Pandemic effects on crisis responders & emergency planners 

The pandemic has affected all of us and uncertainty is mentally and emotionally uncomfortable. The last 18 months have been uncertain on a life and death coin toss for some. Dr Audrey Tang provides some pointers.


 
Many have been through a great deal of sadness, loss and fear and upheaval. Worse still is that in cases when loved ones have been lost, sometimes there has been ‘relief’ was that it wasn’t owing to covid, which is hardly a true comfort. When it came to being able to grieve and say farewell, restrictions meant that even that moment was shattered.  

Neither have we had much to balance the sadness, with weddings, christenings, parties curtailed, cancelled or postponed, there have been few opportunities to reach out and feel the warmth or a hug from friends and families – especially for those who have had to shield. It is just not the same trying to share in the joy of a new baby or exciting life change over an online platform – and that’s even if we’re comfortable using them! Rather than feeling ‘OK to great’, we’ve largely been ‘Not OK to coping’ and we are still unsure of when it will end. 

Something we can learn from crisis responders, which also gives an insight into the conscious processing that is going on for them, as well as physical coping with the crisis situation, is their approach to offering psychological first aid.

The key pillars of psychological first aid include:

• Providing practical care (which doesn’t intrude);
• Assessing needs and concerns – including basic needs (such as food, water or information);
• Listening without the pressure to talk; and
• Connecting people with information.

It is difficult enough to do this at a time of calm, let alone when you feel that everything around you is out of your control.
 
Crisis responders and emergency planners already recognise that people’s reactions can be extreme and differ depending on the event, and the person’s own experience with distress. They also know that the high underlying physical health of an individual is not a given and understand how demographic factors affect response.
 
They have a huge amount of processing to do to offer the most effective and immediate support, at a time when they themselves may also need to focus on their wellbeing and survival.
 
Compassion fatigue

Specific to such care professions is ‘Compassion fatigue’, which can be precipitated by working in a highly-stressful care environment for a sustained period of time, and when the thought of offering more care feels overwhelming.
 
Crisis responders or emergency planners, like other wellbeing care professionals use emotional labour as part of their work. Emotional labour was defined by Arlie Russell Hochschild in 1983 as a socially constructed behaviour where a professional manages his or her: “…feelings to create a publicly observable facial and bodily display… This kind of labour calls for a co-ordination of mind and feeling, and it sometimes draws on a source of self that we honour as deep and integral to our individuality.” For Hochschild, emotional labour was constructed as the outward display of emotion that fits organisational norms. Sometimes, she proposed, those norms are defined by display rules that performers of emotional labour might share (for example, a crisis responder is ‘supposed’ to present as an approachable and sympathetic person – even if they have just been shouted at by the person they are trying to help). One of Hochschild’s strongest claims is that emotional labour causes emotional strain for workers who perform it, because such ‘display rules’ may be at variance with one’s true feelings. But it takes a lot of effort to perform emotional labour and, along with the other pressures of a health crisis, it is a contributing factor to burnout.

Ways in which practitioners have tried to manage this have included detachment, for example seeing the client as ‘the broken leg at station two’ – which does not offer the emotional support the person needs. Neither does it really speak to the reasons why most care professionals entered the job in the first place. It is therefore important to find other ways to prevent burnout, especially at a time when the end of the pandemic is not necessarily in sight.

Tips to support better mental wellness in time of crisis
 
Recognise the signs of stress in yourself or your colleagues. There is a number of potential indicators that suggest that a person’s wellbeing is suffering – and those in the care professions are not immune. These signs include:

• Irritability
• Seeming very tired – or complaining they aren’t sleeping
• Not voicing concerns or stopped talking to management despite an open door policy
• A change in eating habits – eating or drinking more or less than usual- and if eating more - often of high calorie items
• Susceptibility to illness (often because of a depression of the immune system)
• Tearfulness  

Then there are the more subtle signs that may need closer observation, for example, slumping or a slower walk, or a lapse in personal grooming.  
 
All of these signs may be indicators of other issues, but they are also commonly related to stress, often because one of the first things to be affected is the sleep pattern – which in turn may have further repercussions on concentration, interactions and ability to perform to the standards they would want. It never hurts, if you do notice any of these – or recognise them in yourself – to stop and ask: “are you (or am I) really ok?”
 
Don’t pretend everything’s OK
 
If you are feeling depressed, or anxious, try to avoid using smiling or dismissive (eg “I’m fine”) behaviour to cope – it is important to acknowledge your feelings and accept that you are not ‘strange’, ‘a burden or just being silly. Stress, depression and anxiety are very real, and even if you are not at the point of diagnosis, you need to view the negative emotions you are experiencing as a warning that something needs to be done.
 
At the very least, if you find it difficult to speak to anyone, a good start is to try and find an outlet to express your feelings – some people do it through journaling, others through poetry, dance, song, music, art and so on… anything that allows you a little release of emotion can help free your mind enough to think a little more clearly about seeking help, and avoid indulging in coping methods which may cause more harm in the long term.
 
Try to include any of these elements to boost your own sense of wellbeing. Remember that your physical health can affect your mental wellbeing.  Eat, sleep and exercise – getting the blood pumping can help clear your mind.  Overindulgence can result in feeling of guilt and perhaps excess weight which can then be an additional issue to feelings of loneliness in lockdown. But undereating and a lack of sleep can also result in a lack of ability to focus or feelings of anxiety, which also may not help you in forming positive connections. Simply getting out can help you get more Vitamin D, which can increase feelings of happiness and counter things such as Seasonal Affective Disorder (SAD – often exacerbating feelings of loneliness in the winter months), and fresh air is good for us. 

Making your living environment positive as well – photos of the people you love, or feelings of comfort in the place you like to spend time can at least help you feel good in any down-time you might get. Having at least one clear space that feels relaxing and safe can make a huge difference to how you feel. 

Reach outside friends and family -  Talking about your feelings with a coach, or perhaps on an internet forum (but I am always wary about asking people to use the internet too much), or other colleagues can also help create a “community of coping” for you and also enable you to discuss how you feel openly without the fear of judgment from someone that knows you, or the more common attempts to offer solutions rather than hold your anxieties for you, from those who love you.

Be effective in your self-care choices – this is one of my favourite tips and involves three parts:  

• Recognise when you are enjoying something; 
• Decide if that activity energises or relaxes you; and
• Decide what you need – and pick from the list of things you know you enjoy.   

The secret to this is that if we are feeling stressed, then something that relaxes us is going to be far more effective than something that energises us, but if we are feeling down or apathetic, then an energiser may be more useful than a relaxant.

• Build a 'positivity reservoir'. Having photos of moments you love (including thank yous from clients) in a screen shot album to remind you you’ve made a difference
• Checking in regularly with good friends (whether by phone or a funny text)
• Laughing - a lot (there's no harm in cat videos, as long as you don't spend all day watching them)
• Positive affirmations (on post-its or on your phone)
• Gratitude first and last - Think about something you’re grateful for before you sleep, and when you wake up, such as: I'm always grateful for how lovely my bed feels.

Ultimately, remember that looking after yourself means that you are at your best when you look after others.

• Dr Audrey Tang is a chartered psychologist, mental health & wellness expert and author of new book The Leader’s Guide to Resilience, Pearson, £14.99