The coronavirus pandemic (COVID-19) is a terrible thing which we are experiencing at an individual, community, national and international level. There are many people who want to reach out a helping hand to those around them who are or have been affected.

This guidance has been developed for people who are supporting communities and individuals who have been adversely affected by COVID-19. The purpose of this document is to help you to know the most supportive things to say and do for people who are very distressed. It will also give you information on how to approach conversations safely for yourself and others, and not to cause harm by your actions.

It has been adapted from ‘Psychological first aid: Guide for field workers’ to suit the needs of Londoners in the context of COVID-19, offering guidance on providing humane, supportive and practical help to those struggling with the social and psychological effects of this crisis.

It is designed as a framework to be used by those who provide community-based support to those around them. It is not a clinical toolkit or resource for those working in a mental health or social care setting.

Online Psychological First Aid training

Public Health England (PHE) has launched a Psychological First Aid (PFA) training module, aimed at all frontline and essential workers and volunteers. The course teaches the key principles of giving psychological first aid in emergencies and aims to increase awareness and confidence to provide this support to people affected by COVID-19. The online course will complement the guidance outlined in this resource.

The course is free, and no previous qualifications are required.  By the end of the course, outcomes will include: understanding how emergencies like the COVID-19 pandemic can affect us, recognising people who may be at increased risk of distress and understanding how to offer practical and emotional support. The course takes around 90 minutes to complete and is also available in three sessions for the learner to complete at their own pace.

Psychosocial support is a humane, supportive response to individuals and communities who are struggling and who may need support.

Although people may need access to help and support for a long time after an event, psychosocial support is aimed at helping people who are currently affected by or have been very recently affected by COVID-19. To protect your health and safety and those around you – always follow the latest government guidance.

Providing psychosocial support responsibly means:

• Respect safety, dignity and rights
• Adapt what you do to take account of the person’s culture
• Be aware of other COVID-19 response measures and services in place

Providing psychosocial support

1. Communication

To help people in distress feel more safe and secure, understood, respected and cared for appropriately be calm and show

2. Prepare

• Learn about the situation
• Learn about available services and support
• Learn about safety and security concerns

3. Principles

Look*

• Check for safety
• Check for people with obvious urgent basic needs
• Check for people with serious dis- tress reactions

Listen

• Approach people who may need support
• Ask about people’s needs and concerns
• Listen to people and help them to feel calm

Link

• Help people address basic needs and access services
• Help people cope with problems
• Give information
• Connect people with loved ones and social support

*Even though it may not be possible to be face-to-face with those who need support, it is still possible and important to look for signs and understand their needs 

Ethics

Do’s and don’ts are offered as guidance to avoid causing further harm to the person, to provide the best care possible and to act only in their best interest. Offer help in ways that are most appropriate and comfortable to the people you are supporting. Consider what this ethical guidance means in terms of your cultural context.

Do’s

• Be aware of and set aside your own biases and prejudices
• Be honest and trustworthy
• Respect people’s right to make their own decisions
• Be aware of and set aside your own biases and prejudices
• Make it clear to people that even if they refuse help now, they can still access help in the future
• Respect privacy and keep the person’s story confiden- tial, if this is appropriate
• Behave appropriately by considering the person’s culture, age and gender

Dont’s

• Don’t exploit your relationship as a helper
• Don’t ask the person for any money or favour for helping them
• Don’t make false promises or give false information
• Don’t exaggerate your skills
• Don’t force help on people, and don’t be intrusive or pushy
• Don’t pressure people to tell you their story
• Don’t share the person’s story with others
• Don’t judge the person for their actions or feelings

There is extensive evidence that psychosocial factors, such as work stress or where you live, influence the opportunity for good health and wellbeing.

The implications of COVID-19 is being felt by all Londoners. Many people are feeling incredibly anxious about coronavirus for themselves and their loved ones whilst dealing with a wide range of other preexisting or emerging stressors, such as financial pressure or complex health needs.

1.1   How does a crisis like COVID-19 affect people?

COVID-19 is an extremely distressing event, which is impacting people’s lives and wellbeing differently. Individuals, families or entire communities may be affected in similar ways (for example, in the case of illness or bereavement) or may have very different experiences.

Although everyone is affected in some way by this pandemic, there are a wide range of reactions and feelings each person can have. Many people may feel overwhelmed, confused or very uncertain about what is happening. They can feel very fearful or anxious, or numb and detached.

Some people may have mild reactions, whereas others may have more severe reactions. How someone reacts depends on many factors, including:

• The nature and severity of what they experience
• Their experience with previous distressing events
• The support they have from others
• Their physical health
• Their personal and family history of mental health problems
• Their cultural background and traditions
• Their age (for example, children of different age groups react differently)

People will react in their own way to COVID-19. It is important to remember that everyone has strengths and abilities to help them cope with life challenges and there is no one way to do this. However, some people are particularly vulnerable in a crisis and may need extra help. This includes people who may be at risk or need additional support because of their age (children, elderly), because they have a mental or physical disability, or because they belong to groups who may be marginalized or targeted for violence.

Lockdown has also impacted on many of the usual coping strategies individuals and communities use to deal with stress, and on the everyday activity that underpins our emotional wellbeing. During this time, we may need to be more creative and thoughtful about how we look after ourselves.

1.2      What is psychosocial support?

The support described in this guide explains a humane, supportive response to individuals and communities who are struggling and who may need help. It is likely that those who reading this guidance have a lot of experience in supporting those around them, however the stress and impact of COV- ID-19 will have magnified issues and changed circumstances in which they operate.

Providing psychosocial support in response to COVID-19 involves the following themes:

• Providing practical care and support, which does not intrude
• Assessing needs and concerns
• Helping people to address basic needs (for example food, transport or befriending)
• Listening to people, but not pressuring them to talk
• Comforting people and helping them to feel calm
• Helping people connect to information, services and social supports
• Protecting people from further harm

It is also important to understand what this guidance is not…

• It is not “psychological debriefing”
• It is not asking someone to analyse what happened to them or to put time and events in order
• It is not about pressuring people to tell you their feelings and reactions to an event

Who, when and where?

This guidance has been developed for those already providing support to distressed people who have been recently affected by COVID-19. However, not everyone who is affected by COVID-19 will experience a crisis event or  will need support. Do not force help on people who do not

want it but make yourself easily available to those who may require support.

There may be situations when someone needs much more advanced support and has complex requirements. Know your limits and get help from others, such as clinical profes- sionals, colleagues or other people in the area, local authori- ties, or community and religious leaders.

1.3      What to do if you need medical help

• For help from a GP – use the GP surgery’s website, use an online service or app, or call the surgery
• For symptoms of coronavirus (a high temperature or a new, continuous cough), use the 111 coronavirus service
• For urgent medical help, use the NHS 111 online service – only call 111 if you’re unable to get help online
• For life-threatening emergencies, call 999 for an ambulance

1.4       When is psychosocial support provided?

Although people may need access to help and support for a long time after an event, psychosocial support is aimed at helping people who are currently affected by or have been very recently affected by COVID-19.

You can provide support when you first have contact with individuals and communities affected. This is usually during or immediately after an event. However, it may sometimes be days or weeks after, depending on the nature of your relationship or the persons circumstances.

1.5      Where is psychosocial support provided?

You can offer support in ways which it is safe enough for you to do so. Depending on the most recent government guide- lines (for example, social distancing) it may be necessary to change how support is usually provided and adapt to ways which you and those being supported are comfortable with. This may be on the phone, text or online. Don’t assume that everyone will have access to the internet or digital devices to use. Ideally, when appropriate ensure some privacy when talking with the person.

2.1     Respect safety, dignity and rights

The following principles apply to any person or agency involved in responding to COVID-19.

Respect people’s…

Safety

• Avoid putting people at further risk of harm as a result of your actions
• Make sure, to the best of your ability, that the people you help are safe and protect them from physical or psychological harm

Dignity

• Treat people with respect and according to their cultural and social norms

Rights

• Make sure people can access help fairly and without discrimination
• Help people to claim their rights and access available support
• Act only in the best interest of any person you encounter

Keep these principles in mind in all of your actions and with all people you encounter, whatever their age, gender or ethnic background. Consider what these principles mean in terms of your cultural context. If you work or volunteer for an organisation, know and follow the code of conduct at all times.

Here are some ethical do’s and don’ts to avoid causing further harm to the person, to provide the best care possible, and to act only in their best interest.

Do’s

• Be honest and trustworthy
• Respect people’s right to make their own decisions
• Be aware of and set aside your own biases and prejudices
• Make it clear to people that even if they refuse help now, they can still access help in the future
• Respect privacy and keep the person’s story confidential, if this is appropriate
• Behave appropriately by considering the person’s culture, age and gender

Dont’s

• Don’t exploit your relationship as a helper
• Don’t ask the person for any money or favour for helping them
• Don’t make false promises or give false information
• Don’t exaggerate your skills
• Don’t force help on people, and don’t be intrusive or pushy
• Don’t pressure people to tell you their story
• Don’t share the person’s story with others
• Don’t judge the person for their actions or feelings

2.2        Adapt what you do to take account of the person’s culture

London is one of the most diverse and multicultural cities in the world. The impact of COVID-19 will be felt by all Londoners, however particular groups and communities will be disproportionately affected due to inequality, exposure to the virus and loss and require additional or bespoke support.

Culture determines how we relate to people, and what is OK and not OK to say and do.

For example, in some cultures it is not customary for a person to share feelings with someone outside of their family.  Or it may only be appropriate for women to speak with other women, or perhaps certain ways of dressing or covering one-self are very important. You may find yourself working with people of backgrounds different from your own. As someone providing support, it is important to be aware of your own cultural background and beliefs so you can set aside your own biases.

Offer help in ways that are most appropriate and comfort- able to the people you are supporting.

Each individual and community is unique. Adapt this guide to the context, considering social and cultural norms. See the following questions to consider in providing support in different cultures.

Dress

• Do I need to dress a certain way to be respectful?
• Will impacted people be in need of certain clothing items to keep their dignity and customs?

Language

• What is the customary way of greeting people in this culture?
• What language do they speak?

Gender, age and power

• Should affected women only be approached by women helpers?
• Who may I approach? (In other words, the head of the family or community?)

Touching and behaviour

• What are the latest government guidelines for physical greetings?
• What are the usual customs around touching people?
• Is it all right to hold someone’s hand or touch their shoulder?
• Are there special things to consider in terms of behaviour around the elderly, children, women or others?

Beliefs and religion

• Who are the different ethnic and religious groups among the affected people?
• What beliefs or practices are important to the people affected?
• How might they understand or explain what has happened?

2.3        Be aware of other COVID-19 response measures and services in place

All Londoners have been affected by COVID-19, with different types of emergency and crisis response measures taking place. These range from urgent and emergency care, adapted provision of primary and secondary care, temporary accommodation or food distribution. Often it is challenging for those supporting people to know exactly what services are available and where.

Try to be aware of what services and supports may be available so you can share information with people you are helping and tell them how to access practical help.

The best place to start is with the local authority in which the person your are supporting lives. Or alternatively, the Greater London Authority provides updates and guidance on its website.

Whenever possible in responding to COVID-19:

• Protect your own health and safety – always follow the latest government guidance
• Learn what emergency responses are being organised and what resources are available to help people, if any
• Don’t get in the way of emergency responders or medical personnel
• Know your role and the limits of your role

2.4                  Look after yourself

Helping responsibly also means taking care of your own health and wellbeing.

As someone supporting others during COVID-19, you may be affected by what you experience in a crisis situation, or you or your family may be directly affected by the virus.

It is important to pay extra attention to your own wellbeing and be sure that you are physically and emotionally able to help others. Take care of yourself so that you can best care for others. If working in a team, be aware of the wellbeing of those around you as well. See Chapter 4 for more on caring for caregivers.

3.1     Good communication

The way you communicate with someone in distress is very important.

People who have been through a crisis following COVID-19 may be very upset, anxious or confused. Some people may blame themselves or feel stigmatised for things that happened.

Being calm and showing understanding can help people in distress feel more safe and secure, understood, respected and cared for appropriately. Someone who has been through a distressing event may want to tell you their story. Listening to someone’s story can be a great support. However, it is important not to pressure anyone to tell you what they have been through.

Some people may not want to speak about what has happened or their circumstances. However, they may value it if you stay with them quietly, let them know you are there if they want to talk, or offer practical support like a meal or a glass of water.

Don’t talk too much; allow for silence. Keeping silent for a while may give the person space and encourage them to share with you if they wish. To communicate well, be aware of both your words and body language, such as facial expressions, eye contact, gestures, and the way you sit or stand in relation to the other person.

Each culture has its own particular ways of behaving that are appropriate and respectful. Speak and behave in ways that take into account the person’s culture, age, gender, customs and religion. Always follow the latest government guidance on health and safety.

Below are suggestions for things to say and do, and what not to say and do. Most importantly, be yourself, be genuine and be sincere in offering your help and care.

Keep good communication in mind as you look, listen and link.

Things to do and say

• Try to find a quiet place to talk, and minimize outside distractions
• Respect privacy and keep the person’s story confidential, if this is appropriate
• Stay near the person but keep an appropriate distance depending on their age, gender and culture
• Let them know you are listening; for example, nod your head or say “hmmmm….”
• Be patient and calm
• Provide factual information, if you have it. Be honest about what you know and don’t know. “I don’t know, but I will try to find out about that for you.”
• Give information in a way the person can understand – keep it simple
• Acknowledge how they are feeling and any losses or important events they tell you about, such as loss of their home or death of a loved one. “I’m so sorry. I can imagine this is very sad for you.”
• Acknowledge the person’s strengths and how they have helped themselves
• Allow for silence

Things to not do and say

• Don’t pressure someone to tell their story
• Don’t interrupt or rush someone’s story (for example, don’t look at your watch or speak too rapidly)
• Don’t touch the person if you’re not sure it is appropriate to do so
• Don’t judge what they have or haven’t done, or how they are feeling. Don’t say: “You shouldn’t feel that way,” or “You should feel lucky you survived”
• Don’t make up things you don’t know
• Don’t use terms that are too technical
• Don’t tell them someone else’s story
• Don’t talk about your own troubles
• Don’t give false promises or false reassurances
• Don’t think and act as if you must solve all the person’s problems for them
• Don’t take away the person’s strength and sense of being able to care for themselves
• Don’t talk about people in negative terms (for example, don’t call them “crazy” or “mad”)

3.2       Prepare – learn about the situation

Prepare

• Learn about the crisis event
• Learn about available services and supports
• Learn about safety and security concerns

Circumstances and crises related to COVID-19 can be chaotic and often need urgent action. However, wherever possible when supporting someone, try to get accurate information about the situation.

When providing support, learn about the following:

Did a crisis event take place

Important questions

• What happened?
• When and where did it take place?
• How many people are likely to be affected and who are they?

Available services and supports

Important questions 

• Is there a requirement for basic needs like emergency medical care, food, water, or accommodation?
• Where and how can people access those services?
• Who else is helping? Are community members involved in responding?

Safety and security concerns

Important questions 

• Is the crisis over or continuing, such as illness or insecure accommodation
• What issues may they face in their current environment, such as access to medicine, isolation from friends and family

These important preparation questions can help you to understand the situation you are entering, to offer support more effectively and to be more aware of your safety.

3.3        Action principles – look, listen and link

The three basic action principles to consider when providing support to someone affected by COVID-19 are look, listen and link. These action principles will help guide how you view and safely engage with someone, approach affected people and understand their needs, and link them with practical support and information.

Look. Listen. Link.

Look*

• Check for safety
• Check for people with obvious urgent basic needs
• Check for people with serious dis- tress reactions

Listen

• Approach people who may need support
• Ask about people’s needs and concerns
• Listen to people and help them to feel calm

Link

• Help people address basic needs and access services
• Help people cope with problems
• Give information
• Connect people with loved ones and social support

*Even though it may not be possible to be face-to-face with those who need support, it is still possible and important to look for signs and understand their needs

Circumstances and crisis situations can change rapidly, particularly as a result of COVID-19. It is important to take a moment before offering help and give yourself a chance to be calm, be safe and think before you act. See the following questions to consider and important messages outlined in section 3.3.1 to support you to do this.

3.3.1 Look

• Check for safety
• Check for people with obvious urgent basic needs
• Check for people with serious distress reactions

Check for safety

Questions

• Do dangers exist in the environment this person is in?
• Is this person isolated or alone?

Important message

• Try to get help for people in need in a safe way, such as over the phone, online or through NHS Volunteer Responders by calling 0808 196 3646 (8am to 8pm).

Check for people with obvious urgent basic needs

Questions

• Does anyone appear to be critically ill and in need of emergency medical help?
• Does anyone seem to be in immediate danger?
• Does anyone have obvious urgent basic needs, such as food or accommodation?
• Which people may need help in terms of accessing basic services and special attention to be protected from discrimination and violence?
• Who else is available around me to help?

Important message

• Know your role and try to get help for people who need special assistance or who have obvious urgent basic needs
• People who are medically unwell need appropriate help
• For symptoms of coronavirus (a high temperature or a new, continuous cough), use the 111 coronavirus service
• For urgent medical help, use the NHS 111 online service – only call 111 if you’re unable to get help online
• For life-threatening emergencies, call 999 for an ambulance

Check for people with serious distress reactions

Questions

• Does this person appear extremely upset, not responsive, or in a state of shock?
• Does there appear to be group of distressed people?

Important message

• Try to get help for people in need in a safe way, such as over the phone, online or through NHS Volunteer Responders by calling 0808 196 3646 (8am to 8pm).

People may react in various ways to a crisis. Some examples of distress responses to crisis are listed below:

• Physical symptoms (for example, shaking, head- aches, feeling very tired, loss of appetite, aches and pains)
• Crying, sadness, depressed mood, grief
• Anxiety, fear
• Being “on guard” or “jumpy”
• Worry that something really bad is going to happen
• Insomnia, nightmares
• Irritability, anger
• Guilt, shame (for example, for having survived, or for spreading the virus to others)
• Confused, emotionally numb, or feeling unreal or in a daze
• Appearing withdrawn
• Not responding to questions, not speaking at all
• Disorientation (for example, not knowing their own name, where they are from, or what happened)
• Not being able to care for themselves or their children (for example, not eating or drinking, not able to make simple decisions)

Some people may only be mildly distressed or not distressed at all.

Most people will recover well over time, especially if they can restore their basic needs and receive support such as help from those around them. However, people with either severe or long-lasting distress reactions may need more support than described in this guide, particularly if they cannot function in their daily life or if they are a danger to themselves or others. Try to encourage severely distressed people to not be on their own and keep safe until the reaction passes or until you can find help.

People who are likely to need special attention in a crisis (see Section 3.5):

• Children and young people, they will also likely need care from those around them and help to meet their basic
• People with health conditions or physical and mental disabilities may need special help coping during lockdown, to be protected from abuse and to access medical care and other services. This may include frail elderly people, pregnant women, people with severe mental disorders, or people with visual or hearing
• People at risk of discrimination or violence, such as women or people of certain ethnic groups, may need special protection to be safe in the crisis setting and support to access available

3.3.2 Listen

• Approaching people who may need support
• Ask about people’s needs and concerns
• Listen to people, and help them to feel calm

Listening properly to people you are helping is essential to understand their situation and needs, to help them to feel calm, and to be able to offer appropriate help. Learn to listen with your:

• Eyes – giving the person your undivided attention – even when you are not face to face
• Ears – truly hearing their concerns
• Heart – with caring and showing respect

Approaching people who may need support:

• Approach people respectfully and according to their culture
• Introduce yourself by name and organization
• Ask if you can provide help
• Find a safe and quiet place to talk and ask the person you are speaking to do the same
• If the person is very distressed, try to make sure they are not alone

Ask about people’s needs and concerns:

• Although some needs may be obvious, always ask what people need and what their concerns are
• Find out what is most important to them at this moment, and help them work out what their priorities are

Listen to people and help them to feel calm:

• Do not pressure the person to talk
• Listen in case they want to talk about what happened
• If they are very distressed, help them to feel calm and try to make sure they are not alone

Help people to feel calm

Some people who experience a COVID-19 related crisis may be very anxious or upset. They may feel confused or over- whelmed. The following are some techniques to help very distressed people to feel calm in their mind and body:

• Keep your tone of voice calm and soft
• Remind the person that you are there to help them. Remind them that they are safe, if it is true
• If you think the person unreal or disconnected from their surroundings, it may help them to make contact with their current environment and themselves. You can do this by asking them to:
  • Place and feel their feet on the floor
  • Tap their fingers or hands on their lap
• Ask about non-distressing things in their environment, such as things they can see, hear or feel. Have them tell you what they see and hear where you are
• Encourage the person to focus on their breathing, and to breathe slowly

3.3.3 Link

• Help people address basic needs and access services
• Help people cope with problems
• Give information
• Connect people with loved ones and social support

Although each individual situation is unique, people who are affected often need similar things.

Frequent needs

• Basic needs, such as food or befriending
• Health services or help with chronic (long term) medical conditions
• Understandable and correct information about the event, loved ones and available services
• Being able to contact loved ones, friends and other social supports
• Access to specific support related to one’s culture or religion
• Being consulted and involved in important decisions

People may feel vulnerable, isolated or powerless as a result of COVID-19. Daily life has been disrupted for everyone. The changes in place mean many people are unable to access their usual supports, or they may find themselves suddenly living in stressful conditions. Linking people to practical support offers is often crucial.

Remember that sometimes you will be providing one-time support or may supporting someone for a short time. Affect- ed people will need to use their own coping skills to recover in the long term. Help people to help themselves and to regain control of their situation.

Help people address basic needs and access services

In helping people to address basic needs, consider the following:

• Try to help the person in distress to meet the basic needs they request, such as access to food, befriending or welfare support
• Learn what specific needs people have – such as health or social care and try to link them to the help available. Make sure vulnerable or marginalized people are not overlooked (see Section 3.5)
• Follow up with people if you promise to do so

Help people cope with problems

A person in distress can feel overwhelmed with worries and fears. Help them to consider their most urgent needs, and how to prioritize and address them. For example, you can ask them to think about what they need to address now, and what can wait for later.

Being able to manage a few issues will give the person a greater sense of control in the situation and strengthen their own ability to cope.

Remember to:

• Help people identify sources of support in their life, such as friends or family, who can help them in the current situation
• Give practical suggestions for people to meet their own needs (for example, explain how the person can register to receive food aid or material assistance)
• Ask the person to consider how they coped with difficult situations in the past, and affirm their ability to cope with the current situation
• Ask the person what helps them to feel better. Encourage them to use positive coping strategies and avoid negative coping strategies

Coping

Everyone has natural ways of coping. Encourage people to use their own positive coping strategies, while avoiding negative strategies. This will help them feel stronger and regain a sense of control.

You will need to adapt the following suggestions to take account of the person’s culture and what is possible in the particular crisis situation.

Encourage positive coping strategies

• Get enough rest
• Eat as regularly as possible and drink water
• Talk and spend time with family and friends
• Discuss problems with someone you trust
• Do activities that help you relax (walk, sing, pray, play with children)
• Do physical exercise
• Find safe ways to help others in the crisis and get involved in community activities.

Discourage negative coping strategies

• Don’t take drugs, smoke or drink alcohol
• Don’t sleep all day
• Don’t work all the time with- out any rest or relaxation
• Don’t isolate yourself from friends and loved ones
• Don’t neglect basic personal hygiene
• Don’t be violent

Give information

People affected by COVID-19 will want accurate information about:

• The pandemic
• Loved ones or others who are impacted
• Their safety
• Their rights
• How to access the services and things they need

Getting accurate information after a COVID-19 experience may be difficult. The situation may change as new information emerges and response measures are put in place. Rumours may be common.

You may not have all the answers in any given moment, but wherever possible:

• Find out where to get correct information, and when and where to get updates
• Try to get as much information as you can before you approach people to offer support
• Stay up to date on safety advice
• Try to keep updated about available services
• Make sure people are told what is happening and about any plans
• Provide people contact details for services, or refer them directly
• Make sure vulnerable people also know about existing services (see section 3.5)

In giving information to affected people:

• Explain the source of the information you are providing and how reliable it is
• Only say what you know – do not make up information or give false reassurances
• Keep messages simple and accurate, and repeat the message to be sure people hear and understand the information
• Let people know if you will keep them updated on new developments, including where and when. When giving information, be aware that by providing support you can become a target of the frustration and anger people may feel when their expectations of help have not been met by you or others. In these situations, try to remain calm and be understanding

Connect with loved ones and social support

It has been shown that people who feel they had good social support after a crisis cope better than those who feel they were not well supported. With this in mind, linking people with loved ones and wider social support is important part:

• Help people to contact friends and relatives so they can get support; for example, they have a regular time in the day to call a loved one
• If a person lets you know that prayer, religious practice or support from religious leaders might be helpful for them, try to connect them with their spiritual community

Crisis and spirituality

A person’s spiritual or religious beliefs may be very important in helping them through pain and suffering, providing meaning, and giving a sense of hope. Being able to pray and practice rituals can be a great comfort. However, the experience of COVID-19, particularly in the face of terrible losses – can also cause people to question their beliefs. People’s faith may be challenged, made stronger or changed by this experience.

Here are some suggestions about the spiritual aspects of providing care and comfort after a distressing event:

Do’s

• Be aware of and respect the person’s religious background
• Ask the person what generally helps them to feel better. Encourage them to do things that help them to cope, including spiritual routines if they mention these
• Listen respectfully, and without judgment, to spiritual beliefs or questions the person may have

Dont’s

• Don’t impose your beliefs, or spiritual or religious interpretations of the crisis, on the person.
• Don’t agree with or reject a spiritual belief or interpretation of the crisis, even if the person asks you to do so.

3.4      Ending your help

When and how you stop providing help will depend on the context of the individual or community you are supporting, their experiences, your role and situation, and the needs of who you are helping.

Use your best judgment of the situation, the person’s needs and your own needs. If appropriate, explain to the person that you are leaving, and if someone else will be helping them from that point on, try and introduce them to that person. If you have linked the person with other services, let them know what to expect and be sure they have the details to follow up. No matter what your experience has been with the person, you can say goodbye in a positive way by wishing them well.

3.5        People who likely need special attention

People who may be vulnerable and need special help in a crisis include:

• Children, including adolescents
• People with health conditions or disabilities
• People at risk of discrimination or violence

Remember that all people have resources to cope, including those who are vulnerable. Help vulnerable people to use their own coping resources and strategies.

Children, including adolescents

Many children – including adolescents – are particularly vulnerable. COVID-19 has disrupted their familiar world, including the people, places and routines that make them feel secure. Some children will have been seriously affected by a crisis as a result of COVID-19 such as bereavement or separation from parents or caregivers.

Young children are often particularly vulnerable since they cannot meet their basic needs or protect themselves, and their caregivers may be overwhelmed. How children react to the COVID-19 experiences depends on their age and developmental stage. It also depends on the ways their caregivers and other adults interact with them. For example, young children may not fully understand what is happening around them, and are especially in need of support from caregivers.

In general, children cope better when they have a stable, calm adult around them. Children and young people may experience similar distress reactions as adults do.

They may also have some of the following specific distress reactions:

• Young children may return to earlier behaviours (for example, bed-wetting or thumb-sucking), they may cling to caregivers, and reduce their play
• School-age children may believe they caused bad things to happen, develop new fears, may be less affectionate, feel alone and be preoccupied with protecting or rescuing people in the crisis
• Adolescents may feel “nothing”, feel different from or isolated from their friends, or they may display risk-taking behaviour and negative attitudes

Family and other caregivers are important sources of protection and emotional support for children.

People with health conditions or physical or mental disabilities

People with chronic (long-term) health conditions, with physical or mental disabilities (including severe mental disorder), or who are elderly may need special help. This may include accessing food or medicine safely, connecting with basic support and health care, or to take care of themselves.

The experience of COVID-19 and changes to how health and social care services can make different types of health conditions worse, such as high blood pressure, heart conditions, asthma, anxiety and other health and mental disorders. People who cannot move on their own, or who have problems seeing or hearing, may have issues adapting to the changes and accessing the services available.

Here are some things you can do to help people with health conditions or disabilities:

• Help them to meet their basic needs such as accessing food and medicines
• Ask people if they have any health conditions, or if they regularly take medication for a health problem. Try to help people get their medication or access medical services, when available
• Give them information on how to access any services available or refer to an appropriate health or social care team

People at risk of discrimination or violence

People at risk of discrimination or violence may include women, people from certain ethnic or religious groups, and people with mental disabilities.

They are vulnerable because they may be:

• Left out when basic services a re being provided
• Left out of decisions about support, services or where to go
• Targeted for violence, including sexual violence

People at risk of discrimination or violence may need special protection to be safe following COVID-19 and may need extra help to address their basic needs and access available services. Be aware of these people and assist them by:

• Helping them to find safe places to stay
• Helping them to connect with their loved ones and other trusted people
• Providing them with information on available services and helping them to link directly with those services when necessary

You or your family may be directly affected by a COVID-19 related crisis. Even if you are not directly involved, you may be affected by what you see or hear while helping. As someone providing psychosocial support, it is important to pay extra attention to your own wellbeing. Take care of yourself, so you can best take care of others.

4.1      Getting ready to help

Consider how you can best get ready to be support others.

Whenever possible:

• Learn about safety measures in place to prevent the spread of coronavirus and the and roles and responsibilities of different kinds of support for individuals and communities
• Consider your own health, and personal or family issues that may cause severe stress as you take on a support role for others
• Make an honest decision about whether you are ready to help in this particular crisis situation and at this particular time

4.2        Managing stress: healthy habits

A main source of stress for those who provide support are day-to-day stressors. You may be working in a paid or voluntary capacity, doing long hours, with overwhelming responsibilities, with poor communication or management. As a source of support for others, you may feel responsible for people’s safety and care. You may hear stories of other people’s pain and suffering.

All of these experiences can affect you and those around you. Consider how you can best manage your own stress, to support and be supported.

The following suggestions may be helpful in managing your stress:

• Think about what has helped you cope in the past and what you can do to stay strong
• Try to take time to eat, rest and relax, even for short periods
• Try to keep reasonable working hours so you do not become too exhausted
• Consider, for example, dividing the work- load across a team, working in shifts during the acute phase of the crisis and taking regular rest periods
• People may have many problems following COVID-19. You may feel inadequate or frustrated when you cannot help people with all of their problems. Remember that you are not responsible for solving all of people’s problems. Do what you can to help people help themselves
• Minimise your intake of alcohol, caffeine or nicotine
• Check in with those around you to see how they are doing, and have them check in with you. Find ways to support each other
• Talk with friends, loved ones or other people you trust for support

4.3        Rest and reflection

Taking time for rest and reflection is an important part of ending your helping role.

COVID-19 and needs of people you have met may have been very challenging, and it can be difficult to bear their pain  and suffering.

• After supporting the response to COVID-19 in London, take time to reflect on the experience for yourself and to rest. The following suggestions may be helpful to your own recovery
• Talk about your experience of supporting with a supervisor, colleague or someone else you trust
• Acknowledge what you were able to do to help others, even in small
• Learn to reflect on and accept what you did well, what did not go very well, and the limits of what you could do in the circumstances
• Take some time, if possible, to rest and relax before beginning your work and life duties again. If you find yourself with upsetting thoughts or memories about the event, feel very nervous or extremely sad, have trouble sleeping, or drink a lot of alcohol or take drugs, it is important to get support from someone you trust. Speak to a health care professional or, if available, a mental health specialist if these difficulties continue for more than one month