Now is the Time to Prepare for the Second Frontline: Post Covid-19

We are in the midst of the a global pandemic the likes of which the world has not witnessed in many generations. Right now, as it should be, the focus has to be on physical safety, literally trying to stay alive as Covid-19 rampages relentlessly across the globe leaving behind a trail of destruction and death.

I’ve spoken elsewhere about how at a minimum, survival should be everyone’s main aim for this pandemic. Some might argue that’s setting the bar a little low, I wouldn’t. Survival gives us all the foundation to come out of this current global crisis and the potential to grow from it.

A lot of people will be familiar with Malow’s Hierarchy of needs above. It’s been coming up in my social media timelines a lot more recently and for good reason. Right now what matters more than anything is to have our Basic needs met. New research our from front line staff in China noted that the staff didn’t want psychological support right now, they wanted rest and enough PPE to do their jobs safely, i.e having their basic needs met. This I think is similar for the majority of the population.

This emphasis on having our basic need for safety (survival) was prioritised by (most) governments (New Zealand in particular) through taking swift and decisive action. If funds were needed to ensure out physical survival they were found.

Equally decisive planning and then action needs to occur now to plan for how we as a society will meet the psychological needs that WILL arise post Covid-19

Research looking at the psychological impact in the aftermath of a crisis has found that much of the psychological impact has arisen from reduced access to social attachments and community resources. Ireland in particular has a strong legacy of community support at it’s core. Physical and social distancing requirements during Covid-19 have significantly impacted on the availability of this support.

There is a very strong likelihood that the psychological impact of Covid-19 could be felt for many years to come. Some research has found the impact lasting up to two years after the crisis was over. We also need to remember that much of the post disaster functioning research has looked at the numbers directly impacted by the particular disaster, a flood or earthquake in a part of a country, a terrorist attack in a city. This is a global crisis, impacting on everyone, we have not faced anything of this magnitude in our lifetimes.

Death and loss on an unimaginable scale

Unemployment

Poverty

Impact of prolonged isolation

Increased Domestic Violence

Marriage / Relationship breakdown

Burnout

The above will lead to significantly increased levels of psychological distress. How could it not?

There is a an aspect of Covid-19 that makes it difficult to manage, the fact that someone can appear asymptomatic for a period of time before it manifests itself. This is not unlike psychological distress. It can be unseen and unheard for a period and then invariably it manifests itself and makes it very difficult to engage in the fullness of life that we are used to.

In particular I’m worried about children at the moment. They are particularly skillful at hiding / suppressing / internalising their psychological distress, in many cases because they don’t want to burden others with their worries and distress. In particular I’m thinking of the kids of front line health workers and emergency services. Seeing the inevitable high levels of stress their parents are experiencing on a daily basis many will choose, believing that it’s in the best interests of their parents, to suppress their distress. For others it could be because their parents have lost their jobs and are worried about keeping their homes and how will they pay bills and put food on the table.

For some it won’t just be increased psychological distress, it will mean increased risk of PTSD, Depression, Anxiety that will cause so much distress that it will get in the way of every day life and need considerable support to help them through it.

This is why my professional anxiety levels have been rising and not dropping during this immediate crisis. I know / fear what is yet to come and am terrified by how unprepared we are for it.

Myself and many others have been shouting for the rooftops for years now about the under resourcing of our psychological and mental health services in this country. We spend a much smaller proportion of our health budget on psychological and mental health supports than other countries.

People who have lost loved ones, lost their jobs, lost relationships, who are so burned out by caring for others that they can’t continue to go into work, they will all need help to varying levels.

Our psychological and mental health services, despite the best efforts of frontline psychologists and mental health workers, have been grossly insufficient to meet the needs that are out there. In CAMHS alone there was a shortage of 112 Psychologists based on recommended levels from a 14 year old report that never considered what we would need if a global pandemic were to occur. Primary Care Psychology services, trying to operate with skeleton staffing levels trying to provide early intervention struggling with lengthy waiting lists.

We need a national, funded, coordinated, evidence based and community led plan to psychologically manage surviving the impact of Covid-19. This pandemic has eroded the very fabric of our resiliency, our sense of community and community support so this must be at the centre of any plan, how we support our communities to recover.

Distress is a normal reaction to an abnormal event. Not everyone is going to need, nor should need to see a Psychologist for individual therapy in the aftermath of Covid-19 but many more than we are used to are going to need varying levels of psychological support.

We have always had (in theory anyway) a system of psychological and mental health supports that is population based with increased resources for increasing need, looking in something like this:

In the Post Covid-19 era, when it comes, we will continue to need a tiered or stepped approach to mental health supports. But when our current reality is that in particular the top 3 levels cannot meet the existing demand, how if our current levels of funding and resourcing continue will we meet an increased demand?

The sad but incontrovertible reality is that we cannot possibly meet the demand that is yet to come. I say this not to add to anxiety levels and not to have hope, but we cannot afford to acknowledge this reality.

The cost of not preparing for what is yet to come is too high to ignore.

We’re not yet ready, but we can be, if we start making plans now. The Psychological Society of Ireland in January 2020 published a Manifesto for a Psychologically Healthier Ireland and much of this should form the initial blueprints for what we need to plan for.

For me, a top priority is providing support to parents. The will be at the epicenter of this. They will be the ones whose employment status will be relevant to the whole family, they will be the ones trying to support their children. Support the parents you support the whole family.

In terms of resourcing our psychological and mental health services, there needs not to be a manifesto based commitment to increase funding, there needs to be an immediate and sustained increase in funding to a minimum of 10% of the overall health budget.

We have a national based recruitment system that has long been unfit for purpose and impedes getting the right people in the right place at the right time. In the national interest this needs to be immediate scrapped and replaced with local recruitment. Unless we get the right people in post and quickly we will lose time and the cost of that lost time is people’s psychological functioning.

We need to remove barriers to people who want to provide psychological support on a different levels. There are hundreds of potential Assistant Psychologists who if offered meaningful and paid employment can make a valuable contribution in the post Covid-19 era. We have multiples of people who could train as Counselling or Educational Psychologists but can’t meet the realities of self-funding for three years and paying tens of thousands in fees. We need to fund all the training courses in professional psychology to make sure that we have at least the minimum levels of graduates coming through

We’re not yet ready for what is yet to come. We can be if the political will to recognise the inevitability of what is yet to come is there and more importantly the political will to take decisive action to plan for how we will meet that need.

To end with a message of hope, one thing I think that will help us all in the aftermath of Covid-19 is to replace social distancing with increased social connectedness. To have a greater awareness and appreciation of having close friends, of connecting with family, or reaching out for help and offering it. To have a greater appreciation for what we previously took for granted as the supposed small and inconsequential things in life, a hug, a walk on the beach, dinner with friends. These were never small things but with the rapid pace of life maybe we failed to appreciate how important they really were.