Additional guidance on the mental health and wellbeing aspects of coronavirus (COVID-19) for London

Context

Many people who both live and work in London are feeling incredibly anxious about coronavirus (COVID-19) and how it might impact them, their loved ones and London’s businesses. There has never been a more important time for London to work together.

Public Health England has developed guidance for the public on the mental health and wellbeing aspects of coronavirus (COVID-19) and guidance for parents and carers on supporting children and young people’s mental health and wellbeing during the coronavirus (COVID-19) outbreak for children and young people. The national guidance still applies and should be referred to in the first instance. Additionally, everyone is required to follow existing Government advice on keeping social distancing and self-isolation if they or a member of their household starts to display symptoms. This information has been translated into a number of different languages for those who speak limited English.

The below is guidance to complement Public Health England’s national work and includes reference to some local support in London. The information will be updated in line with the evolving situation.

This iteration of the guidance includes information for:

As part of our coordination role, we are producing regular working papers on what we do and do not know about the impact of COVID-19 on Londoners’ mental health and wellbeing, implications for transition and recovery planning, and suggested actions we take, locally, sub-regionally and regionally. The latest paper is available to download from the link below.

It is important to note that this work is iterative and will build over time. Comments and feedback are, therefore, welcome and encouraged. We are aware that many partners are undertaking their own research and already acting on findings; please do share the evidence you have, lessons learnt and actions taken, so that we can build a more complete picture and spread best practice.

What does the latest evidence, research and intelligence tell us?
Working Paper 2

Black, Asian and Minority Ethnic communities

It is recognised that Black and Asian, and Minority Ethnic communities are disproportionately impacted by COVID-19, this is likely due to a number of factors.

The Mental Health Foundation has compiled a useful resource which examines issues such as racism and discrimination, and key mental health statistics for specific BAME communities. It also signposts to sources of advice, information and support available here.

The Joint Commissioning Panel for Mental Health has produced guidance for commissioners of mental health services for people from Black, Asian, and Minority Ethnic (BAME) communities. While it is slightly dated (2014), it remains relevant today. The messaging in the document reflects the views that services need to recognise the impact of racism, violence and conflict on the mental health and mental wellbeing of people from BAME communities.

Service plans should be developed to reduce the experience and impact of racism and stigmatisation in the community, as well as within mental health services, because such experiences can (a) aggravate the course of mental disorder in BAME communities and (b) undermine the quality of care of BAME patients and carers. The guidance covers research findings over the last 50 years that repeatedly show that BAME communities have more adverse experiences and negative outcomes within mental health care compared to the majority population in relation to:

  • inequalities
  • access
  • experience of care
  • within BME group differences
  • between BME group differences

Public Health England has developed guidance to support individual mental health and wellbeing during COVID-19 here.

There is mental health and wellbeing guidance for London on Thrive LDN’s website. There are also London-level mental health and wellbeing guidance available for specific communities, by organisations such as Black Thrive and Taraki.

In 2019 government published its latest data set outlining detentions under the Mental Health Act. The main facts and figures confirm that certain ethnic groups are overrepresented in the number of detentions:

  • Among the five broad ethnic groups, people in the Black ethnic group were the most likely to have been detained under the Mental Health Act in 2017/18 (commonly known as being ‘sectioned’), and people in the White ethnic group were the least likely to have been detained.
  • Among the specific ethnic groups, Black Caribbean people had the highest rate of detention out of all ethnic groups for which ethnicity was reliably recorded.

Further ethnicity facts and figures can be found here.

Carers

For existing carers, as detailed in the PHE national guidance, there should be a care plan in place for carers to ensure up to date information. Wherever possible, this should include relevant details agreed with the person cared for, in the event of sickness or care being transferred to someone else. A contingency plan can include practical details of professionals working with that person or medications. Specific COVID-19 related support can be found on the Carers UK website.

It is important that carers look after their own wellbeing, particularly in this additionally stressful time. Carers UK offer ideas for a wellbeing action plan; one idea is connecting with others. This could be by talking with family and friends over the phone or online, or with other carers through Carers UK’s Jointly App.

New carers may be overwhelmed caring for someone in a COVID-19 context. Support and advice for new carers can be accessed through the Carer’s Trust , who are able to list local support to unpaid carers in London. This includes information on money, taking care of carers’ own wellbeing and mental health, and support for respite from caring responsibilities. Carer’s Network provide a short 5 step process for new carers who may be overwhelmed. This includes

1) Getting a Carers Assessment

2) Checking whether the carer qualifies for Carer’s Allowance

3) Inform their GP to receive advise on how to best look after their health

4) Consider if flexible working is an option

5) Explore the possibility of taking a break from caring duties and look into options to support them to do that.

Age UK provide local support for those caring for older people.

Young Carers

It is important that young carers with caring responsibilities can access the support they need and are able to continue to look after their own mental health and wellbeing. The Children’s Society provides support and advise to young carers, with 83 local projects in London for this group.

Young carers can also contact Youth Access, whose advice and counselling network provides local service to young people . The British Youth Council has further resources for young carers.

Kooth is a free, online, anonymous mental health support service for any young person.

Income has been impacted

Worries about finances

If the COVID-19 outbreak has caused you to take time off work or resulted in your income being reduced, it can be extremely stressful. If your income has reduced during the COVID-19 outbreak, you may want to complete a budget form. The charity Money and Mental Health has developed a budget form which allows you to put down all of your incomings and outgoings to understand better how the reduction in income will affect you. They have further support and guidance on mental health and money during the coronavirus pandemic too.

If you need further help understanding and addressing changes to your income, Policy in Practice has a list of FAQs and an online chatroom.

 

Employment rights are laws which protect you at work. If you have a problem at work which is causing you stress, the Mayor of London’s Employment Rights Hub has information about rights and support you may be entitled to. This is available in 20 languages. For advice on a problem at work, you can also call the ACAS helpline on 0300 123 1100.

If you would like to find out what support may be available to you during the COVID-19 pandemic, Child Poverty Action Group has produced an online tool to support you with this.

If you need advice on mental health related law (such as discrimination, and mental capacity), Mind has a Legal Line that you can email or call 0300 466 6463 (open Monday-Friday 9am-6pm excluding bank holidays).

Looked-After Children and Care Leavers

Looked after children and care leavers may require extra support throughout the COVID-19 pandemic. They may be experiencing isolation, a reduction in support services; financial difficulty, and job losses leading to potential destitution. They may also feel removed from friends and family with limited contact due to the lockdown or continued social isolation policy.

The Care Leaver Covenant supports care leavers, and they have created a useful page in response to COVID-19 detailing support organisations and resources, which can be found here.

There are also advice and support lines that are available, please use the links for more information/timings for the advice lines.

Become Charity0800 023 2033

Coram Voice: 0808 800 5792 or WhatsApp: +44 (0)7758 670369

Migrants

Some migrant groups will face their own set of unique challenges during this time, they may be feeling unsure of their future in this country and struggling to cope with family and loved ones living abroad.

Some will currently be struggling to access the rights they are entitled to or find that they are not eligible for government relief at all, adding to an already stressful situation.

Black, Asian and Minority Ethnic (BAME) Londoners are more likely to be employed in frontline roles – whether it’s in the NHS, as care workers, shelf-stackers or bus drivers. This exposure puts them at greater risk of catching the coronavirus in the first place and can cause great anxiety.

Many asylum seekers and refugees are particularly hard hit by the lockdown. Not only are asylum seekers more than five times more likely to have mental health needs than the general population, lack of freedom of movement and ability to leave the house may be retriggering for those who may have experienced “locked down” situations before.

Access to healthcare

The Government has issued specific advice and guidance on the health needs of migrant patients.

It is important to know that no charges will be made in the diagnosis or treatment of coronavirus (COVID-19). This applies to everyone, including anyone living in the UK without permission:

  1. No charges apply to testing for COVID-19, even if the result is negative, or to any treatment provided for COVID-19 if the result is positive or up to the point that it is negatively diagnosed. The same is true of most other infectious diseases.
  2. No immigration checks are required for overseas visitors that are known to be only undergoing testing or treatment for COVID-19.

NHS 111 can help you if you have an urgent medical problem and you’re not sure what to do, they have access to translators if you need them.

Translations exist in written format, video format and audio format with easy share button developed by Doctors of the World. You can find them on their website.

A number of key services supporting vulnerable migrant groups, offering advice and guidance, have had to scale back or completely seize their activities. Some specific information and a range of services still available throughout this period can be found below:

Mental health support

Organisations are developing digital support and groups for this period, such as the Refugee Council – for more information, please see here.

Public Health England has translated their 10 top tips on mental health, Every Mind Matters, into a number of different community languages as social media assets. These are suitable for Twitter and Facebook.

If you are a key worker, it is important to look after your mental health. Mental Health at Work has compiled a list of useful resources for those working on the front-line of the Covid-19 pandemic.

The Mayor of London has developed an information page on wellbeing during Covid-19 on London.gov.

If you are a migrant or refugee in an abusive relationship, you may face unique issues that make it hard to reach out for help. Imkaan’s directory of services lists a number of specialist services run by and for migrant women.

University of East London (UCL) hosts a Mental Health and Wellbeing Portal for Refugees & Asylum Seekers which enables mental health and social care professionals, community organisations, statutory, international and national third sector organisations and refugees and asylum seekers themselves to easily access information, resources and practical tools in one place.

Staying connected

The BBC provides news coverage in a range of different languages, to find yours go to https://www.bbc.co.uk/ws/languages

Guides on how to use Zoom has been translated into community languages by civil society organisations. The link to the guides can be found here – https://drive.google.com/drive/u/0/folders/1EaVbPVOEmBd675QvITHgysh_8HmiaGrB

Additional information

The Government has published guidance for those affected by changes to UK immigration and borders due to coronavirus (COVID-19). You can read the guidance on their website.

The Mayor of London has developed an information page with specific guidance for non-UK nationals. This page hosts specific information about visas and immigration, the EU Settlement Scheme and more.

Employment & welfare rights

Find out more about the support available if you are a migrant living in the UK:

Government support available to non-UK national residents can be found here.

NHS entitlements of non-UK national residents can be found here.

The Mayor of London has developed an online employment hub to help Londoners understand different employment rights and enforce their rights at work. The guidance is available in a range of different community languages. For specific guidance on your employment rights and coronavirus, visit this dedicated page.

The NRPF Network has produced a factsheet with information for local authorities on support for people with no recourse to public funds; their rights and entitlements and Home Office changes.

For those migrants needing help with shopping, food parcels and other support a London-wide Mutual Aid Group specialising in support for migrants, refugees and asylum-seekers has been established.

Translations of Covid-19 information

The Mayor of London is supporting Doctors of the World to translate essential Covid-19 guidance based on NHS and Government health advice and information.

Translations exist in written format, video format and audio format with easy share button. You can find them on their website.

Linguist Aid is a community initiative to connect volunteers who speak a foreign language with local mutual aid groups. It acknowledges the multilingual assets people have so that support can reach those with limited English skills.

Young migrants/ Non-UK Nationals

Children and young people may require additional support throughout this time. Below are services for non-UK nationals with specialist support for children and young people:

Organisations such as Young Roots are developing specialist support for young migrants throughout this period – for more information please see here.

There have been concerns around the use of Zoom and privacy setting. Organisers need to review the privacy setting of the meeting or there is a risk of externals to interfere.

Parents

Disruption to the normal way of life may bring additional challenges for parents and families. PHE guidance has provided advice for parents and carers on how to support children and young people of various ages during this time. The guidance highlights the importance of parents looking after their own mental health in order to maintain own wellbeing and that of children and the whole family. The below advice is intended to link to further resources and support parents’ metal health and wellbeing during the COVID-19 outbreak.

Parents with existing mental health needs

Access to your existing mental health services is still available during this time, if you feel your mental health is deteriorating it is advisable to contact your GP or your support worker. If you want to talk to someone right away, the mental health helpline page has a list of organisations you can call for immediate assistance.

If you do not have existing mental health needs but are worried about your mental health, you can also try the mood assessment quiz, which is designed to recommend resources to help you better understand how you feel.

For parents with existing mental health needs, you can follow five steps shared by Mind Wise to support and maintain good mental health throughout this period:

  • ensure that you have access to any prescribed medication
  • try to follow a routine including exercise which aids wellbeing and helps provide some structure for the day
  • try to maintain a good sleep habit
  • have an up to date crisis plan or a Wellness and Recovery Plan
  • take it easy on yourself and appreciate that this is a strange time for everyone.

Further online resources for parents and guardians with existing poor mental health can be accessed through Our Time.  This includes a list of resources covering children stories and videos on how to explain mental health to children and young people and parenting with a mental illness.

Additional resources can be accessed via:

Rethink Mental Illness has also provided advice on how to look after mental health during this time.

Family Support Virtual Family Centre has an online hub available to any parent or carer, irrespective of where they live. Further information about the service, including a video trailer, can be found here.

Parents, mental health and work

It is more important than ever that we consider our mental health both in and out of work. As such it is recommended to set aside some time each day to look after your mental wellbeing, whether that’s practising mindfulness, reaching out to a friend or colleague to discuss what’s on your mind, or making sure you stay physically active.

Good Thinking is both a website and a mobile app which provides digital support to look after mental health and wellbeing during this time. It covers common issues like stress, anxiety, poor sleep or low mood. These resources are NHS approved and mostly free for Londoners.

CAMHS resources was created for young people, carers and professionals to pool together lots of helpful resources from across the internet that are available to help support your mental health and well-being. Children’s charity, Barnardo’s, has an advice hub for parents.

Here are further sources of tips and advice on looking after your mental wellbeing during the COVID-19 pandemic and beyond:

Making family life less stressful

The Centre for Parent and Child Support (CPCS) has produced a range of resources across Facebook, Instagram and Youtube to support parents during this time and help make family life less stressful.

Beacon House Therapeutic Services & Trauma Team has developed freely available resources so that knowledge about the repair of trauma and adversity is in the hands of those who need it. There are a range of free to use resources, including those specifically on child and family mental health.

Inner World Work has a dedicated page to parents and carers of children living with trauma pain. Anyone can print or email the relevant resource to a parent or carer they know who needs you to see them, to feel understood, to know they are not alone.

Dr Karen Treisman’s page of resources and links supports children and adults around anxiety, worry, stress, and fears; including those specific to COVID-19.

MumsAid offers a number of resources and a counselling service online, via telephone, and video session for pregnant mothers and for those with a baby under two.  The team have a specialist YoungMumsAid service that offers sessions to mums that are between the ages of 16 and 19.

 

Homelessness

Those at risk of losing their accommodation or homeless people will need more support during COVID-19 pandemic. Face to face homelessness assessments are likely to have been replaced by telephone consultations.

The housing and homelessness charity Shelter, provides wide-ranging advice for those facing problems with their housing, including homelessness, on its website. It also operates a free emergency phoneline for those facing a housing crisis. Details of this service are available on Shelter’s website.

Shelter’s website currently includes a page setting out advice for those facing different housing problems during the Covid-19 crisis. This page, covers issues such as difficulties with covering rent or mortgage payments, being asked to leave by a landlord, where to seek help if you are homeless or at risk of losing your accommodation, help for those suffering domestic abuse, and getting repairs carried out. The Mayor also sets out how the rights of those renting in the private sector have changed during the Covid-19 crisis.

Although Shelter’s phoneline is open to young people, the charity Centrepoint runs a telephone advice service specifically for young people. Details of this service and answers to frequently asked questions about homelessness during Covid-19 are available here.

LGBTQI+ communities

The House of Commons Women and Equalities Committee, Health and Social Care and LGBT Communities Report was published in 2019. The report summary acknowledges that ‘ We have found that too few health and social care providers are actively thinking about LGBT people when they plan their services and that senior leaders are not doing enough to ensure that LGBT-inclusion is hardwired into commissioning strategies.’

The NHS LGBT Action Plan and LGBT Health Team is led by Dr Michael Brady, National Advisor for LGBT Health, NHS England and NHS Improvement, their action plan can be found here. The 2018 report LGBTI Populations and Mental Health Inequality also provides useful insight and statistics that support that LGBTQ+ people are over-represented in mental ill-health stats.

Stonewall have produced a report on mental health in the UK. They also have a list of LGBT-inclusive groups and organisations who are supporting individuals during the COVID-19 pandemic.

London Friend are providing mental health support for LGBTQI+ Londoners throughout the COVID-19 pandemic, which can be found here.

Akt are providing support for LGBTQI+ young people (aged 16-25), their list can be found here.

Intersectional LGBTQI+ resources

The MeeTwo app provides further resources of support for LGBT+ young people.

The Albert Kennedy Trust supports young LGBT people between 16 and 25 years old.

Gendered Intelligence works with the trans community and those who impact on trans lives with a particular focus on supporting young trans people under the age of 21.

Imaan is the UK’s leading LGBTQ Muslim charity, with an online community with forums of discussion.

Blackout UK supports black LGBTQ+ men by celebrating the diversity of their experiences and views, and building a sense of community across the UK.

Loneliness

Anyone can feel lonely and during these periods of pro-longed social distancing and lockdown measures it is common for Londoners to feel lonely. Many Londoners will miss seeing family and friends, taking part in usual hobbies and activities, and meeting people at places of connection, such as places of worship, playgrounds and local businesses.

Loneliness is a subjective, unwelcome feeling of lack or loss of companionship, which happens when there is a mismatch between the quantity and quality of the social relationships that we have, and those that we want. People may choose to have a small number of relationships but won’t feel lonely, whereas someone else might have a larger number of relationships but feel lonely. Loneliness can have a detrimental impact on an individual’s physical and mental health and wellbeing.

For some Londoners loneliness might be an existing feeling which has now been exacerbated in the current situation, making it even harder for them to connect with others or access support. However, for others this will be a new feeling and they might be struggling to cope – with many finding it difficult to admit their feelings, know where to find and access support, or the support they need being beyond the remit of the current provision they are receiving.

With social distancing measures likely to continue in some form, and the usual ways we connect and build relationships limited, it is especially important for all Londoners to take steps to tackle feelings of loneliness by staying in touch and connect with family, friends and neighbours, both online and over the phone, and to seek other opportunities to connect, such as volunteering, joining an online activity, or supporting the local community.

 

Information and support for people who are experiencing feelings of loneliness

  • The Mental Health Foundation has information on loneliness and what you can do to help yourself and others. It has detailed guidance on how to nurture and build relationships during the coronavirus pandemic.
  • Mind has information about loneliness, how to cope and how it relates to mental health.
  • The Government’s Let’s Talk Loneliness campaign has advice on how to tackle loneliness during the Covid-19 crisis and how to care for yourself and how to support others, they also have signposting to other support available.
  • The Campaign to End Loneliness has guidance on how to stay connected during the covid-19 crisis.
  • The Marmalade Trust has information on what causes loneliness, how to talk about it and tips for understanding loneliness and helping yourself and others feel more connected.
  • The Cares Family has 12 ways that you can keep feelings of loneliness at bay.
  • The British Red Cross has 6 facts about loneliness to keep in mind when looking after yourselves and other.
  • The Mayor of London has information and guidance and volunteering opportunities in London, and through the Mayor’s #LondonTogether campaign you can read and share your own examples of how Londoners have come together to support one another during this crisis.

Who is at risk of loneliness?

Whilst all Londoners will be feeling the negative effects of loneliness and isolation, we know that some groups are disproportionately more at risk of chronic loneliness and will need support at this time.

  • Young Londoners – Young Londoners are reporting feeling more lonely due to Covid-19 than others age groups and before the crisis loneliness was more common in young Londoners. The Mental Health Foundation found that in April 2020, 44 per cent of 18 to 24 year old’s felt lonely because of coronavirus, compared to 16 per cent in March. The Children’s Society has advice to cope with loneliness for young people and a blog on Student Beans shares good ways to combat loneliness.
  • Low income families and single parents – Low income households are reporting higher levels of loneliness since the Covid-19 crisis. Touch points and support that parents normally rely on for connection (i.e. schools/nurseries) are closed and some are struggling to access and afford devices and data to stay connected. Young Minds has guidance on how to support your families wellbeing during isolation, Gingerbread has dedicated Covid-19 support for single parent families and Family Action provides a support and befriending line for isolated parents.
  • BAME Londoners – People from BAME backgrounds are more at risk of experiencing certain factors that can cause loneliness, this includes feelings of not belonging and experiencing discrimination. More information about how loneliness can impact BAME communities can be found here and wider mental health support services available for BAME Londoners can be found in the section above.
  • Asylum seekers and refugees – Asylum seekers and refugees will be more at risk of loneliness as usual places where connections are formed maybe closed or have restrictions on the way you can interact. They may be struggling to cope with family and loved ones living abroad and may have limited personal income available to buy technology and/or data for staying connected. They may be finding it hard to access the rights or find that they are not eligible for government relief at all, exacerbating feelings of aloneness. Due to additional barriers such as lack of confidence, cultural differences and language, they may also struggle to access support from local support groups. Mental health support for migrants can be found in the section above.
  • Older Londoners – Older Londoners are already more likely to be lonely and digitally isolated. Age UK offers information on loneliness for older people and befriending over the phone, as well as Silverline, the older person’s helpline. Local Age UK’s in London will be providing local support, such as virtual books clubs and coffee mornings.
  • LGBTQ+ Londoners – Older LGBTQ+ Londoners are more likely to live alone and, under lockdown and social distancing measures, younger LGBTQ+ Londoners may be living in hostile home environments. Many may be reluctant to reach out to mainstream community support for fear of discrimination. Opening Doors London has a tele-befriending line for LGBTQ+ Londoners over the age of 50 and the Outside Project has set up a LGBTQ+ mutual aid Facebook group. Further signposting and wellbeing support can be found on London Friend’s website and in the section above.

Digital isolation

Covid-19 has placed greater importance on digital connections yet connecting online is not an option for all Londoners. In 2018, 7% of Londoners were internet non-users and 6% of Londoners had zero of the five basic digital skills. Digital isolation can have many causes: an absence of devices, connectivity limitations and inability to afford data, a lack of digital skills and confidence, and lack of close at hand support. Londoners who are more likely to be digital isolated include: older Londoners, asylum seekers, low income young Londoners, and low incomes families.

It is important that non-digital forms of communications and support for Londoners are considered by organisations:

  • FutureDotNow has set up DevicesDotNow to get the most vulnerable online during the Covid-19 crisis, they are targeting the 1.9 million households who do not have access to the internet and are digitally excluded.
  • Age UK has advice on how to help older friends and family get online.
Perinatal and postnatal mental health and wellbeing

New and expectant mothers should continue to seek out and receive routine care during COVID-19. All Services are still running and available for women, partners, and families. Services are predominantly providing care via a combination of telephone and video appointments, but are able to do home visits or clinic appointments where required.

There is likely to be increased anxiety around changes to the way maternity services are delivered and anxiety around perceived safety while attending appointments in different settings.

One in 10 women develop poor mental health during pregnancy or within a year of giving birth. Suicide is the leading cause of death for women in the perinatal period. Within this context, it is critical for pregnant and new mothers to be able to continue to receive the care and mental health support they need throughout this time.   Perinatal mental health support includes those mothers who may have existing mental health concerns, or new mental health conditions that develop during this time. The type of support and help depends on the severity of the cases, leading to different forms of interventions. An overview of the estimated numbers of women who experience perinatal mental illness is illustrated here by the Maternal Mental Health Alliance.

The Maternal Mental Health Alliance has produced guidance for new and expectant parents, as well as those that work with them. These can be accessed below:

For professionals working with mothers and families

For new and expectant parents

New and expectant mothers would also be able to seek support through their local IAPT team, which include Perinatal Mental Health Leads.

Routine NHS services for expectant mothers 

Accurate and relevant information about where to go for pregnancy services in London can be found on the My Health London webpage. This website contains information about on NHS maternity care services provided throughout London and helpful links to support pregnant women, their partners and family.