'Supported isolation is likely to be particularly stressful'

Our journalist Ella Rhodes spoke to Dr Holly Carter and Dr Dale Weston, Public Health England.

In this kind of outbreak, does the psychological get considered as important in amongst all the biological and medical issues?

Human behaviour will be a key factor affecting the speed and spread of the coronavirus, and therefore an understanding of the psychosocial factors that affect human behaviour in this context will be essential. When managing infectious disease outbreaks (such as the coronavirus outbreak), it is crucial that the authorities who are managing the outbreak understand the psychosocial factors that affect public behaviour and response during such outbreaks. This includes an understanding of: factors that affect the way in which members of the public interpret communication and information from authorities; factors that may make people more or less likely to comply with recommended protective behaviours (e.g. supported isolation, self-isolation, hygiene measures); and the potential impact of the outbreak and recommended prevention and protection measures (e.g. isolation) on longer-term psychological outcomes. Psychologists can therefore provide vital support in ensuring that infectious disease outbreaks are managed effectively, and the importance of their role in providing this support is increasingly recognised. 

From a psychological perspective, what’s needed / what’s likely to change over the next month or so, when it comes to coronavirus?

Public Health England are taking a phased response to managing the coronavirus outbreak, with each phase having implications for actions that healthcare professionals, and members of the public, are expected to take. The initial phase focused on containing the outbreak. In order to contain the virus, public health teams rapidly identify, trace and monitor those who are known to have come into close contact with anyone who has tested positive for coronavirus, or who has been in an affected area. Part of this process has included asking those who have travelled back from affected areas (e.g. Wuhan, the Diamond Princess) to undergo supported isolation at specialist facilities for 14 days.

However, as the scale of the outbreak grows, the response will move from the contain phase to a delay phase. During the delay phase, people will be expected to self-isolate in their own homes for 14 days, rather than undergo supported isolation. Both supported and self-isolation may potentially have short- and long-term psychological implications. Supported isolation is likely to be particularly stressful for those involved, since it involves being away from home and potentially isolated from friends and family. Factors that may make supported isolation particularly stressful include longer duration of isolation, pre-existing mental health conditions, access to basic supplies (e.g. food, water), lack of information, financial loss, and stigma around the disease.

While likely to be less stressful than supported isolation, self-isolation may also result in considerable stress for those asked to observe it. To ensure that the psychological effects of supported or self-isolation are minimised, those affected should be provided with accurate, consistent information about: the nature of the outbreak; the actions being taken to manage the outbreak; and the reasons they are being asked to undergo supported or self-isolation. If changes to the duration of supported or self-isolation are needed, these should be communicated as soon as possible, and explanations given as to why this is necessary. 

As well as asking people to self-isolate, during the delay phase members of the public will be expected to take protective hygiene actions to reduce the spread of the disease. Such measures currently include following “catch it, bin it, kill it” advice, and increasing the frequency and duration of handwashing. Should the coronavirus become established in the UK, population distancing strategies may be implemented. These can include school closures, promoting home working where possible, and advising people to avoid large scale gatherings. To promote adherence to recommended protective behaviours, it is vital that authorities communicate effectively with members of the public about what actions they need to take, and why. Psychologists can play a key role in informing such communication strategies. 

Are psychologists involved with this ‘on the ground’?

There are various ways in which psychologists can help ‘on the ground’ during infectious disease outbreaks, and psychologists are currently involved in several ways in helping to manage the coronavirus outbreak.

The first is that they are carrying out research to understand public behaviour during the coronavirus outbreak. This includes examining: public perceptions of the threat from the coronavirus, their perceived self-efficacy in taking protective actions, and their perceived efficacy of the protective actions they’re being asked to take; and public perceptions of authorities’ communication, and how this can affect public willingness to comply with recommended protective behaviours. This understanding can be used to inform guidance and policy for communicating with members of the public during infectious disease outbreaks.

The second way in which psychologists are helping in response to the coronavirus outbreak is by using this (and other) research to provide evidence-based advice to Government and authorities on: how to communicate effectively with members of the public during the outbreak, including the importance of providing honest, consistent information about the nature of the outbreak and the actions people can take to protect themselves and others; how the way in which authorities manage the outbreak affects public behaviour, and hence affects the outcomes from the outbreak; and the likely longer-term psychological effects, both from the outbreak itself and from the protective measures taken (e.g. supported and self-isolation), that may need to be managed.

The third way in which psychologists are involved in the coronavirus response is that they are providing psychological support to those suffering poor mental health as a result of the outbreak, or as a result of measures taken to manage the outbreak (e.g. supported isolation). Such support may include being on hand to provide psychological support to those who need it, as well as screening those who have undergone supported isolation to identify anyone who may need additional support.

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