

The potential for buffering incomes within the household depends on partners' employment rates, which are much lower for Pakistani and Bangladeshi women. As a result, 29% of Bangladeshi working-age men both work in a shut-down sector and have a partner who is not in paid work, compared with only 1% of white British men.

Bangladeshis, black Caribbeans and black Africans also have the most limited savings to provide a financial buffer if laid off. Only around 30% live in households with enough to cover one month of income. In contrast, nearly 60% of the rest of the population have enough savings to cover one month's income.
Read the full report here.

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Are some ethnic groups more vulnerable to COVID-19 than others?

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The COVID-19 pandemic has affected some sections of the population more than others, and there are growing concerns that the UK's minority ethnic groups are being disproportionately affected. Following evidence that minority groups are over-represented in hospitalisations and deaths from the virus, Public Health England has launched an inquiry into the issue.

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in the left sidebar on the home page select 'register/login'.

Unlike other websites, registering is a human process so you won't get an instant acceptance.

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Get in touch. Tell us what you think of the findings. Ask us any questions. Do this by registering here on the MHFE website and then using the networking function to find and network directly with the local and national CLMH project leads.

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Learning Centres in Derby include:
Blagreaves: Derby Moor Community Sports College Boulton: Allen Park Centre Arboretum: Derby Multicultural Centre Darley: Kedleston Road Centre, Rycote Centre Littleover: Littleover Community School Normanton: Village Learning Centre Derwent: Landau Forte College

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Welcome to the Derby Adult Learning Service - Derby Adult Learning Service

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Learning Centres in Derby include: Blagreaves: Derby Moor Community Sports College Boulton: Allen Park Centre Arboretum: Derby Multicultural Centre Darley: Kedleston Road Centre, Rycote Centre Littleover: Littleover Community School Normanton: Village Learning Centre Derwent: Landau Forte College

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Simon's slides

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Published 11.5.20: 'OUR PLAN TO REBUILD: The UK Government’s COVID-19 recovery strategy'

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Published 11.5.20: 'OUR PLAN TO REBUILD: The UK Government’s COVID-19 recovery strategy'

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11.5.20 This evening, DfE published details of phased wider opening of schools, colleges and nurseries

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11.5.20 This evening, DfE published details of phased wider opening of schools, colleges and nurseries

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Plans for schools, colleges and early years settings across England to potentially open to more children and young people have been set out today (11 May).

As the Prime Minister announced yesterday, by 1 June at the earliest primary schools in England may be able to welcome back children in key transition years - nursery, Reception, Year 1 and Year 6.

Secondary schools, sixth forms and colleges will also work towards the possibility of providing some face-to-face contact with young people in Year 10 and Year 12 to help them prepare for exams next year.

However, as the PM has said, progress will be monitored every day. If the virus stays on the downward slope, and the R remains below 1, then - and only then - will it become safe to go further, move to the second step and reopen schools.

Early years settings may also be able to open for all children. The aim is for other primary years to return later in June, but this will be kept under review, and there are currently no plans to reopen secondary schools for other year groups before the summer holidays.

Priority groups, including vulnerable children and children of critical workers who have been eligible to attend throughout school closures, will continue to be able to attend schools, colleges and early years settings as they are currently.

The transmission rate has decreased, and the aim is that by 1 June at the earliest it will be safe for a greater number of children and young people to return to education and childcare. As a result, the Government is asking schools and childcare providers to plan on this basis, ahead of confirmation of the scientific advice.

This will only happen when the five key tests set by Government justify the changes at the time, including the rate of infection decreasing and the enabling programmes set out in the Roadmap operating effectively.

Guidance to the sector, published today (11 May), sets out a range of protective measures to ensure education settings remain safe places, including:

reducing the size of classes and keeping children in small groups without mixing with others

staggered break and lunch times, as well as drop offs and pick ups

increasing the frequency of cleaning, reducing the used of shared items and utilising outdoor space

Preparation for the potential reopening of schools will be part of the second phase of modifications to social distancing measures which the Prime Minister set out yesterday - following more people returning to work in step one, and coming alongside the possible reopening of some non-essential retail in phase two.

The Government will continue to work closely with the sector in the build up to and following pupils' return.

Education Secretary Gavin Williamson said:

I know how hard schools, colleges, early years settings and parents are working to make sure children and young people can continue to learn at home, and I cannot thank them enough for that.

But nothing can replace being in the classroom, which is why I want to get children back to school as soon as it is safe to do so. The latest scientific advice indicates it will be safe for more children to return to school from 1 June, but we will continue to limit the overall numbers in school and introduce protective measures to prevent transmission.

This marks the first step towards having all young people back where they belong - in nurseries, schools and colleges - but we will continue to be led by the scientific evidence and will only take further steps when the time is right.

Whilst there will be no penalty for families who do not send their children to school, families will be strongly encouraged to take up these places - unless the child or a family member is shielding or the child is particularly vulnerable due to an underlying condition.

The Scientific Advisory Group for Emergencies advising the Government has a high degree of confidence that the severity of the disease in children is lower than in adults and a moderately high degree of confidence that children aged up to 11 are less susceptible to it.

All staff are already eligible for testing, and staff in shielding and high-risk groups should remain at home.

From 1 June, all children and young people eligible to return to their settings will have access to testing, if they display symptoms, as will any symptomatic member(s) of their household.

This will enable children and staff to get back to school if they test negative, and if they test positive a test and trace approach can be taken. Where a setting has a positive case, Public Health England will advise on the appropriate course of action, and the relevant group of people with whom the individual has mixed closely, should be sent home and advised to self-isolate for 14 days.

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Details on phased wider opening of schools, colleges and nurseries

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Plans for schools, colleges and early years settings across England to potentially open to more children and young people have been set out today (11 May). As the Prime Minister announced yesterday, by 1 June at the earliest primary schools in England may be able to welcome back children in key transition years - nursery, Reception, Year 1 and Year 6.

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New briefing: Trauma, mental health and coronavirus Supporting healing and recovery

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New briefing: Trauma, mental health and coronavirus Supporting healing and recovery

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On 5 May 2020, the Centre for Mental Health published this new highly topical briefing which looks at the mental health implications of the pandemic, including the potential psychological consequences of quarantine conditions.

The briefing explores:

who may be at most risk of harm from trauma in the current situation

the work that will be needed to address its social and psychological effects

the concepts of healing from trauma, including the collective role of the community and the need for a trauma-informed response.

A copy is attached or access it online: https://www.centreformentalhealth.org.uk/trauma-mental-health-and-coronavirus
Please share it with your networks.

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South Cumbria and Lancashire Collaborative response to COVID-19

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South Cumbria and Lancashire Collaborative response to COVID-19

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We had already begun work as part of a collaborative embracing both NHS and non NHS organisations focused on providing easier access to relevant services and support prior to COVID through a new digital app, ORB.  As a result of COVID this has evolved into a response aimed at fast tracking the apps release to support our workforce and citizens but also supporting each other to recognise gaps and issues particularly around digital exclusion.  I thought this would be useful to share in case similar work is going on in other regions.

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Coronavirus will increase race inequalities

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Coronavirus will increase race inequalities

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From Runnymede's Deputy Director Dr Zubaida Haque on 26 March 2020, looking at existing societal inequalities and how the impact of COVID-19 will affect black and minority ethnic communities given this context.

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Coronavirus will increase race inequalities

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All any of us can think about at the moment is the coronavirus pandemic and how it will affect us, our families, wider communities and society as we know it. Here, our Deputy Director Dr Zubaida Haque looks at existing societal inequalities and how the impact of COVID-19 will affect black and minority ethnic communities given this context.

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7.5.20 DfE has pulled together on a single webpage all guidance on maintaining education and skills training 

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7.5.20 DfE has pulled together on a single webpage all guidance on maintaining education and skills training 

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This is operational guidance on new arrangements and responses to questions for organisations delivering further education including general further education colleges, sixth form colleges, and other providers.
It will be updated and expanded as information becomes available and in response to questions from colleges and other providers.

NB. Does NOT include adult education.

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Maintaining education and skills training provision: further education providers

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This operational guidance provides further detailed information on new arrangements and responses to questions for organisations delivering further education including general further education colleges, sixth form colleges, and other providers. The guidance relates to the announcement made by the Secretary of State for Education on 18 March 2020 regarding cessation of classroom delivery for most learners due to outbreak of coronavirus (COVID-19).

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'Coronavirus: Thousands of homeless 'back on streets by July'

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Thousands of homeless people who have been housed during the coronavirus pandemic could return to the streets by the end of June, a charity has warned.

Since the lockdown began, more than 14,500 people who were on the streets or at risk of sleeping rough have been given emergency accommodation.

But Crisis has warned contracts between local councils and hotels are due to end as government funding runs out.

The government said councils must continue to provide accommodation.

But councils have asked the government to be clear on what extra practical support they will get.

Local authorities in England began moving rough sleepers into emergency accommodation such as hotels in March after the start of the coronavirus lockdown.

The councils were given £3.2m from the government as part of an emergency scheme called "Everyone In", which was aimed at stopping the spread of the virus.

But earlier this month, it emerged government funding for that scheme was to end. The government said it had given councils an extra £3.2bn in funding to help them deal with the pandemic, although that money is not specifically for the emergency rough sleeping scheme.

Crisis called the action to house rough sleepers over the past weeks "extraordinary", adding: "This has demonstrated that when the political will is there it is possible to end homelessness."

But the charity said the government should take further action to provide everyone with permanent housing, warning that if not people will be forced to return to the streets.

Matt Downie, director of policy at the charity, said most contracts between local authorities and hotels are set to end at the end of June and the charity had received "no indications at all" from the government that more money is coming to extend the scheme.

Mr Downie said: "We will take one of two paths here: one is that 15,000 people are permanently helped out of homelessness through the amazing Everyone In scheme, or we will see a massive increase in rough sleeping in this country just at the point when we thought it would be possible to avoid that.

"It's within the government's control to make decisions so that doesn't happen, for example to either continue hotel schemes or to give alternative arrangements to local authorities and individuals."

Crisis has estimated it would cost £282m to provide the people in emergency accommodation with permanent housing and support for the next 12 months.

The charity also carried out a survey of 150 charities and organisations in England, Scotland and Wales and found more than half reported a rise in people seeking help during the lockdown.

Some people have lost their homes because their jobs have gone, while for others there have been relationship problems or an end to sofa surfing arrangements.

Crisis wants the government to pass an emergency homelessness bill forcing councils in England to provide emergency accommodation for a year to anyone who becomes homeless during the pandemic.

The Welsh government has given a £20m to councils, after an initial £10m, to help councils house rough sleepers "and ensure no-one need return to rough sleeping".

Meanwhile, the Scottish government has announced £350m to help councils, charities and groups, including those working with rough sleepers.

And Northern Ireland's Housing Executive approved emergency measures including the sourcing of additional temporary accommodation for those who are homeless.

The body representing local councils in England and Wales, the Local Government Association, said councils had faced "significant challenges" housing large numbers of homeless people since the coronavirus outbreak.

Cllr David Renard, the LGA's housing spokesman, said the overwhelming majority - nearly 15,000 - of rough sleepers and homeless people have been found accommodation.

But he added: "Following the initial surge in demand for accommodation, councils are also now experiencing an urgent need for more accommodation as people, including young people, continue to face homelessness and rough sleeping.

"While the recently announced funding for councils to support rough sleepers is positive, we still need clarity from government on what additional practical support will be available to councils to help them move people out of hotels and temporary accommodation and into housing."

The government said any suggestion it is rowing back on its commitment to support rough sleepers is untrue, adding: "We are clear that councils must continue to provide safe accommodation.

"Our new rough sleeping taskforce will ensure as many people as possible who have been brought in off the streets in this pandemic do not return. We have accelerated plans for new services - backed by £433m - which will ensure 6,000 new housing units will be put into the system, with 3,300 available in the next 12 months."

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Thousands of homeless 'back on streets by July'

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Thousands of homeless people who have been housed during the coronavirus pandemic could return to the streets by the end of June, a charity has warned. Since the lockdown began, more than 14,500 people who were on the streets or at risk of sleeping rough have been given emergency accommodation.

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'Coronavirus: Watchdog to investigate racial inequalities'

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The human rights watchdog will investigate racial inequalities "laid bare" by the coronavirus outbreak.

The Equalities and Human Rights Commission will examine "the loss of lives and livelihoods" of people from different ethnic minorities.

This week a report found that people from ethnic minorities are at a higher risk of dying from coronavirus.

Equalities Minister Kemi Badenoch has said work is under way to find out the reasons for the greater risk.

However speaking in the House of Commons, she rejected claims that "systemic injustice" is the cause of ethnic minorities being more likely to die from coronavirus in England.

She also told MPs the UK was"one of the best countries in the world to be a black person".

The Equalities and Human Rights Commission (EHRC) says its inquiry aims to address "serious issues that have yet to be fully answered" and will provide evidence-based recommendations.

Announcing the investigation, watchdog chair David Isaac said: "Now is a once in a generation opportunity to tackle long-standing entrenched racial inequalities.

"Only by taking focused action to tackle race inequality across Britain will we become a fair country in which every individual can reach their full potential.

"This inquiry is part of our long-term strategic approach to tackle the structural inequalities that the coronavirus pandemic has laid bare."

The EHRC inquiry will be able to compel government departments to provide evidence to the inquiry and its terms of reference will be published in a few weeks, once race equality leaders have been consulted on the proposals.

This comes after thousands took part in marches protesting about racial inequalities.

The demonstrations were triggered by the death of George Floyd - an African-American man who died on 25 May when a white police officer continued to kneel on his neck after he pleaded he could not breathe.

On Tuesday, a Public Health England report found that the impact of coronavirus is "disproportionate" for Asian, Caribbean and black ethnicities.

It said if you strip out age and sex, people of Bangladeshi ethnicity have twice the risk of death than people of white British ethnicity.

People of Chinese, Indian, Pakistani, other Asian, Caribbean and other Black ethnicity had between a 10% and 50% higher risk of death when compared to white British people.

Responding to the report, Health Secretary Matt Hancock said "much more work" needed to be done to understand "what's driving these disparities".

Meanwhile, Met Police data revealed that a disproportionate number of ethnic minority groups were fined for alleged breaches of the lockdown in London.

'Injustice'

Shadow women and equalities Marsha de Cordova welcomed the inquiry saying: "The coronavirus crisis has shone a light on these inequalities, but the government has consistently failed to take action to save BAME people's lives during this pandemic.

"Now is the time to take steps to tackle systemic racism, discrimination and injustice in Britain."

A government spokeswoman said further work with the government's racial disparity unit will "develop our understanding and shape our ongoing response to coronavirus".

"The government is committed to levelling up and spreading opportunity around this country. This will be a hugely important part of the economic and social recovery from the pandemic," she added.

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Coronavirus prompts racial inequalities inquiry

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The human rights watchdog will investigate racial inequalities "laid bare" by the coronavirus outbreak. The Equalities and Human Rights Commission will examine "the loss of lives and livelihoods" of people from different ethnic minorities. This week a report found that people from ethnic minorities are at a higher risk of dying from coronavirus.

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'Disparities in the risk and outcomes of COVID-19'

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ETF Excellence Gateway Special educational needs and disability exhibition site

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ETF Excellence Gateway Special educational needs and disability exhibition site

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'Communities of Practice for managers and practitioners'

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The four Centres for Excellence (CfE) in SEND are each hosting Communities of Practice (CoPs) covering topics within their individual themes ( People - Weston College, Community - City College Norwich, Careers - Oldham College and Specialist Support - Natspec). These CoP are open to anyone working in Education and Skills with an interest in improving experiences for learners with an inclusion need (SEN). The focus of the CoPs is to share and identify effective practice and to work collaboratively as a community of professionals to address challenges.

In addition to our CfE and Employer Spoke events, you might want to check out joint school and FE 'Specialist Spotlight' CPD events delivered by nasen which are part of the Universal SEND Services programme. The events are booked via the Whole School SEND website events page. Those events highlighted as Post 16 are listed below with a direct link to book.

Events

March

19th, Using The Gatsby Benchmarks to prepare learners with SEND for employment. In this session, Oldham College, will outline the different Gatsby Benchmarks and how to approach these creatively in a way that supports SEND learners - both for having an understanding of the world of work, and for helping them to secure employment. 16:00 - 17:00

19th, The role of a mentor and how it is fundamental for learners with autism. This Weston College ledcommunity of practice will be facilitating a themed discussions on the role of a mentor and how it is fundamental for learners with autism. 13:00 - 16:30

20th, A progression pathway model to support learners with severe or complex needs. This Weston College led community of practice will be facilitating themed discussions on a variety of topics, with this particular session focusing on a progression pathway model to support learners with severe and complex needs. 15:00 - 16:30

25th, All Our Talents: Positive Progression for young people with SEND. This event is being held in Winchester, Hampshire. The event is to support career progression for students with SEND and to help employers find new talent and save on recruitment costs. Hampshire County Council and the Enterprise M3 Careers Hub are bringing together education professionals, key national speakers and leading employers to share best practice and the benefits of inclusive recruitment for all involved. 10:00 - 15:00

25th, Strategies to engage employers: Thinking outside the box. In this session, Oldham College, will explore creative and innovative strategies to engage employers. They will share examples of events and strategies they have used to engage employers. 16:00 - 17:00

26th, Unlocking potential: Equipping SEMH for employability success. Luminate Education Group's 14-16 Skills Programme (supports year 10 and 11 students), offers specialised Social, Emotional, and Mental Health (SEMH) support. In this webinar, they will share their project that focuses on creating a bespoke intervention for learners to navigate challenges, reshape negative thoughts, and foster resilience through the use of the equilibration process. Grounded in psychology research, our evidence-based approach, supported by skilled staff, aims to remove barriers, boost confidence, and ensure success for vulnerable students and support them in their next steps. 13:30 - 15:00

26th, Strategies for teaching, learning and to support our learners with behaviours of concern. This session, facilitated by Natspec, will provide an opportunity to focus on topics related to understanding and supporting learners who display behaviours of concern. Topics include, understanding what 'behaviours of concern' are and how to identify triggers and appropriate strategies. 15:45 - 16:45

April

23rd, Inclusive approaches for our Maths and English for Post 16 learners. In this webinar, City College Norwich share their effective inclusive practice of how they support learners with Maths & English, including initial assessments, strategies to integrate inclusive learning and English and maths to ensure greater collaboration between delivery staff to benefit learners.13:00 - 14:30

30th, Sustainability programme for learners with SEND. In this webinar, City College Norwich share their road map to sustainability and the curriculum activities they have developed and are developing for their learners to have a sustainable future. Hear about their approaches leading to employment.15:30 - 17:00

May

8th, A toolkit - Effective inclusive support strategies for tutors and support staff. In this webinar, City College Norwich share their approaches and toolkit which ensure that learners with learning difficulties, differences or inclusion needs have their needs met and can achieve their aspirations. We want our learners to live full lives by thriving independently in their community, moving on to further or higher study, an apprenticeship or into the world of work. 15:00 - 16:30

17th, Job coaching and employer engagement. In the first theme of City College Norwich's Community of Practice, their focus will be on job coaching and employer engagement, where they will be discussing effective SEND employer engagement: 1) Approaches to employer engagement 2) Barriers and challenges with employer engagement 3) Effective strategies to inform approaches.12:00 - 13:30

June

14th, Job coaching and learner training. In the second theme of City College Norwich's Community of Practice, their focus will be on job coaching and learner training. Join them to share and shape together and explore the challenges and strategies for effective SEND employer engagement.12:00 - 13:30

18th, Inclusive approaches for our Maths and English for Post 16 learners. In this webinar, City College Norwich share their effective inclusive practice of how they support learners with Maths & English, including initial assessments, strategies to integrate inclusive learning and English and maths to ensure greater collaboration between delivery staff to benefit learners.10:00 - 11:30

July

5th, Job coaching - job matching, carving and sustainable employment. In the third theme of City College Norwich's Community of Practice, their focus will be on job matching, carving and sustainable development. Join them to share and shape together and explore the challenges and strategies for effective SEND employer engagement. 12:00 - 13:30

Resources

As part of our Community of Practice offer, we have produced a number of resources and delivered a number of free training sessions. The resources and recordings of webinars can be found on the Resources from the centres page under the headings used across the SEND Exhibition website.

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SEND Communities of Practice for managers and practitioners - The Education and Training Foundation

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The three Centres for Excellence (CfE) in SEND are each hosting Communities of Practice (CoPs) covering topics within their individual themes.

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'Coronavirus: GPs not told when patients removed from 'shielding lists'

Some extremely vulnerable people have been told they have been removed from shielding lists via text message, without the knowledge of their GP.

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Some extremely vulnerable people have been told they have been removed from shielding lists via text message, without the knowledge of their GP.

This has caused confusion, with charities demanding clearer guidance for this group as lockdown eases.

GPs say they should be notified when their patients are added or removed from the lists.

Shielding has now been extended until the end of June and is under constant review, the government says.

Around 2.2 million people in the UK are staying at home to protect themselves from the virus because they were told they were at high risk of being seriously ill with Covid-19.

But 40 healthcare charities say the lack of a clear plan for their future is causing anxiety and potentially putting their health at risk.

'Doesn't make sense'

Samantha Bruce, 35, from Rotherham, has severe asthma and was told to shield on 25 March.

Out of the blue on Friday, she received a text message telling her she no longer needed to shield, and her food deliveries would be stopped.

Her first reaction was that it could be a scam, so she called her GP - but he "didn't have a clue" why she'd been sent the message.

Further investigation by her GP revealed that Samantha no longer ticked the required boxes to shield, based on her medication.

Rather than feeling reassured, she was left confused and anxious.

"It doesn't make sense - the virus isn't going anywhere so why is it that suddenly I don't need to shield anymore?"

Samantha also has two children - aged four and 10 months - to consider, and her husband is disabled and can't drive. The change in advice has thrown up questions for the whole family.

"Do I let my son go back to school?" she asks, if her risk increases by taking him there and coming into contact with other parents.

She has already decided she "won't set foot in a supermarket" anytime soon and has arranged priority deliveries instead.

But the fear of contracting the virus is still "very worrying".

"If I ended up in hospital I would have to involve my mum and dad with the children, and that's putting them at risk," she says.

'Utter mess'

Alison Cook, director of external affairs at Asthma UK and the British Lung Foundation, said they had heard of more people getting these official text messages with no explanation.

At the same time, other people have received letters asking them to shield for longer - until the end of June.

"This is an utter mess," she said.

"There doesn't seem to be any evidence or logic behind these letters and texts."

The government says all decisions about whether someone should shield are "clinically led" - in other words, made by doctors.

"Clinicians are identifying people who had initially been advised to shield from coronavirus but no longer need to do so," a spokesman said.

GPs say this is a complex process and as the guidance changes, shielding will be relevant to different people.

"However, it is important that as guidance changes, and patients are either added or removed from 'shielding lists' based on conditions they have or medication they are taking, that GPs and relevant specialists are advised about this," the Royal College of GPs says.

"This is so that doctors can communicate effectively with their patients, if they have questions."

Shielding is taking a huge toll on millions of people who have not been outside of their home since March.

They include people with cancer undergoing chemotherapy, those who have had bone marrow or stem cell transplants in the last six months and those with severe respiratory conditions, such as severe asthma.

What links them is that they are all at high risk of becoming seriously ill with coronavirus. As a result, they would have received a letter advising them to shield nearly 10 weeks ago, or been told to do so by their GP.

That means they cannot leave their house, meet friends or family or come into contact with someone with coronavirus symptoms.

'Stuck and isolated'

Sarah Davis, 29, a freelance artist and sculptor who lives in London, knows how that feels. She has not left her house for 50 days now.

She was diagnosed with Hodgkin lymphoma, a type of blood cancer, in 2017 and had to have a stem cell transplant in 2018. The impact on her immune system means she is extremely vulnerable.

Shielding started off feeling surreal, now it just "feels so unending", Sarah says.

She can't exercise properly indoors, she's had to give up all her freelance work and with the easing of lockdown measures for the general population, she feels left behind.

"We have had no new information in weeks. I feel stuck and isolated, unable to work in my art studio or move to a new house as planned," she says.

"Having been ill with cancer in the past, I do have coping mechanisms, but it is still a very triggering experience - to be locked away again and not know when it will all end."

Sarah wants the plight of people like her to be discussed at a national level so that they feel included in plans for their lives, as valid members of society.

She is not alone - a group of 40 healthcare charities has written an open letter to the UK governments, calling for consistent advice on shielding measures for extremely vulnerable people.

They include Macmillan Cancer Support, British Lung Foundation and Asthma UK, MS Society, Kidney Care UK and Cystic Fibrosis Trust - who all say more support and advice is needed as members of these people's households start to leave home to go to work or school.

Prof Martin Marshall, chairman of the Royal College of GPs, says patients should contact their GP or hospital specialist if they are in any doubt about whether to shield or not.

There is nothing Sarah would like more than to go outside and feel a sense of normality again - but she worries that when that decision is made, it could be for the wrong reasons.

"I don't want to be told to go out when it's not safe," she says.

"Staying indoors feels like a new normal - it's scary to come out of that, despite the fact I'd love to do it."

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People removed from 'shielding lists' via text

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Some extremely vulnerable people have been told they have been removed from shielding lists via text message, without the knowledge of their GP. This has caused confusion, with charities demanding clearer guidance for this group as lockdown eases. GPs say they should be notified when their patients are added or removed from the lists.

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'Disparities in the risk and outcomes of COVID-19'

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We understand more than ever the effects of racial discrimination across this country, for many black people the cases of violence against individuals such as George Floyd in the USA and the many historic incidents in the UK are deeply triggering. Treating mental health must be a priority in the fight for equality and welfare of black people in the UK.

We also understand that the NHS is currently in crisis and therapy is not always readily available. Our aim is to link as many black individuals and families in the UK with certified, professional, black practitioners for sessions as soon as possible.

Our aim is to use the money raised to pay in full for therapy sessions for those in need. We have created a website http://www.blackmindsmatteruk.com/ so that individuals may choose a practitioner to their liking, keeping confidentiality and dignity our focus. Our instagram account: https://www.instagram.com/blackmindsmatter.uk/ provides resources as well as making mental health in the black community relevant and accessible.

This is a state of emergency for black people's wellbeing and we need your support to help us bridge the gap so that access can become available.

This is no small feat and we need you to make this happen. Black Lives Matter. Black Minds Matter.

Read more

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Black Minds Matter UK organized by Annie Agnes

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We understand more than ever the effects of racial discrimination across this country, for many black people the cases of violence against individuals such as George Floyd in the USA and the many historic incidents in the UK are deeply triggering.

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By Dr Jeanne Hardacre, Founding Director, Impact4Health & Dr Alexander Margetts, Clinical Psychologist, University of Leicester

We have just spent 5 days as members of the newly-formed Training & Education Faculty for NHS Nightingale Hospital London. Alongside the phenomenal core team, we and others have been immersed in helping to shape, define and road-test a sustainable, scalable methodology for preparing staff for the work they will be doing in the largest Intensive Care Unit (ICU) in the world.

The work is ongoing, and we have not yet had a chance to fully process our reflections. However, we have some early safety-critical insights which we feel it is important to share quickly with clinical, strategic and operational leaders at all levels. We know people leading colleagues right now through these extraordinary circumstances need pragmatic, relevant and practical help, not theory and rhetoric. We offer this blog on that basis.

Keeping staff safe must be a top priority in this Covid-19 environment. No matter how large or well-equipped the hospital, without its workforce, it cannot save patients. It is this that is galvanising movements to insist on routine testing and providing full Personal Protective Equipment (PPE). In a similar way, if we do not guard ourselves from the psychological effects which accompany this work, we may inadvertently and potentially cause harm to our mental health and wellbeing, both short and long-term.

Every leader and team member in healthcare has a key part to play in this; in the tone we set, the way we behave, and in the practical support we make available. So, how do we quickly create a culture where staff safety and wellbeing underpins the quality of our care for patients?

Based on work from the pre-Covid-19 era on psychological safety 1,2, "just culture" ³ and cultures of high quality care ⁴, we have observed three priorities:

Safer Expectations: what we expect of ourselves and others needs to be realistic, honest, and gentle. Our habitual mindsets of striving for perfection, admiring "heroic" self-sacrifice, and upholding rigorous self-critique are at best misplaced, and worst potentially damaging in this harsh Covid-19 context. The safety of our patients is usually foremost. With Covid-19, the safety of ourselves and colleagues must come first. This may feel counter-intuitive, but if we are not physically and psychologically protected, more of us will become ill, and our patients will be less likely to be treated and recover.

Safer Conversations: we have to acknowledge the fear and uncertainty we are all feeling, without shame. We must name and normalise these emotions, giving each other permission to emote and talk about them. Key to this is creating and embedding safe spaces, safe places, and safe processes, to have the conversations we might otherwise avoid. Building on and refining methodologies and models from Human Factors, we need to move from a rational, objective approach to pre-briefing and de-briefing, to one which places human emotions and feelings at its heart. Every day effectively becomes a Schwartz⁵ Round for our clinical, management and leadership practice.

Psychological PPE: we must think about and enhance our mental health and wellbeing, now, and after, working in Covid-19 units. Just as we 'don', 'doff', and monitor our physical PPE, we need to check our (and others') "Psychological PPE". Together with the wider Wellbeing Faculty Team, we have started to develop an evidence-informed skills training session to enhance self-care and resilience, and hopefully mitigate burnout, moral injury, compassion fatigue, and PTSD6,7. This should be a part of core mandatory induction training for all staff, clinical and non-clinical. Even for those used to challenging ICU environments, it is important to acknowledge some of the unique aspects of Covid-19: higher mortality rates, ever-changing teams and shift patterns, personal and family health threat and anxiety, rapidly-adapted buildings and treatments, all whilst under press scrutiny and public idolisation.

We hope that by sharing our early experiences and learning insights, we can co-create with you and others the safest culture, most appropriate leadership responses and most effective ways of educating colleagues, helping all of us feel relatively safer as quickly as possible in these unprecedented circumstances and rapidly-evolving times.

Author contact details: jhardacre@impact4.co.uk / a.margetts@nhs.net
References

1. Frazier, M.L. et al (2017) Psychological Safety: A meta-analytic review and extension Personnel Psychology 70; 113-165

2. https://blog.dropbox.com/topics/work-culture/amy-edmondson-on-the-power-of-psychological-safety-in-distribute accessed 4th April 2020

3. Marx D. Patient Safety and the Just Culture Obstetrics and Gynaecology Clinics of North America. 2019 Jun; 46(2);239-245

4. West, M et al. (2014), Collective leadership for cultures of high quality health care, Journal of Organizational Effectiveness: People and Performance, 1(3); 240 -260

5. Pepper, JR., et al.(2012) Schwartz Rounds: reviving compassion in modern healthcare Journal of the Royal Society of Medicine" 105; 94-95

6. British Psychological Society (2020) The psychological needs of healthcare staff as a result of the Coronavirus outbreak

7. Guidance for planners of the psychological response to stress experienced by hospital staff associated with COVID: Early Interventions (2020) Covid Trauma Response Working Group Rapid Guidance

Dr Jeanne Hardacre

Jeanne is an organisational behaviour specialist with a background in developing leadership, teams, organisational culture and human systems. She works independently and has over 20 years' experience developing and supporting clinical and healthcare leadership teams across a wide range of services. Jeanne volunteered as an early member of the Education and Training Faculty at NHS Nightingale in London, helping to set up and develop training and support for staff preparing to work there.

Dr Alexander Margetts

Alex is a Clinical Psychologist and BABCP accredited CBT therapist with experience in working with individuals presenting with common mental health difficulties. He is currently a Clinical Tutor for both the Leicester Doctorate in Clinical Psychology and Royal Holloway IAPT CBT Training course. Most recently he has worked with the Education and Training Faculty at NHS Nightingale London, to help develop their mental health and wellbeing training for all new staff working there.

(Visited 3,196 times, 2 visits today)

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Psychological PPE: Survival Kit for Creating a Safer Culture in the Covid-19 context by Dr Jeanne Hardacre & Dr Alexander Margetts

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By Dr Jeanne Hardacre, Founding Director, Impact4Health & Dr Alexander Margetts, Clinical Psychologist, University of Leicester We have just spent 5 days as members of the newly-formed Training & Education Faculty for NHS Nightingale Hospital London.

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In response to physicians' growing concerns amid the COVID-19 pandemic, the Physician Health Program (PHP) has launched a virtual peer-support group available to all BC physicians. Peer-to-peer connections promote shared learning, resiliency, and hope. Weekly sessions are co-facilitated by psychiatrist Dr Jennifer Russel and manager of clinical services Roxanne Joyce.

To be as accessible and physician-centred as possible, the sessions are drop-in with no commitment required. The focus is peer support, not psychiatric care, and all participants have the option to join anonymously. Conversations so far have explored wellness, work-life balance, pressures of working within COVID-19, acknowledging feelings of helplessness and anger, mindfulness, breathing strategies, working with limited PPE, and more. Many have also shared moments of joy and inspiration.

The PHP program of BC helps physicians, resident doctors, and medical students, as well as their families. When doctors and their families reach out for support, we are there to understand their situation, to support, and to advocate, both individually and collectively, as they strive to improve their mental and physical health.

We take confidentiality seriously. Your identity, personal information, and the fact you contacted us will be held in full confidence. Information pertaining to you and/or your family will be released to third parties only with your explicit consent or as required by law.

PHP is pleased to offer the weekly peer-support sessions as a permanent service. Email peersupport@physicianhealth.com for details. We also offer prompt, personalized, confidential counseling, life coaching, support, and referral services. Our intake line is open 24/7 (1 800 663-6729). Our general office line is 604 398-4300 (8:30 a.m. to 4:30 p.m. M-F). Website: www.physicianhealth.com.
-Roxanne Joyce
Manager, Clinical Services, Physician Health Program.

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Psychological PPE: Peer support beyond COVID-19

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In response to physicians' growing concerns amid the COVID-19 pandemic, the Physician Health Program (PHP) has launched a virtual peer-support group available to all BC physicians. Peer-to-peer connections promote shared learning, resiliency, and hope. Weekly sessions are co-facilitated by psychiatrist Dr Jennifer Russel and manager of clinical services Roxanne Joyce.

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Provide Emotional Personal Protective Equipment (PPE) for Physicians Facing Psychological Trauma From the COVID-19 Crisis

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Provide Emotional Personal Protective Equipment (PPE) for Physicians Facing Psychological Trauma From the COVID-19 Crisis

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By SUZAN SONG MD, MPH, PhD

The U.S. now has the highest number of COVID-related deaths in the world, with exhausted, frightened physicians managing the front lines. We need not only medical supplies but also emotional personal protective equipment (PPE) against the psychological burden of the pandemic.

As a psychiatrist, my role in COVID-19 has included that of a therapist for my colleagues. I helped start Physician Support Line, a peer-to-peer hotline for physicians staffed by more than 500 volunteer psychiatrists. Through the hotline and social media, physicians are revealing their emotional fatigue. One doctor shared her sense of powerlessness when she couldn't provide comfort but instead had to watch her young patient with COVID-19 die alone from behind a glass window. Another shared his sorrow after his 72-year-old patient died by suicide. She was socially isolated and didn't want to be a burden on anyone if she contracted COVID-19. An internist felt deep distress and alarm that her hospital was quickly running out of ventilators and had 12 codes in 24 hours.

Through a brief survey I conducted across the U.S., 269 physicians reported moderate to severe symptoms of anxiety (53%), depression (43%), and insomnia (16%). About 46% wanted to see or would consider seeing a mental health clinician for severe anxiety (30%), not feeling like themselves (27%), or being unhappy (21%). These are all similar statistics to the front line health care workers in Wuhan.

Physicians are overwhelmed by death, uncertainty, and patients' fears as they struggle to live. We are witness to the helplessness that families and loved ones feel, and powerless in our ability to protect without the proper equipment or directives from administrators. We feel the deep sense of aloneness leaving a hospital shift to return to a home in which we may be responsible for getting loved ones sick.

These are all parts of vicarious trauma - the emotional residue of witnessing the pain, fear, and terror, that trauma survivors have endured. Vicarious trauma is one of the occupational hazards of working in a pandemic. People feel emotionally numb or shut down, have difficulty sleeping, feel more irritable or use destructive coping (over/under eating, substance abuse, engaging in risky behavior), lose a sense of meaning in life or feel hopeless about the future, and can experience relationship problems.

But our psychological burden isn't only from the vicarious trauma of witnessing despair. The lack of available masks, slow and inadequate testing, poor executive leadership, ill-informed and potentially harmful guidance, and punitive behavior by some hospital administrators towards those who have raised concerns about public health safety, have inflicted moral injuries when we have to make ethical decisions around resource scarcity. Who gets put on a ventilator? Who gets to wear the PPE? How do we let people die alone without anyone by their side? How do we choose which patients to treat? By age? By co-occurring diseases? By COVID-19 positive status? The answers to these will challenge our "do no harm" ethical principle, as someone will suffer and potentially die because of our decisions.

Moral injury, initially defined by researchers from veterans hospitals, refers to the emotional, physical, and spiritual harm people feel after perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. It's when we have to comply with policies that we fundamentally disagree with, putting us in difficult ethical challenges.

Physicians aren't new to rationing in the health care system. MRIs aren't ordered on every lower back pain or headache. We know how to manage illness, and while this is a new coronavirus, our colleagues in China and Italy have shared clinical management protocols. But mixing moral injury with vicarious trauma will lead to physician burnout.

We need to "do no harm" by providing emotional personal protective equipment (PPE), in addition to appropriate medical PPE. Now isn't the time to cut compensation to our front line physicians or turn away skilled physicians due to our fears of living near doctors. We need to build transparency, communication, and collaboration between physicians, administrators, and leadership. All health care systems should be prioritizing trust and togetherness through a clear mechanism of soliciting perspectives and feedback without fear of punishment for raising concerns. We need more guidance on rationing, so we don't worsen disparities, and ensure physicians are supported to make these difficult ethical decisions. We should ease the emotional burden that physicians face, to equip them with the moral courage to save lives in this pandemic and to endure the inevitable losses to come.

Suzan Song, MD, MPH, PhD is a Harvard and Stanford trained psychiatrist, currently Director of the Division of Child/Adolescent & Family Psychiatry and Associate Professor at George Washington University Medical Center.

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Provide Emotional Personal Protective Equipment (PPE) for Physicians Facing Psychological Trauma From the COVID-19 Crisis

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By SUZAN SONG MD, MPH, PhD The U.S. now has the highest number of COVID-related deaths in the world, with exhausted, frightened physicians managing the front lines. We need not only medical supplies but also emotional personal protective equipment (PPE) against the psychological burden of the pandemic.

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Psychological PPE: Exploring Compassion Fatigue And Learning How To Keep Ourselves Psychologically Well

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Psychological PPE: Exploring Compassion Fatigue And Learning How To Keep Ourselves Psychologically Well

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Hosted by the University of Toronto Faculty of Medicine
Faculty of Medicine COVID-19 Wellness Series
Health care professionals everywhere are tirelessly working around the clock to provide the best possible care for their patients in these unusual circumstances. Consequently, many of them are experiencing personal psychological concerns such as stress, exhaustion, and guilt, to name a few.

Join the University of Toronto Faculty of Medicine on Wednesday, May 27 from 6:00 - 7:00 p.m. (ET) as we explore the impact of compassion fatigue and burnout on health care professionals as a result of the COVID-19 pandemic. Their speakers will also share how to develop skills (psychological PPE) to optimize your own personal health and mitigate the psychological impact of your work.
Click here to register for the webinar

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Psychological PPE: Exploring Compassion Fatigue and Learning How to Keep Ourselves Psychologically Well

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Hosted by the University of Toronto Faculty of Medicine Faculty of Medicine COVID-19 Wellness Series Health care professionals everywhere are tirelessly working around the clock to provide the best possible care for their patients in these unusual circumstances. Consequently, many of them are experiencing personal psychological concerns such as stress, exhaustion, and guilt, to name a few.

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What is Emotional PPE? Podcast with Dani Chammas

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What is Emotional PPE? Podcast with Dani Chammas

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We are delighted to have Dani Chammas, psychiatrist and palliative care physician, back on the GeriPal podcast to talk about emotional PPE. None of us can recall who originated the term, but we've all heard it bandied about much needed for front line providers treating patients with coronavirus. Headlines about the New York emergency room doctor committing suicide are likely only the tip of the iceberg in terms of the trauma, distress, and moral injury taking place.

We talk with Dani about key issues and questions, including:

What is trauma? What is moral injury?

Is this a big deal? What evidence do we have?

What can we do about it? Dani goes over 3 broad buckets of responses, organized with the letter C: Connection, Culture, and Coping.

Normalizing rather than stigmatizing clinicians seeking mental health support

We also decided to add a page to GeriPal titled "emotional PPE" with a list of resources for providers caring for patients with COVID, and we will link to that page once it's up.

For now, here are some important mental health resources for providers:

The NYC COVID Worker Care Network is a self-organizing network of 2500+ volunteer mental health professionals, spiritual care providers, facilitators, healers, and community builders supporting all essential COVID workers during the evolving crisis. We facilitate individual support encounters, support groups, stress-reduction training, and grief rituals via Zoom or telephone encounters. Centered around a five-member Organizing Team, the network's daily operations are led by a passionate group of varied volunteers known as The Hub. Volunteer support providers are placed into groups of 10, known as "pods." A pod facilitator organizes each pod and connects the pod to The Hub. Pods are autonomous and choose how best to support the essential workers as they engage.

Pro-Bono Counseling for Frontline Physicians and APCs A free convenient short-term psychotherapy option for physicians and APCs on the frontline in the COVID-19 pandemic. The COVID19 Pro Bono Counseling Project is devoted to helping Bay Area front-line healthcare workers. All psychotherapy is conducted remotely. The frame is short-term, but the Project organizers anticipate that in some cases the therapy may continue longer-term. In addition to individual therapy, there is also a list of free support groups. The Project's therapist-volunteers are a diverse group representing a variety of degree backgrounds (including some psychiatrists) and different approaches to psychotherapy. Visit the Pro Bono Counseling Project website for a database of therapists and a calendar tool through which therapists can show the specific free hours they can offer. There are even evening/weekend appointments available, as well as some therapists who are offering short sessions (e.g., 30 minutes). To learn more, see this brief video that explains how our project works.

Physician Support Line. A national network of mental health workers who provide support for physicians. See an NBC video about this service.

Disaster Distress Help Line. The Disaster Distress Helpline, 1-800-985-5990, is a 24/7, 365-day-a-year, national hotline dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories. Stress, anxiety, and other depression-like symptoms are common reactions after a disaster. Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.

How to be a Catalyst of Calm in COVID19. Drs. Keri Brenner, Danielle Chammas, and Mariana Schmajuk share their expertise on the psychological aspects of coping with serious illness. They reflect on what distress looks and feels like during this pandemic and share practical tips and resources for coping. Learn how you can stay connected to your authentic self and most important relationships during times of uncertainty. Speakers: Keri Brenner, MD, MPA, Palliative care physician, psychiatrist and Clinical Assistant Professor of Medicine at Stanford Danielle Chammas, MD, Palliative care physician and psychiatrist at UC San Francisco Mariana Schmajuk, MD, Psychiatrist and Clinical Assistant Professor of Medicine at Stanford)

-@AlexSmithMD

TRANSCRIPT
Eric: Welcome to the GeriPal Podcast, this is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, who is our guest today?

Alex: We're delighted to have Dani Chammas, who's a psychiatrist and palliative care doctor at UCSF. Welcome back to The GeriPal Podcast. Is this your third time?

Dani: Third time.

Alex: Third time's a charm. Delighted to have you back.

Dani: It's good to be back.

Eric: On today's episode, we're going to be talking about emotional PPE for front-lines of coronavirus. Dani, are we going to be talking about donning and doffing emotions?

Dani: We can if you want to.

Eric: Well, we'll talk about what the heck emotional PPE is. But before we do, do you have a song request for Alex?

Dani: My song request is I Got You, Babe, by Sonny and Cher.

Alex: Why I Got You, Babe by Sonny and Cher?

Dani: I'm really hoping that our colleagues on the front-lines know that we got you, babes.

Alex: This is good, I thank the babes.

Dani: Yeah.

Eric: Let's hear it, Alex.

Alex: (singing) They say we're young and we don't know, we won't find out until we grow. Well, I don't know if all that's true because you got me and baby I got you. I got you, babe. I got you, babe. I got you, babe.

Alex: I should've changed to I got you, babes.

Dani: Yeah. Maybe at the end.

Eric: Well, Dani, I want to thank you for coming on our show. For those listeners who haven't listened to your podcast that you did on therapeutic presence in the time of COVID, really strongly encourage our listeners to listen to that. Today we're going to be talking about emotional PPE in the era of coronavirus. Dani, maybe before we get deep-dive in emotional PPE, what do we mean by that?

Dani: What do we mean by that? Well, Eric, for weeks we've been having this intense discussion around the need for personal protective equipment, PPE. To help protect frontline workers who are working with the sick. We have been talking about masks and gowns and shields and all the physical gear that protects from infection. I've been seeing a growing movement that people want to broaden this, not just from physical PPE but from emotional PPE. I wish I knew who to credit, I don't know exactly who first gave birth to this phrase. But I've seen it in a few contexts now from colleagues in mental health that are taking on efforts at their institution to make programs and interventions that focus on protecting the emotional and psychological health and intactness of healthcare workers on the front-lines of this pandemic. My hope, I'll add is that this concept gets discussed sort of far and wide.

Alex: To provide some more context with headlines about doctor committing suicide. "She tried to do her job and it killed her." Said the father of Dr. Lorna Breen, who worked in a Manhattan hospital hit hard by the Coronavirus outbreak. This is from the New York Times. I believe you've heard of other... Here, it goes on. She was in the trenches, in the frontline. He said, "Make sure she's praised as a hero because she was. She's a casualty as much as anyone else who died." I heard that this is not an isolated incident. You've heard Dani of other health care workers in the front lines, who have struggled emotionally and even committed suicide.

Dani: Yeah, I was just reading about an EMT, also in New York who recently killed himself under similar, extremely distressing conditions that he was exposed to. I don't know how you guys feel when you hear those stories but I know I get this really uncomfortable feeling in my chest when we lose someone to suicide. I'm just grappling with what could we have done? How could we have protected you? But yeah, far and wide.

Alex: Suicide, it's like the tip of the iceberg. This is the extreme when it gets to this point. When someone feels like they can't go on living any further and end their life. But it's just a sign of this deep, hidden from view, the rest of the iceberg, which is all of this emotional pain, suffering, moral injury, other... I don't know what the words, help us find the right words to describe what it is we're feeling.

Eric: What are we dealing with, Dani?

Dani: Well, I want to get into the meat of emotional PPE, but I think you guys are right, let's do a little bit of sort of laying the groundwork - background stuff before we get there. You guys are always good sports. So if you guys are game, I'd actually love to throw out a couple of statements that you and ask you to let me know if you think they're true or false. What do you think?

Eric: Okay, we're game.

Alex: True, okay, we're ready.

Dani: Can you do that? Okay, true. No pressure but also don't mess this up, okay?

Eric: I feel like I'm playing code names. We were very playing a lot of code names at home with another family on Zoom. So I feel like this is just like that.

Dani: Okay. Five statements, here it goes. Statement number one.

Eric: I'm going to crush Alex.

Dani: You're going to crush him. Statement number one, true or false? The psychological footprint of a disaster like a pandemic deeply contributes to the morbidity and mortality, both during the disaster and long after it?

Eric: Maybe, more data, more studies are indicated.

Alex: Maybe is not an option.

Dani: Maybe from Eric. Alex, do you think he can beat him?

Alex: True.

Dani: True. Alex is the winner. Yeah, history has taught us so in time and again. All right, good job, Alex. Work harder, Eric. Statement two, true or false, as we speak many frontline medical workers are being impacted by deep sources of emotional distress? These are some of the things you were talking about, Alex. Trauma, secondary trauma, vicarious trauma, moral injury, moral distress.

Eric: True but I don't know if I know all of the definitions for those.

Dani: So true is correct but yeah, let's go ahead and define them. What is trauma? What a great question. When we're talking about trauma, I would say like the strictest most clinical definition would be the DSM criteria of trauma. Which says that a person is exposed to threatened or actual death, threatened or actual serious injury, either by direct exposure or direct witnessing. I would say that most of us in mental health kind of acknowledge that this clinical definition is pretty narrow. That there's a range of really distressing and disturbing things that can be experienced as traumatic. So when we're thinking about a frontline worker, we're talking about a tidal wave of death coming their way, that they're not able to stop. Having to walk past overflowing freezers of dead bodies to get into the hospital. All this stuff, well also worrying like am I going to get sick? Am I going to get my family sick? What's coming next? Are we even at a peak? All of these things are really traumatic.

Dani: When we talk about secondary trauma or vicarious trauma, it's basically indirect exposure to trauma by hearing people's first-hand accounts. We see this all the time in medicine. Then moral distress or moral injury is a unique thing. It's this discrepancy that happens when one's core moral values are not aligned with what somebody is forced to either do or not do because of the constraints of their situation. So this would be more along the lines of being forced to pick who gets lifesaving care. Going to med school doesn't teach us how to deny people care that can save their lives. Being forced to tell a family they can't be with their loved one while that person dies. Then watching that person die alone. Being forced to work outside of your scope of practice in a way that you just don't feel adequate to do.

Alex: Yeah, or coding a person who you feel has near-zero or zero chance of resuscitation. You feel like you're doing harm to this person in their last moments of life.

Dani: Absolutely. I was talking just yesterday to a psyche resident in New York who's been tasked with taking care of a super intense ICU case. That they just didn't feel like they were trained to do. Repeatedly, this resident was telling me, "I can't do this, I can't do this." It was so distressing because they just were so aware of this feeling that they were hurting the person by not being able to give them the right kind of care. Joan... Yeah, you go.

Eric: So I'm just trying to think about this, like in medicine, let's separate medicine and psychiatry. I know I probably shouldn't be saying that.

Dani: You just have had a lot of enemies, Eric. [laughter]

Eric: When we talk about trauma, we think about like trauma bed, they're coming to the emergency room, there's trauma. Exposure to trauma in my head is like exposure to that type of medicine. I'm also hearing when we're thinking about in psychiatry, there's this kind of broader emotional trauma that you're also talking about. Is that right, am I getting that right?

Dani: Yeah, I think you're talking about trauma to the body, right?

Eric: Yeah, very medicine thing, we try to devoid ourselves from all emotions.

Dani: That's too funny. Yeah, no when we're talking about trauma in psychiatry, we're talking about the psychological experience of being exposed to what you're talking about. So the psychological experience of thinking my life is on the line or watching someone else die or have their arm cut off. Whatever physical thing you're thinking about, we're just talking about the psychological experience of witnessing or experiencing it.

Eric: Yeah, I guess we also don't think that much of medicine like the work that we do in the ICU or with dying patients, usually as that being traumatic. But it certainly sounds like it can be.

Dani: Certainly, yeah and it's a good distinction. We're talking about trauma, we're talking about vicarious trauma, we're talking about moral injury. These aren't new things that COVID brought to us, it's just the intensity of how much of it we're having to take in right now. Is definitely apt for the people on the front-lines. So we're going to feel the impacts of it a lot more. Yeah.

Dani: I'll add, this distinction is really important. But for the purposes of us talking, I think we're just going to have to think about all of these a little bit together. Really, anything that someone on the front-lines is forced to experience or do or witness. That has a potential to make them feel like their psychological, moral or physical self is not intact.

Alex: When you mentioned secondary trauma, might not be people on the front-lines? That might be people who are hearing stories from colleagues about their experiences. Is that right?

Dani: Yeah, and I would say that there's a sort of a spectrum. It's not like it is trauma or it isn't. Some of us are closer, some of us are further. Some of us get it for longer and more intensity, some for less. So we're getting different doses. But yeah, secondary trauma, we see it a lot in therapists, we see it all the time because people have to sit and hear these terrible, terrible things happening to other people. But you can certainly have it just hearing the experiences of your colleagues and things like that.

Alex: Okay, all right, great. You got more true false for us?

Dani: I do, I have true or false for us.

Alex: Wait, where are we? I don't know if I got a chance to respond to that one.

Dani: We'll count that one as a tie.

Alex: All right, sounds good.

Dani: Number three, true or false? Many more frontline workers are at risk of being exposed to similar emotionally distressing experiences in the coming weeks and months?

Eric: I see where we're going here, true.

Alex: Wait, many more frontline workers are at risk of being exposed in the coming months than...?

Dani: Than have already been exposed.

Alex: Okay, so we'll have more people in the coming months.

Dani: More to come, yeah.

Alex: Yes, I'm going to say true as well and the reason I say true mine is data-driven. Is that if you look at the US as a whole, the number of hospitalizations for coronavirus is going down. But if you take out New Jersey, New York, and Connecticut, it's going up. So it's going down in the place that's been the epicenter but the rest of the country, it's still rising.

Dani: Remind me to take you to trivia night the next there's a trivia night. I love that.

Eric: Alex is using test-taking skills. I've learned who my professor is on this test, I'm answering in a way I think she would.

Dani: All right, true or false then. Everybody exposed to these emotionally distressing experiences is going to have significant emotional dysfunction as a result?

Eric: False.

Alex: False.

Dani: Good job. I told you not to mess it up and you didn't. False, right, this because you guys work at the VA, so you see this all the time with the veterans. Everybody is deeply affected by disturbing experiences. But we know from the literature that not everybody will respond in the same way. Some get emotional dysfunction, some don't. They've been... Yeah.

Eric: Are there protective factors that we know of or are we going to get into that later?

Dani: Yeah, we are because that's going to be what informs how we pick our PPE. So many people have asked this question. Why do some Israeli kids exposed to war get PTSD and others don't? There are, there some factors there's nothing we can do about. Your genes kind of stuck with those, your personality. Your personal mental health history, there's very little we can do. But there are others that are totally modifiable and interminable and those are the ones we're going to be drawing on today when we think through what goes into emotional PPE.

Alex: PTSD, you mentioned the term, Post Traumatic Stress Disorder. Does that term apply to what we're talking about here or is that a specific term that's used for war or violence?

Dani: So PTSD is one thing that we're trying to protect them. But it's one of many potential outcomes from exposure to trauma. It's not even the most likely outcome from exposure to trauma. For many people, depression is a more likely outcome from exposure to trauma. But there are many places of emotional dysfunction that exposure to trauma can take you to and PTSD is one of them. It just happens to be the only one that actually requires exposure to trauma as part of its definition. The other ones you can get to via other routes if you will. So it's one of the outcomes we are trying to protect people, one of many outcomes we're trying to protect people from.

Alex: Okay, thank you.

Dani: Yeah, all right, final quiz question. Winner takes all on this one. True or false, we have a moral imperative to not only protect the physical health of our colleagues?

Alex: True. [laughter]

Dani: I should change the end of the statement now. [laughter]

Dani: ...but to bathe them in jello [laughter]

New Speaker: Help me out, Dani.

Eric: We have a moral imperative to ignore the distress of healthcare workers. I'm going to say false on that one.

Dani: But to protect to the best of our abilities is their emotional health. It was true, Alex wins. I actually would argue that this is the most important of the questions because if it's our duty, then we have to get in action. We should have gotten in action like months ago at this point or weeks ago.

Eric: Well, it's interesting because there's a lot of talk about the imperative to keep health care providers safe by having adequate PPE. We talked about that. We talked about adequate physical PPE. You're arguing also that there is imperative that we dawn this emotional PPE and we have resources for this emotional PPE for healthcare workers.

Dani: Yeah. If anything, I'd say we have more resources, we just have to make use of them. So we can go there.

Alex: Okay, good, so we should go there now? So what is emotional PPE? What can we do?

Dani: What can we do? Well, I'm going to say that there is sort of like a golden... Not a golden rule, a golden caveat in mental health that we have to give credit to really quickly. Which is that you can't tend to the psychological health of anybody if you haven't tended to their basic needs. This is sort of Maslow's thing. So before we go there, let's just all acknowledge together like food, hydration, sleep, being able to go to the bathroom. I would say for frontline workers, I've broaden that, like access to reliable childcare. Not wondering if you're going to have some kind of huge pay-cut while you're working harder than ever and at great risk. There's a lot of basics have to be in place. But if we put those in place if we say that those are like a given, then I would say the rest of what goes into emotional PPE falls into three main sort of organizing buckets in my head. This is when you can ask me about the buckets.

Alex: Yeah.

Eric: What are the buckets?

Dani: What are the buckets? Great question. So I'm going to call the first bucket connection. It's called connection. What do you guys think might fall into the bucket of connection?

Eric: Maintaining contact with family, talking with your team as far as health care providers.

Alex: With your colleagues, particularly, because I think it's harder. There are so many challenges to connection because social distancing requirements, some of us are working from home, doing telephone work. Then-

Eric: Listening to your favorite podcast hosts.

Alex: There you go.

Dani: Best one.

Alex: Right. Connection with... In palliative care, in geriatrics, one of the reason many of us went into this because we love working in teams. We may not be working in teams as much. My understanding is even for people who can go in to see patients who have COVID, sending one person in, not the whole team. So connection with your team, connection with your family. We're talking about emotional connection here too.

Dani: Yeah. No, all of the above. So interpersonal connection is arguably one of the best, strongest psychological buffers to emotional distress that we have. I think you guys are right on, this virus is cruel because it is like the things we need to do to combat it are huge barriers to connection. So I think we have to be thinking about our frontline workers and the fact that the perception of being in the trenches together is always better than the perception of being in the trenches alone. All the things you talked about, I would add when Alex you said emotional connection. I think hand in hand is the idea of validation and empathy. Using our connection to validate, we know how powerful validation is. It helps people be seen, especially validation that doesn't incite extra panic.

Dani: I would say, sort of the flip side of validations importance is the deep, deep risk that comes with invalidation at times of severe emotional distress. So let's go hypothetical together. Let's picture a colleague, let's say New York on the front-lines had just a grueling day. What kind of forms of invalidation, subtle or not subtle, do you think they might be experiencing?

Alex: Well, yeah it could range from everything like in... I think in New York in general people are supportive of healthcare workers like on their way home from the hospital. But I've heard of cases, for example, in Mexico, where healthcare workers actually ostracized because they're viewed as vectors of disease. That they might actually be transmitting the virus and things thrown at them, assaulted. That's probably the epitome, the worst possible invalidation. Here you are working so hard in the front-lines and then you are ostracized from your community or assaulted because of it.

Dani: Yeah, that's definitely the extreme. I hear what you're saying about gratitude being present in New York. But I'll give you a counter-story. I have a friend who's a neurologist who works in New York. He's being asked to work sort of outside of the scope of his practice in the setting of his hospital being in crisis. He put on a mask the other day and decided to go for a run because he really needed to de-stress. As he ran through the city, he came across a group of people partying in the park, hanging out with each other as if nothing was going on. He got the most intense emotional reaction to it. He was livid. He called me so pissed off. I think what was really underneath it for him was this deep sense of disregard, of invalidation, of a world acting like what he was going through wasn't even happening right now.

Dani: Then he probably went home, logged into Facebook and saw that Johnny from high school English class doesn't really get what the big deal is with this whole Corona thing. Opened his email and got like an admin email saying, "Great job, everyone. We're going to need more hours." Flipped on the news and listen to Trump talk. Like layer of layer of subtle and not subtle invalidation all day long as they go through these experiences.

Alex: Yeah, some of these. So the example of the violence in Mexico is extreme. But it's almost like in the concept of microaggressions, for example. I think about this in terms of race or gender. You could make an analogy here and maybe it's not even analogy. Maybe these are sort of microaggressions about invalidating the experience of Coronavirus or the science of it or what healthcare workers are doing. Putting themselves at risk and spending hours and emotional investment and trauma to go through.

Eric: You can imagine going home after a shift in the ED in New York or in the ICU now, where a lot of cases are. Having 60%-70% of your hospital ICU now COVID patients. Then seeing a post on next door that it's not much worse than the flu. The flu doesn't do this, folks, the flu doesn't make 60% of your hospital COVID intubated patients.

Dani: Right, yeah. So when we think of emotional PPE, how do we make sure that these workers know that their experiences and sacrifices are seen, that their suffering is real?

Eric: How do you do that?

Dani: How to do it is like the million-dollar question.

Eric: The random emails from your hospital CEO I'm guessing is not the... It's something.

Dani: It's something, let's not take it away.

Eric: Let's not take it away.

Dani: It's a hard one to answer because you can do it on so many levels. Individuals reaching out to check-in, interdisciplinary teams creating spaces to have regular meetings. All the way up to Schwartz rounds, like Zoom Schwartz rounds that bring us together and have these shared experiences be seen and validated. There's now this national anonymous physician support hotline that you can call seven days a week like almost all hours a day and reach a volunteer psychiatrist. If you need someone to hear you out, bear witness to what you're going through. This is also why I reached out to you, guys. I think just last week after you did the GeriPal love letter to our colleagues at Columbia. The reason I reached out was because I'm so grateful for things right now that safeguard connection and validation.

Eric: Alex, we filled the bucket. Well, we really didn't fill it, I got-

Dani: You put a candy in the bucket, I liked it.

Eric: A teaspoon of water into the bucket.

Dani: Yeah.

Eric: Okay, connection, one bucket.

Dani: Wait, before I leave - connection.

Eric: More on connection.

Dani: It's just like one other thing to say about connection, which is just acknowledging the deep power of the language we choose. We talk a lot in palliative care about how important narratives are because the narrative that a person writes, can deeply impact how they experience a situation. So, Alex, I'm going to give you two different lines. You can pick one and you can leave the other one for Eric, okay?

Alex: Okay.

Dani: All right. Option number one. You've been the victim of some deeply intense experiences this month. Option number two. You've survived some deeply intense experiences this month.

Alex: I'm supposed to pick the best one or I'm supposed to pick one that I would use myself?

Dani: Which one would you rather put out into the world to a colleague on the front-lines?

Alex: I would say "the survived".

Dani: Yeah.

Alex: Yeah.

Dani: Yeah, the survived. We know from all the trauma literature and things that people who come through a trauma with the self-concept of the survivor, as opposed to being a victim, do better emotionally. Our language has power. We talk about this all the time in palliative care. Our language helps us find meaning. Now, more than ever, we have to be choosing the words, choosing the messages that are telling people, "Hey, we see, we think what you're doing is heroic and brave and meaningful. Even if you're having to come into contact with some really dark, not so pleasant things in the process."

Alex: It sort of bolsters their sense of resiliency and praises them for getting through the tough time. Rather than setting up the dynamic of victim-hood and-

Dani: Powerlessness.

Alex: Yeah, powerlessness.

Dani: Okay, I think we've done that bucket justice.

Eric: Right, bucket one, connection.

Dani: Bucket one.

Eric: There are three buckets, right?

Dani: Three buckets. I gave them all Cs, so you have some alliteration. So bucket two, C. Bucket two I'm going to call culture. In the setting of frontline healthcare workers, I'm going to say creating a culture in the workplace environment that will be protective at times of emotional distress. So I feel like I'm asking you guys more questions than you might want. But I'm going to do another one.

Alex: I like it.

Dani: Just to flip it around on you, guys. You guys. Eric and Alex, are you 100% safe from this virus?

Eric: No.

Alex: No.

Dani: No. None of us are. Yet we know that creating a sense of safety and security and comfort is deeply helpful in the setting of emotional distress or trauma. It's very buffering for your psyche. So my follow up question is would you say that there are some of our colleagues who are concerned about having adequate resources available to optimally protect their physical health while doing this work?

Eric: Yes.

Alex: Absolutely.

Dani: Yeah. You're like, "Dani, look at the news. We're hearing this, they're screaming it at us. They're so scared that there isn't enough protection, enough PPE, enough reliable guidelines around PPE to feel safe in their monumental work." People are questioning even the motivation behind the guidelines. Is this because of what would really keep me safe or is it because of supply? Is it because of money? They're going home and googling like how do I sterilize my masks? This feeling of being inadequately protected it's bleeding out of the doors of the hospital. Am I going to get my kids sick because of this? Am I going to get my mom sick because of this? I have no doubt whatsoever that this extra bonus level of concern about safety and about if the system values my safety is having a deep psychological impact on people. Far beyond like the safety from the virus itself.

Alex: Right. So the whole... The fact that nursing homes account for about half the deaths in the US, the nursing homes are given far less PPE, testing, et cetera. The people who work in those nursing homes just must feel so devalued, unsupported because of that choice that we're making as a society. The culture within the nursing home must be one of not feeling like you're in a supportive cultural environment. Is that sort of what you're getting?

Dani: Yeah. No, it is heartbreaking to watch people sacrifice so much. At the same time, be questioning if leadership if administration actually even cares about them. Yeah, I think I've talked about... No, we won't go there.

Alex: But what can you do about that? So as a health care worker, I could express support for a colleague and try and establish a connection with them. But I can't, other than being activist-

Dani: You don't have a sewing machine over there.

Alex: Right.

Dani: Making little masks.

Eric: I think the concern is that you don't want to tell people don't worry, everything's going to be okay when it's not. That could further increase distrust and it's interesting, we're using the word perception of safety. We also don't want to falsely state that everything is going to be fine.

Dani: Totally. So yeah, we have to actually try to get the equipment that people need. But I think you're right on, Eric. How different would it be if your leadership said something like, "You're right, this is an ideal? We're going to do our best to improve. We want to work with you and troubleshoot the best ways to keep you safe with the resources we have while we're still trying to get more resources." That's such a different message than, "No, you're delusional, this is a non-issue. There's no safety concern here."

Eric: Yeah.

Dani: Either way, we still want to get people more masks but there's a very different cultural feeling based on the message that we're sending around people's sense that they're not cared for, that their safety isn't important.

Eric: So connection culture?

Dani: Well, culture get moving. I would say that just sort of gets at, we have to put words to it, a big piece of culture is effective leadership and communication. Children who experience trauma are incredibly buffered by having a reliable, solid primary caregiver in their lives. It's not totally analogous, it's not the same thing. But I would say that having a reliable, solid leadership, supervisor, administrator in your workplace setting. You feel is trustworthy and has your best interests at heart is going to be huge as a piece of emotional PPE right now. I would even say I think the last time I was here I was dashing algorithms and things like that. But I would say having reliable algorithms in place right now so that people have guidance on how do I manage resources when there aren't enough? How do I manage remains, manage goodbyes, manage all of these things? Is going to protect from the isolation and the moral distress that comes with people having to make these on ideal decisions seemingly alone. That all falls under culture. How do we create a workplace culture where people are protected more emotionally?

Eric: Yeah. Third bucket.

Dani: Third bucket C. Do you have any guesses?

Eric: Carrots, eat carrots.

Dani: Okay. Third bucket I'm going to call coping.

Eric: Connecting, culture, and coping the three buckets.

Dani: Yeah. How do we support coping? Do you guys have go-to coping strategies?

Alex: Yes.

Dani: Wait, let me say it again. Do you have go-to healthy coping strategies?

Eric: No.

Dani: You can change your answer if you need to.

Alex: I bike five or six times a week and love it.

Dani: Actually, I think every time I've seen you, Alex, you've just gotten off a bike ride that's longer than accumulative bike-riding for the last 36 years of my life. Yeah. How about you, Eric, do you have a go-to?

Eric: I did some gardening this weekend and it was great.

Dani: It was great. Yeah. No, they're like so many things we know are effective. Self-compassion, exercise, yoga, meditation, quality time with loved one. I think you talked about donning and doffing emotions but yes, Eric, I'm going to hold you on that. We talked last time about this, using the times when we change our masks and wash our hands. It's like these symbolic rituals to cleanse our inner experience. I just heard that Eric Widera is going to be hosting a guided meditation every Monday at lunchtime.

Eric: Hopefully not.

Dani: Just kidding but Stanford is and it's a real thing, it's opened to everybody. Stanford does these guided meditations that run at lunchtime. Headspace is free now for health care workers. There's so much stuff out there. We know that people who at baseline have healthy coping strategies are going into this pandemic with more of an emotional buffer. That's in part because they decreased stress fair enough. But it's also because there's a sense of empowerment that we feel when we have the belief that there are things we can do to manage and impact our own emotions. That's protective. So we have to be asking how do we encourage frontline workers to access those strategies? How do we create access and education around developing and strengthening coping strategies right now? Then what do we do if that's not enough?

Eric: Now, I think one of the challenge is even when you bring up guided meditation. Is that my work life takes up a large portion of my day. I kind of want to just get done with my work and get home to these other things that are important to me. The idea of doing something, which I know would probably be very healthy for me, like guided meditations. Sounds great but on my list of priorities, it will not fit in. How do you deal with that when your day is already full and then somebody's saying, "Now you have to attend this guided meditation class at noon?"

Dani: Well, in part, I would say, "Hey, pick the things that you like because they're not going to feel like checklist things. There's a menu of stuff that's helpful, so pick the ones that call to you." Maybe the thing you're going to do at home with your family is actually the best form of coping for you. But I think the other thing I would say as an advocate for mental health is what if I asked you, Eric I get it. I don't want to get infected by this virus but the sweating and the discomfort and the edginess of putting on the mask and the gown and stuff. Then taking it off and having to wash my hands, it makes me like three minutes too late and I get this kind of rash on my face. But I get it, it's probably good for me.

Eric: We're saying the PPE burnout, people are just so sick of all of this. I get your argument though, that there are some things that we should do because it does protect us.

Dani: It does protect us. I think the other piece is we need to be ready for like if those things aren't enough. What do we do next? Would you guys say... I don't know but would you say you have a good sense of what symptoms would make you want to test yourself for COVID?

Eric: It's growing day by day.

Dani: It's growing.

Eric: Yeah.

Dani: Okay. Would you say-

Alex: A skin rash on my toes.

Dani: On your toes. My husband actually ran in today, he's like, "Look at my toes, are they COVID toes?" I was like, "No, babe, you're good."

Eric: I actually got tested today. Yeah, asymptomatic testing.

Eric: It was oropharyngeal and I gagged so hard that I grabbed the person's arm to push away. I had trauma, Dani.

Dani: What do you think the person experienced? [laughter]

Eric: I know.

Dani: Would you say then, having just been tested, you have like an equally sort of sophisticated understanding about signs and symptoms of stress reactions to be watching for with yourself? That might trigger you like, "Hey, I need more support, I need more mental health screening right now." Personal mental health risk factors, things in that vein.

Eric: If I had to grade myself from elementary school to medical school as far as where I am with that, I'd probably be at somewhere around third or fourth-grade.

Dani: Good, sounds fair, I'll take that. Third or fourth-graders are impressive. But no, we do need to... We've educated people so much around the virus but we haven't done a lot of work educating people about this is what a stress reaction is, this is what a red flag is. That you need a little bit more. This is how you get a mental health screening. All of these things we know about the infection, so little we know about how we protect on the other side of it.

Alex: So what is a stress reaction?

Dani: There's a lot that comes out in stress reactions, I don't think we can go through it all. But some of the big ones that come to my mind are disturbed sleep. If you start seeing disturbed sleep without a clear reason. It's not like a pager going off. If you start getting somatic symptoms, headaches, body aches that aren't normal for you. If you find that you're like irritable, angry, distracted, isolated without a clear reason why. None of these mean you're doing anything wrong, we're in a profoundly stressful situation. But those are the types of things that you see in a stress reaction that would be little red flags for me, saying, "Okay, this person needs more coping. This person needs maybe a mental health evaluation or more support."

Dani: But we should all know this, like I wish that colleague on the front-lines days before she got to where she got knew that and was able to say, "Okay, these red flags are coming up."

Eric: Just because I never thought about before. When psychiatrists like you say the word coping, is there a definition that you use? What is coping? See, I told you I'm a third-grader.

Dani: Yeah. What is that show like am I smarter than a fifth-grader? I can't remember much of it, a third-grader.

Eric: I may have to repeat third-grade here.

Dani: Coping is just how we deal with or process the feelings that we're having. Coping itself is not a good or bad thing. There's unhealthy coping. I have a feeling I don't like, I'm going to go drink and eat 10 Ding-Dongs. Then there's healthy coping, I have this feeling I don't like, what can I do to deal with it, to process it, to be able to tolerate it?

Eric: Yeah. Probably a lot of what people are seeing is rates of alcohol intake pretty much gone up dramatically, pretty much everywhere.

Eric: A lot of people are using alcohol to cope with this, I wouldn't even say social distancing, it's often social isolation, worry about the pandemic, worry about safety. Certainly, where the healthcare providers are doing the same.

Dani: Yeah. I would say then that the last piece of this coping bucket, is that we need to have accessible psychological support very easily available as a form of PPE. Not only just accessible because we know that accessing support, not everyone's going to need it. But for people who do, it's obviously, going to be protective factor. Well, you guys are both in psychiatric treatment right now, right?

Eric: In the last 45 minutes, I've been. [laughter]

Dani: Don't answer the actual question though because I would never ask you that question. But it will lead me to my next question, which is you guys have been working in medicine for a long time. How psychologically easy do you think it is for most of us in medicine to say, "Okay, yeah, I'll sign up for formal mental health care, yeah, sure?"

Eric: Incredibly hard.

Alex: Totally hard.

Eric: Again, going we've got busy schedules, we're working during the day when those things are happening. We are... I think you hear plenty of stories about when people have problems and they submit it. That they're also put in a bureaucratic system that they may have ramifications as far as their career, as far as what they have to do. Yeah.

Alex: Let me add to that. That I remember when I was in residency, I worked with a pair of folks who have been former chief residents of a distinguished hospital, which I won't name. One of the sayings from that hospital was the strong will be strong and the weak will be weak. The strong will be strong and the weak will be weak. So there's this culture if we were going to go back to the other C, of asking for help, showing signs of weakness is not desirable. Working your way through it, toughing it out, grinding it out is a sign of the strength. I think that's true, not just in that hospital because that would be unfair. But sort of culturally, it's part of the hidden curriculum in medicine as we break people down through grueling years of medical school and internship and residency and clinical fellowship. Then we build them back up in ways that are analogous to military bootcamp.

Alex: Yeah, so I think there is this embedded within the culture. We did this study on crying and medicine at one point. We asked people, medical students, and interns, what their experience was with attendees who were crying? Their experience was as soon as they start crying, they leave and they hide and they're embarrassed and they don't talk about it. So there's this hidden curriculum here that sort of ingrains in us. That asking for help is generally not something to be desired in medicine and it's something potentially even to be ashamed of.

Dani: Yeah, what a sad commentary. We're like help yourselves but don't. So I think that you guys are kind of spot-on and this is one of my soapboxes. It sounded like a warning, it's like warning she's about to get on a soapbox but this is one of my biggest problems with medical culture. If we really want to have this emotional PPE, then we have to say that as important as access is the need to normalize and even celebrate the importance of mental health care right now. We need to take like an unequivocal strong stance in saying that we would rather a healthcare provider that takes the steps to care for their mental health over the one you described, Alex. Over a healthcare provider that just toughs it out and ignores the problem. Hand in hand with that is the message that we would rather celebrate the bravery of healthcare providers who asked for help than mourn the loss of one more hero for whom suicide is less intimidating, the reaching out.

Dani: There's a reason the doctors have such a high suicide rate. There's a profound impact that our bias against psychological illness has had on ourselves and our colleagues. It's time for us to be accountable for it. I'll come off my soapbox.

Alex: Yeah, well, that's great and in the spirit of normalizing, I've sought psychological health, mental health counseling on three different occasions. I can think of off-hand for myself and relationships and family issues. I found it tremendously helpful in all cases and I encourage people to seek it out and try it. Don't feel like you're shamed or suffering alone. Are there resources, Dani? Are there specific resources for people in the time of Coronavirus? What numbers can they call or who can they reach? How much of this is local or are there national resources?

Dani: Yeah. I want to start just by thanking you for that disclosure because I think that is how we do it. We just have to really own our own vulnerability as humans. We can't expect our colleagues to do it, we can't do it. So thank you, Alex. There are a lot of resources, a lot. I don't know all of them, so there are national hotlines that we can put the numbers too on the podcast page that people can call sort of 24/7. There are, I know in San Francisco we have a whole network of pro-bono psychiatrists, who are willing to do this work for free via video with any healthcare worker that needs that support. I know in New York they have the same thing going on. There are things like apps and stuff that might be less intimidating.

Dani: But what I was wondering and maybe if I just ask you on air, you guys will be less likely to say no. But I was wondering if we could actually make an emotional PPE resources page on GeriPal. Where we could try to put these all together because I can't tell you how many of these efforts I'm seeing on all my different psych pages. I think if people could write in and we could accumulate all the national things available, all the local things available, so people know what they have access to. That'd be a nice organizing thing we could do for everyone because there's a lot.

Eric: Absolutely.

Dani: Yes.

Eric: We're going to rely on you. So our listeners too if you have other resources, we'll have a menu bar titled Emotional PPE. How about that, Dani?

Dani: Love it.

Eric: With all the things that we talked about today. Some of them are great. Dani mentioned things like Headspace, free app for healthcare providers. Dani, the last question I have for you because there is some concern amongst physicians. About like physician health programs, these state programs-

Dani: Caring for the caregiver, yeah.

Eric: Yeah, and your license is also dependent. If you get reported to these, your license's depending on completing them. I've heard that it's like a big business now too.

Dani: Yeah.

Eric: How does that fit into all of this?

Dani: It's a sad commentary on the whole medical field and medical culture. I think how it fits in with emotional PPE? I think we need to, in the short term, make completely anonymous resources available. That physician hotline for any physician across the country that you can call, it's like 7:00 AM to midnight and get a psychiatrist is 100% anonymous. So I think we have to have that there because people aren't just paranoid. Some of these concerns are legitimate. I understand why we're also hesitant to seek out or disclose care. I think on the other end of it, may this be time for a long-overdue change in how we treat these things. We have created a system that would rather like an impaired physician go unchecked. How about every single person you know, hashtag emotional PPE and ask for a call to action? To change the way that healthcare deals with accessing mental health support. I wish I had a better answer for that one.

Eric: Is there anything else, any last thoughts, Dani or last questions, Alex, that you have?

Alex: Not from me.

Dani: I think probably my last thought would just be a call to action. So for the individuals like the three of us who are listening to this podcast, please right after you hear it, reach out non-intrusively check in with somebody that you know who's on the frontline. For the leaders who are listening, please don't just be mindful of emotional PPE, be champions of it. Champions of connection, of culture, of coping. I guess the last one would be that in case there is someone out there who is feeling hopeless right now and listening to us talk. I promise you that I've seen many, many hopeless people that I myself have been deeply hopeless at different parts in my life. It is a feeling and as with all feelings, new feelings await you, even if it's hard to see that right now. So please, please, please reach out for support if you need it because I promise that you are valued and you're cherished. I'll leave it at that.

Eric: That was absolutely wonderful.

Alex: That was beautiful.

Eric: It kind of aligns with our song, I got you, babe.

Dani: I got you, babe. We've got you, babes.

Eric: We've got you, babes.

Alex: We'll see.

Alex: (singing) They say our love won't pay the rent before it's earned, our money's all been spent. I guess that's so we don't have a pot but at least I'm sure all the things we've got. Babe, I've got you, babe, I've got you, babe.

Eric: Nice. Dani, it's always great to have you on.

Alex: So great to have you on, Dani. Thank you so much.

Dani: Always.

Alex: Thank you to our listeners, thank you Archstone Foundation for funding us.

Dani: Thank you to our colleagues on the frontline, we see you, we see the heroic work you're doing.

Dani: Sorry, I wasn't supposed to talk. [laughter]

Alex: No, that was great. That's great, yeah. [laugher]

Eric: That was the first C. [laughter]

Dani: It was...nice.

Eric: With that, good night, everybody.

Alex: Bye, everybody.

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What is Emotional PPE? Podcast with Dani Chammas

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We are delighted to have Dani Chammas, psychiatrist and palliative care physician, back on the GeriPal podcast to talk about emotional PPE. None of us can recall who originated the term, but we've all heard it bandied about much needed for front line providers treating patients with coronavirus.

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Linno Rhodes - trauma and adult education

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Linno Rhodes - trauma and adult education

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This is a guest lecture from an Australian Adult Education lecturer from 2018. Really supported my thinking about how we can approach education from a trauma perspective.

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I4P Lecture Series - Linno Rhodes, 'Adult Literacy - Between the lines'

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From the Centre for Mental Health

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Jo Wilton and Alec Williams

25 April 2019

In recent years, understanding of trauma has increased significantly. Alongside this has been a growing recognition of the role institutions can play in perpetuating trauma, inadvertently causing further harm to some of the most vulnerable people they work with. Understanding the impact of trauma on women is therefore vital for providing effective services.

Engaging with complexity offers public services a brief guide to the principles of trauma informed care and how to put it into practice. Looking at the concept of trauma (including causes, impact and prevalence), the report explores the model of trauma-informed care, and UK organisations currently employing such approaches.

The resource was produced by Centre for Mental Health and the Mental Health Foundation in collaboration with the Association of Mental Health Providers, the National LGB&T Partnership and the Race Equality Foundation. It was commissioned by the VCSE Health and Wellbeing Alliance, a partnership between the Department of Health and Social Care, NHS England and Public Health England. Engaging with complexity follows the 2018 Women's Mental Health Taskforce report, whose recommendations included the wider use of trauma informed care.
This report is free to download below. Please consider making a donation to enable us to carry out further life-changing research.
Last updated: 28th October, 2019

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Jo Wilton and Alec Williams 25 April 2019 In recent years, understanding of trauma has increased significantly. Alongside this has been a growing recognition of the role institutions can play in perpetuating trauma, inadvertently causing further harm to some of the most vulnerable people they work with.