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.
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.
To help people in distress feel more safe and secure, understood, respected and cared for appropriately be calm and show
*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
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.
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.
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:
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.
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:
It is also important to understand what this guidance is not…
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.
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.
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.
The following principles apply to any person or agency involved in responding to COVID-19.
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.
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.
Gender, age and power
Touching and behaviour
Beliefs and religion
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:
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.
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.
Things to do and say
Things to not do and say
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
Available services and supports
Safety and security concerns
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.
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.
*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.
Check for safety
Check for people with obvious urgent basic needs
Check for people with serious distress reactions
People may react in various ways to a crisis. Some examples of distress responses to crisis are listed below:
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):
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:
Approaching people who may need support:
Ask about people’s needs and concerns:
Listen to people and help them to feel calm:
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:
Although each individual situation is unique, people who are affected often need similar things.
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:
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.
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
Discourage negative coping strategies
People affected by COVID-19 will want accurate information about:
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:
In giving information to affected people:
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:
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:
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.
People who may be vulnerable and need special help in a crisis include:
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:
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:
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:
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:
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.
Consider how you can best get ready to be support others.
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:
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.