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Covid-19 has been declared a global pandemic. The impacts will include not only the direct impacts of the virus itself, but indirect health impacts such as adverse patient outcomes through services being overwhelmed and disrupted. The psychological impacts of this situation should not be under-estimated. Psychological principles from disasters and trauma, can provide us with some evidence based guidance for assisting patients, communities and ourselves in these unprecedented times.
Psychological first aid refers to a set of strategies which have been shown to mitigate distress and assist people to cope and respond positively, in disaster situations. Although these principles may have originally been used in situations such as war and natural disaster, they are just as applicable in a pandemic such as covid-19. It is important to note that in disasters most people are resilient. Even if people are understandably distressed initially, most will recover well without formal mental health interventions. The principles of psychological first aid are often used in developing community level responses, and may be just as well utilized by non-health professionals.
The following principles may assist people who are distressed in the early/acute phases of a disaster, such as the covid-19 pandemic. An overarching principle of psychological first aid, is to assist people to find their own innate resilience and coping strategies, which will be different for everyone. Although covid-19 is new for all of us, we have all been through tough times before and have helpful experiences we can draw on to get us through. Please note that psychological first aid does NOT involve encouraging people to talk about an experience they may find traumatic, if they don’t want to. Mandatory critical incident debriefing in disasters has not been shown to be helpful, and may cause harm. If someone does want to talk, then listen compassionately.
People need to feel safe and feel that they are not under continuous threat. Stay up to date, so you can give your patients accurate information. In the covid-19 situation, ensuring safe surroundings, adhering to infection control procedures, helping people meet basic needs (such as toilet paper!) and reassuring them that medical care will be available for them for any problem when they need it, may help to promote a feeling of safety.
While most people will cope with the days of continuous media surrounding a cyclone or natural disaster, the unrelenting torrent of information about covid-19 may continue for months. It will be healthy for all of us to “turn it off”, and limit our exposure to such distressing media. Encourage whatever calming activities a person enjoys, whether it be yoga, talking to friends, ignoring everyone, or mowing the lawn.
Connection to family, community and culture are important protective factors in natural disasters, but will be much more difficult in covid-19. Encourage people to connect to friends and family via phone, internet and social media (if they find it supportive). Don’t forget about colleagues who are often an important social support but who may be distanced if working from home. The supportive tearoom debrief may need to be modified for covid-19.
People who feel empowered and retain a sense of control of their lives tend to have better mental health outcomes, and this is particularly true in disaster situations. You can encourage your patients to engage in meeting their own needs and in caring for others, even if done remotely. If people are quarantined at home, there is still much they can do which is useful. Encourage healthy eating and sleeping routines, and positive activities such as getting things done around the house.
Hope comes in many forms. Reassure people that these are exceptional times, and a variety of feelings and responses are normal. There is no right or wrong way to feel, and it is understandable to feel distressed, but most people recover well with time, even if they feel distressed initially. Positive and hopeful stories about the response effort in the pandemic will help to foster a sense of hope. As GPs, keeping a sense of hope for our patients always, can be a strong therapeutic intervention.
Overall, doctors tend to respond well psychologically in disaster situations. We are fortunate to have the skills to serve others and make a meaningful difference. This gives us a sense of control, in circumstances which can otherwise seem chaotic and disempowering.
Tips which may assist in looking after yourself in the current pandemic:
NQPHN is now offering FREE EAP support for all general practice and pharmacy staff in response to the current COVID-19 pandemic.
An Employee Assistance Program (EAP) is a work-based intervention program designed to enhance the emotional, mental, and general psychological wellbeing of all employees and includes services for immediate family members.
To access this confidential service, please contact AccessEAP on 1800 818 728 and identify as one of these groups when calling into our service, starting with Northern Queensland Primary Health Network, then either Chemist Staff or GP staff.
For more information on AccessEAP, visit their website at www.accesseap.com.au
NQPHN has also created an EAP support poster to advise staff of the service availability:
The guidelines summarise interim recommendations for surveillance, infection control, laboratory testing and contact management for COVID-19.
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