‘We had to bring people together’

Ella Rhodes spoke to some of those psychologists, as well as BPS President David Murphy about the Society's response. 

'Like many around coronavirus, the penny dropped for me later than it should have done. When it did, I realised normal business as usual had to stop and we had to bring people together.' So says David Murphy, the British Psychological Society's President at the helm of its response as Chair of the COVID-19 Coordinating Group, along with Deputy Chair Professor Daryl O'Connor, Chair of the Society's Research Board.

David told me that his approach to responding to the crisis had been informed by a book he had come across some years ago, and by coping with a previous personal and professional tragedy. The book, Improv Wisdom: Don't Prepare Just Show Up, by Patricia Ryan Madson, former head of drama at Stanford University, encourages readers to apply some of the key principles of improv to coping with daily life, such as acceptance of what you are given to work with, embracing average, giving and accepting support and expecting to make mistakes. David told me that had was forced to put these ideas into practice after his friend, mentor, and Joint Director colleague at Oxford University, Professor Paul Kennedy, passed away at work – suddenly and unexpectedly in September 2016.

David said that, although the experience was extremely traumatic for staff and trainees, it also taught him some valuable lessons – to accept help from wherever you find it, to be open and honest was about the emotional and practical challenges rather than trying to 'keep up appearances'. 'I've been drawing on these same lessons in coping with the COVID crisis', he explained. 'In a Board of Trustees meeting I put forward the idea of setting up a BPS-wide coordinating group. From the idea being approved to the first meeting was a matter of days, and we've got an amazing group of people who have come together. The first subgroup was up and running two days later and it published a really excellent guidance document three days after that!'

The coordinating group began by prioritising areas that were time sensitive, and in which the Society can have an impact, including disease prevention, staff wellbeing, the effects of confinement especially on vulnerable groups, the psychological care of patients and relatives and adapting psychology services. The first guidance released was a set of recommendations for leaders and managers of healthcare services which emphasised a need for visible leadership, for physical safety needs to be met, and to normalise psychological responses in an unprecedented situation.  

The BPS and eight other professional bodies have also published guidance for psychological professionals during the crisis. It covers five areas – keeping psychological services and therapies open, maintaining training programmes for psychological professions, remote delivery of therapy and interventions, taking a psychological approach to prevention, care and treatment, and supporting NHS staff, organisations and teams.

How are psychologists responding?

Dr Julie Highfield, who led the COVID-19 coordinating group's staff wellbeing subgroup, is a Consultant Clinical Psychologist in Wales' largest Critical Care Unit in Cardiff. Since the outbreak reached the UK, Highfield has been involved in supporting her team through a period of rapid planning and change, and helping them to stay calm and communicate effectively. 'My support with C-19 patients is just starting, and I am trying to work out how to support the staff with video links to patients who are less sedated… We are working out how we might provide family support over telephone links.'

Highfield has been invited, by her Health Board, to become part of a group considering the wellbeing of wider staff groups. 'It's hard to slow down all this knee-jerk reaction, but I truly think that systems need psychologically informed action, not psychological intervention, now. Upping access to counselling and psychotherapies is probably not the most prudent use of resources, it's better that they support managers and systems to "contain" distress, just as much as we are trying to contain the virus. We have to be very careful of encouraging emotional processing of trauma when right now people are not in safe spaces to do this – let's think about principles of psychological first aid instead.'

Trauma clinician, Consultant Clinical Psychologist, and clinical academic (UCL) Dr Jo Billings and colleagues Dr Michael Bloomfield, a Consultant Psychiatrist at the Traumatic Stress Clinic and academic at UCL, and Senior Lecturer and trauma researcher Dr Tayla Greene, have formed a COVID-19 trauma response working group. Billings said the group knew they were in a unique position, as trauma specialists, to collate academic and clinical evidence and best practice guidelines to share advice with colleagues in acute hospital trusts and throughout the NHS to help support the psychological needs of staff.

Billings said they intended to support NHS colleagues by providing a trauma-informed response to the pandemic. Some of the group's members are also feeding information to NHS England to align responses at local and national levels. 'So far we have sought to gather best practice evidence and expert guidance and collate these resources on our website making them available to everyone. One of our initial tasks from our local acute hospital trust was to produce a one-page document with practical advice for front line staff about coping with stress. To develop this we drew on current research, resources being developed by different clinical groups across the UK and expert opinion from colleagues in the working group.' The group is currently compiling guidelines on early interventions to psychological trauma and compiling best practice evidence – summarising this in a document for planners and managers on how to support staff.  

Health Psychologist, consultant and coach Dr Roseanna Brady has adapted some of her coaching work for medical consultants. 'Given the pressures they are and will be under, finding flexible effective ways to support them is vital. This involves re-contracting with them individually and very likely on an ongoing basis as their needs change. The idea of SMS messaging targeting self-care was well received, so I am using that as well as telephone or video one-to-one sessions. The SMS messages are consistent with NHS approaches during this time and I am keeping up to date with the evidence and guidance. The telephone or video sessions are tailored to each individual as before.'

A number of psychologists have been working with the government in its response including Health Psychologist and Professor Susan Michie (UCL) who has been working as a member of the government's COVID-19 Behavioural Science Advisory Group. As well as working to translate the behavioural science evidence base for policymakers, Michie and her colleagues have also written a number of articles for the BMJ Opinion on behavioural strategies to reduce the transmission of the virus, and the ways communities can be involved in managing the pandemic.

Professor Stephen Reicher (University of St Andrews) and colleagues have been working to advise government on the potential for public disorder in the face of challenges thrown up by COVID-19 as part of the government's Scientific Advisory Group for Emergencies. The group wrote that large-scale rioting would be unusual in this type of emergency, while acts of altruism would be much more likely. The group made some suggestions to reduce any risk of public disorder, including that government should give clear and transparent reasons for its strategies, set clear expectations for how the response would develop and promote a sense of collectivism and community.

Both Michie and Reicher have written on this work for our website.

Changing roles

Highfield said she was a firm believer in creating systems which sustain wellbeing rather than 'dancing around the edges with resources'. 'I draw from models such as the Job Demands Resources models, work from Michael West, Amy Edmondson's work on Psychological Safety, and the recent Tavistock Model for organisations. As for COVID, well I am lucky to have a bright trainee who is digesting the limited literature on staff working in highly infections diseases, including work from people's experiences of other outbreaks (MERS, SARS etc).'

Billings said her working group, being formed of clinical academics and specialist trauma clinicians, understood the demands of responding to clinical need as it evolves. 'We are therefore working together to collate, disseminate and produce key communications to support our colleagues in the NHS as they deal with the physical and psychological demands of responding to Covid 19.'

Over the coming weeks Highfield said she imagined there would be a period of settling into the 'new normal' as she supports managers who are unable to think straight in the chaos, and coordinates low-level staff and family support. Beyond this, Highfield said she would be working to support teams to process their experiences and help to rebuild for a different future. 'I do believe there will be some positives out of this – we are already learning some of the red tape is not needed and some processes are archaic, and I believe there will be post-traumatic growth.'

Billings said the UCL group would continue to collate evidence and best practice throughout the crisis to share with colleagues. 'We anticipate that the psychological response to supporting staff will be phase-based, with initial focus on supporting staff with practical needs and self-care, and subsequently, as the crisis dissipates, will involve developing pathways for screening and treating staff with ongoing psychological distress.'

Brady said she will adapt her practice depending on the research and guidance which is disseminated and the feedback she receives from those she works with. 'I will also be looking at how to provide online support to groups of healthcare professionals and find ways to do this without compromising confidentiality.'

'We're all facing the same issues'

A tweet Murphy sent out – a 'mind map' of the areas in which psychology could make a contribution to managing the pandemic – drew a huge response from psychologists and medical professionals from across the world. 'It was a handwritten, scrawly thing… I think if I'd done a perfect thing with everything looking pristine, the response would have been much less. I've had comments from people all over the world. If I'd known that was going to happen I wouldn't have posted it on a Saturday night – I didn't sleep that night! I was replying to comments from the UK, then America, then there was a little pause and then there were things from Australia, I spoke to someone in Pakistan at about 4am, then there was someone in Armenia. On Sunday I got into a conversation with a Spanish doctor who was describing the experiences they're having and how it's affecting the staff.'

One of the contacts David made through the responses to his tweet was Dr Theresa Jones, a clinical psychologist and BPS member, based in Kenya, who had been involved in responding to a number of humanitarian crises including the Ebola outbreak in Africa. 'A few days later she was taking part in the first meeting of the BPS Covid Coordinating Group! I'm so grateful to people for sharing. We're all very much facing the same issues.'

Many more psychologists are working to contribute to the COVID-19 response in various ways, along with providing evidence-based perspectives for The Psychologist and other outlets.