'There are many narratives happening simultaneously, not one simple story'
We are living through history – this time will be written about in multiple disciplines for years to come. There is no singular impact of the pandemic. Many talk of unexpected positive aspects of life under lockdown, others have highlighted how it has amplified vulnerability and risk for those who were already facing hardships. Many have stepped up to help with community responses; become closer to neighbours they might only have known in passing before the pandemic. Many others are facing understandable challenges to their mental wellbeing, amplified by loneliness and bereavement. The virus has impacted on people differently – those who are older, those with pre-existing health conditions, men and Black and minoritised groups being especially at risk. There is no singular experience. The meanings are numerous.
On 14 May 2020, members of our Advisory group met over video link (a new experience for most of us). All of us have been affected by the pandemic, personally and professionally finding ourselves in changed landscapes. We have been meeting to think about how we build on earlier work encompassed in the 2018 BPS document on safeguarding children and young people, to expand that thinking across the lifespan. We talked and reflected on experiences from a range of areas. We have no new document to share at this stage, but we do have impressions, informed by our professional thinking, which we hope are useful to share. This article is a beginning point of discussion.
A decision-making model
We talked about the decision-making model for safeguarding, and how it might be relevant right now. The diagram above illustrates a number of factors appearing to influences on our lives and decision-making in relation to safeguarding issues. Each layer represents a system exerting influence – in this example – on a child. Some of these layers are close (parents and peers) and some are distal (professions/organisations) but all exert influence, with different significance at different points in time. At each layer, there are factors which render that part of the system more or less vulnerable. Of course, these layers interact with each other, which can lead to increased risk or increased resilience. The wedges represent influences which permeate every layer of influence on the child. They are based on themes which appear and reappear in inquiries and are critical determinants of whether a system is more or less safe.
Our task in the Safeguarding Advisory group, is to now to see if this model can be applied across the lifespan. In our discussions in May, we began pulling together themes which we have noticed during the pandemic.
Wellbeing and stress – In our discussions, wellbeing seems to be a central theme. There have been huge, rapid social adjustments for the whole population to respond to the threat of illness. The pivoting of personal circumstances is vast. Thinking of our model, every layer has been affected – from governmental level, services, community, schools and down to children and families.
For many people, this has meant changed work situations (e.g. working from home, working differently, being furloughed). Many parents are juggling some level of home schooling, the impacts of which may differ depending on ages and needs of the children. All of us are affected by not seeing extended family and friends in person.
There has been shift to social and work in-person contact to new digital formats, which can be both helpful and problematic. Most people find the concentration and mental effort of digital work exhausting. We are not meant to stare closely or continuously at screens for long periods. Some are working from home, in spaces that can accommodate that. Other people are huddled in their bedrooms, with their laptops on their knees and the potential to be interrupted by children or others. The challenges around boundaries and for healthy postural working are obvious. No wonder tiredness has been a theme for many who we work with, and for some of us too.
Clinicians may also be helping clients who have experienced trauma – the ethics and clinical suitability of emotionally charged work at home, must be carefully thought about for both clinician and client. Extra care is needed in a range of ways – for instance in relation to boundaries, unwinding after sessions and transitioning back into home life, without the usual routines of moving out of consulting rooms. Please visit the BPS website for a rich range of resources for working during the period of the pandemic.
Many of us are working with increasing pressures, perhaps increased meetings or the demands to change ways of working. This might be working with varying levels of personal and protective equipment (PPE) when offering in-person care. For some, the nature of the work has changed to working with people who are acutely ill and at the end of life. Some areas have faced shortages in staffing due to sickness levels. Some settings have been very good at supporting staff with new pressures, offering comprehensive employee assistance programmes (EAP), extra supervision and practical support, such as free parking and decent staff rest rooms. Other organisations have been less supportive, pressuring staff to work in offices when they can do their jobs at home, increasing the risk of cross infection. Some workplaces have fostered a tone of compassion around self-care, whilst others have adopted a more ‘stress inoculation’ focus, reminiscent of the ‘stiff upper lip’.
Many are using new digital working, even to ‘meet’ colleagues. This can affect the sense of team cohesion, where people normally work in physically and psychologically close settings. Elsewhere, digital meetings have actually made it easier for people to meet without the challenges of travel.
But not everyone is part of this digital world – we need to think about this for our clients, the people we serve. Some, especially older people and/or those from disadvantaged backgrounds (e.g., individuals with a learning disability or other disability, asylum seekers, people who are homeless and individuals with very low income) find themselves entirely digitally excluded. People living in rural areas, or unable to afford premium packages, may also have significant problems with connectivity. Other people do not feel safe to speak about particular issues from home, particularly around trauma. Some may be in abusive relationships with an intimate partner, parent and/or child, and so are unable to talk at home, where they can be overheard.
We must remember that people at the margins become vulnerable, potentially forgotten or overlooked. Thinking through the suitability of offering digital work to clients is new and unfamiliar territory for many of us, and we are having to do things which may feel at the very limits of our skills sets. For those who are digitally excluded, workers may be faced with other new adaptations – more travel and home visits which take place outdoors, on doorsteps and in gardens.
However, there have been some surprises in working by phone. For instance, some people who experience debilitating levels of shame – somehow the break with in-person eye contact can actually facilitate dialogue. People with autism, may prefer phone contact. There have been opportunities to bring family members together in session, which may have been very difficult to organise prior to lockdown.
There is so much to think about in the workplace and in personal life that it is easy to overlook well-being and working in a sustainable way under increased probably long-term pressure. Taking extra rest periods and using annual leave are vital for pacing oneself, as it is increasingly clear that responding to the pandemic is going to be a marathon, not a sprint. There is a sense that the pace that has been adopted within services is not a sustainable one, and things need to ease for staff, especially if there is a second wave.
Attitudes and heuristics – As applied psychologists, we have noticed lots of themes in ‘thinking about thinking’ which are pertinent to safe systems. The pandemic is not having singular impacts – there are many narratives happening simultaneously, not one simple story. The disproportionate impacts on different parts of the population are stark, with many showing heightened vulnerability to becoming very seriously ill from the virus. The groups at most risk are older adults, men, those with underlying health conditions and those from Black, Asian and minority ethnic (BAME) backgrounds. No-one knows exactly why these differential effects are there, and the answers may lie in multiple factors.
However, there are serious questions to be answered about the socially constructed determinants of health (Marmot, 2020), the effects of inequality (IFS, 2020) structural racism (Williams, 2016; and the Webinar – COVID19 and BME: a conversation with experts, 12 May, 2020) and other forms of prejudice, stereotyping and discrimination such as ageism, which mean that the already vulnerable may be rendered at further risk. More recently, concerns about structural racism have been raised as amplifying risks to people from BAME communities (see Khadj Rouf’s reflection piece).
We urge that unexamined attitudes are made transparent and challenged – such as a sense of fatalism about older people not recovering from the virus, or an ‘inevitability’ that older lives will be lost because of frailty. These views can affect decisions about the allocation of resources designed to keep us safe. There is a risk of dehumanising the pandemic, and its impacts upon those who are vulnerable. There may be additional challenges for parents with mental health problems; BAME communities; refugees, all of whom face socially constructed barriers in gaining access to help.
Some of us have also noted attitudes which can affect the safety of workers in settings. We have noted themes such as the ‘hero’ narrative, which can lead staff to feel as though they must be superhuman, not needing rest, potentially leading to self-sacrifice or pressures to work in unsafe conditions. Others have found that the narrative is changing over time – initially around an ‘all hands on deck’ response, from an emphasis on staff wellbeing at a time of crisis; shifting to renewed pressures to ‘business as usual +’ as social restrictions ease, and there are renewed concerns about waiting lists for therapy and interventions. There is a risk of this ‘business as usual’ narrative occurring too soon and overwhelming workers – who are expected to continue with the same productivity levels as before Covid-19. This is an unfair expectation, and wherever employees feel that their health and safety is at risk, they should be encouraged to seek the support of their local Employee Assistance Programme or trade union representative.
This has raised another theme, again connected to stress and wellbeing. We know that thinking under high or prolonged stress can lead to more extreme, binary thinking and a heightened use of stereotyped thinking. As people get more tired or anxious, they can lack the headspace to entertain different perspectives. It can be easy to becoming critical, blaming, pressurising, or paranoid. This is human and none of us are immune to it – stress can exacerbate existing ways of thinking or bring out dormant ways of thinking. It is useful if we notice how we are thinking and its impact on ourselves and our behaviour towards the people in our life. In team settings, we need to be aware that the unhealthy side of consensus building is ‘groupthink’. The risky side of going into reactive mode, is the failure to think of unintended consequences upon safety.
There are risks that decision-making during a crisis risks becoming siloed and ill thought out. Joined up, relational working can suffer – and yet, it is this communication across different agencies which is so crucial for safe systems. Again, when stress levels are high, it becomes even more important to make time to step back, reflect, and plan. The redeployments of primary and secondary care staff to medical settings has meant that the usual network of help has been much reduced for clients. In adult mental health settings, we see that clients may be experiencing stress at multiple levels, thereby increasing their risk of relapse. This is further compounded by a relative lack of access to the adaptive coping strategies that they have been building on during their treatment.
Power, closed settings and communication - We have also noted that many institutions offering residential care to vulnerable people, such as inpatient wards and care homes, are now either closed to outside visitors or have very limited access for family members and professionals who are not immediate staff. This is very challenging for all concerned and digital platforms or telephone may be the only way of gaining ‘access’ to family members. This is especially challenging where residents have additional complex needs around speech, language or communication. There have been huge concerns about the safeguarding of vulnerable people, again touching on ageism mentioned earlier. There is a danger of ‘normalising’ death rates amongst the frail and elderly, or true numbers of deaths being masked or not counted in the national Covid 19 deaths. And of course, whilst there are legitimate infection control reasons to close inpatient and residential settings, reducing one risk can have the unintended consequences of increasing another – anything that resembles an institution which is sealed, should worry us, because of the relative power of institutions over individuals, and the challenges of escaping potential harm if an institution is sealed and controls major aspects of a person’s life (physical and mental wellbeing; food; clothing; shelter; finances etc, in Abraham Maslow's terms).
At a societal level, the need to respond to the spread of Covid-19 has meant that social restrictions have curtailed aspects of civil liberty – again, balancing the tensions of risks to public health with with potential risks to civil liberties. Keeping ethical considerations in mind is arguably even more important during a pandemic, with the need to keep issues of consent, capacity, freedom and safeguarding under regular debate, and ensuring that those with lived experiences are part of meaningful discussions if these happen at the level of decisions about care.
Community fabric and public services – Community services have been impacted during Covid-19, with many services having to operate at reduced levels due to temporary staff redeployments. Services already stretched thin due to a decade of austerity and reduced public spending have been stretched even thinner. This makes already compromised systems even more unsafe.
It can be particularly difficult to get referrals to Multi Agency Safeguarding Hub (MASH) actioned and to galvanise professional networks. There has been an impressive civic response, but the impacts on already vulnerable children, young people and their families have been marked. Some families do not have enough food in their cupboards. There are large numbers of children still at school, either due to vulnerability or because they are the children of keyworkers, but safeguarding concerns may not be picked up for many children and young people as they are not attending school (see Anne Peake’s reflection piece).
Children with additional needs may struggle with severe anxiety, attachment difficulties and many with other conditions. Welfare calls on a weekly basis appear to be helpful and appreciated, and again there is increased use of digital media as a workaround for not being able to meet face to face.
There have also been some unanticipated positive impacts within the safeguarding children landscape. Social distancing can mean not engaging with negative peers; young people who are at risk of involvement in county lines are easier to identify; drug dealing and presumably drug taking has reduced. Some children have been benefitting from smaller class sizes. There may be reduced levels of on-street targeting for exploitation and a reduction in some forms of crime (eg, burglaries) (The Guardian, 2020).
There have been troubling reports regarding the increased risks of within-home violence, including intimate partner violence, child abuse, and risk of online exploitation and abuse (United Nations, 2020). These impacts may only become more apparent after social restrictions are eased further, and services start to be able to offer safe spaces for people to seek help again.
Looking ahead - As lockdown eases, there will be a long and uncertain period ahead. The health, social and economic effects will start to be realised, with some already vulnerable communities particularly hard hit. There are hopes that the society that emerges may have a commitment to a fairer, more equal society, and one which is more sustainable for the planet.
At an everyday level, applied psychologists will be preparing to help clients again. This may be helping families to support their children to re-engage with schools as they re-open. The BPS has produced guidance in this area, and other areas, to support practice during the pandemic. It may be helping people to have space to grieve for loved ones who have died, and where the usual rituals around death have not been observed during the pandemic. It may be helping people to access trauma-informed support in the aftermath of abuse. There may be concern and anger regarding governmental responses, and care and attention is needed to repair any ruptures in public trust in health messaging, particularly as there is concern about a potential second wave of the pandemic in the autumn and winter period.
There will be new working adaptations until the pandemic subsides, and an ever-emerging picture which presents opportunities for creativity and resilience, or risks and vulnerabilities.
As the course of the pandemic changes, it is hard to predict how large the level of population mental health needs will be in the coming months and possibly years. It is clear that may be a complex landscape of needs, for those who have been seriously ill with Covid; those who have cared for those seriously ill, or been involved in palliative care; for those bereaved during this time; for those people who have been rendered even more vulnerable, or become vulnerable during the pandemic. It is clear that we are not ‘all in the same boat’. Some communities, particularly Black, Asian and minoritised ethnic groups, been harder hit than others. These groups tend to be under-served or mis-served and so public services need to examine carefully how they will ensure that they offer appropriate bereavement care; psychological therapies including for PTSD; help with trauma, including moral injury for staff; and ensure care for the longer term aftermath for people who have had severe illness from Covid.
Keep our heads clear for the times ahead
In sum, we hope that this article provides some useful reflections from our perspective as applied psychologists interested in safeguarding. The pandemic has had such massive health, social and economic impacts, the repercussions of which may be felt for a long time to come. We have noticed changes in our working landscapes that could affect safeguarding – some of which hinge around the wellbeing of our colleagues and ourselves, team dynamics, attitudes and heuristics and how our thinking may be affected when we are tired or in ‘threat mode’. Some of the usual support and safety nets in society have become less visible or reduced in the effort to respond to the health emergency. Reacting to one risk can mean that other risks go unattended. Life for some during lockdown will have been more unsafe than usual, whilst for others it will have meant greater safety, opportunities for family and community connection, and perhaps a rethinking of relationships with the natural world. There are opportunities for creativity and new ways of working, some of which may continue after the pandemic is over.
As applied psychologists, we need to keep our heads as clear as we can for the times ahead, as there will be much new terrain to navigate in helping each other, and those who need our help in the aftermath of Covid-19.
A range of BPS Guidance and resources for professionals and the public during the pandemic
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