Dr Noreen Tehrani a leading British Psychological Society psychologist working with the NPWS has written this blog considering how we can take care of our essential workers during the Coronavirus outbreak.

In order to reduce the spread of the Covid-19 and prevent unmanageable pressure on the National Health Service the government has introduced lockdowns, closed shops and other meeting places and instituted two-meter distancing between people.  Where an individual has contracted the virus there is a need for self-isolation in terms of not leaving the house but also within the home to prevent the virus spreading to other family members.

However, in order to protect the health, safety and wellbeing of the wider community essential workers need to continue working while putting themselves at potential risk of infection. These workers face huge daily work pressures to provide the support and services often with reduced resources.  At the same time the essential workers have a life outside their workplace and their own uncertainties on how things are at home and how elderly dependents are coping.  The effects on this special group can be physical and psychological stress and trauma.

It is easy to identify some of the essential workers, however, the groups we depend upon is perhaps much wider than may be considered.  This list may not include all essential workers but provides some indication of those who need support.

Essential Workers – Public Services

NHS, Police, Fire and Rescue, Military, Teachers, Refuge Collectors, Prison Service, BBC, Water, Sewage, Power and Social Workers

Essential Workers – Private Services

Transport, Farming, Food Retailers, Funeral Directors, Red Cross Emergency Teams, Postal Workers, Religious Leaders, Crematoriums, Cemeteries, Social Care and Delivery Workers.

Organisations and management are in a challenging situation, they can feel extreme pressure to meet government tasking and objectives within limited resources, finances and deployable workers.  It is also recognised that unlike many other major incidents this situation is likely to last many months.  Managers and supervisors need to make sure that their teams do not wear out and at the same time help to motivate them to continue working under high pressure over and extended time.  It is important that managers and supervisors have the knowledge, skills and tools to help them take care of their teams and to demonstrate a high level of compassion and understanding at a human and organisational level.  It is also important that the essential workers recognise the symptoms of stress, burnout, compassion fatigue and trauma and know how to build their resilience and protect their wellbeing at this difficult time.

What can Leaders/Managers do?

We know from organisational and military psychology there are factors which help to build resilient organisations.  Positive leadership (1,2) is particularly important however this means that leaders must be self-aware and able to understand and to respond appropriately to the needs of their teams for support and guidance.  The example set by leaders demonstrating positive attitudes when dealing with problems and imbuing a sense of hope, optimism and commitment will influence the atmosphere within the team creating a stronger sense of cooperation and engagement.  During a crisis it is important that senior management are available and visible either physically or through digital platforms.  Leaders need to show they care, understand and support their workers by being prepared to listen particularly to those on the front line.  

Showing Compassion 

Leaders and managers must also be compassionate in recognising the concerns of individual workers.  Leaders should be at the forefront of demonstrating care, putting the needs of the worker first particularly if a worker is struggling with mental health problems, has worries about their elderly parents or children, or are going through a divorce or bereavement.  The key to the caring approach is communication and flexibility, listening and acknowledging problems and then looking for solutions which can help to meet the needs of the individual and the organisation.

Maintaining Standards

The Health and Safety Executive Management Standards (3) are a good place to start.  Whilst it is recognised that it is difficult to maintain all the standards during a crisis it is important to identify the standards which can be maintained and maximised.  

  • Demands: including issues such as workload, work patterns and the working environment
  • Control: how much say the person has in the way they do their work
  • Support: which includes the encouragement and resources provided by the organisation, line management and colleagues
  • Relationships at work: which includes promoting positive working practices to avoid conflict and dealing with unacceptable behaviour
  • Role: whether people understand their role within the organisation and whether the organisation ensures the person does not have conflicting roles
  • Change: how organisational change is managed and communicated

It is the supervisor’s role to make sure that the team does not become burnt-out, some may be willing to continue working even when they are exhausted.  Essential workers provide essential services and for some of these workers there will be a sense of duty to continue working beyond what is reasonable and healthy. This willingness to perform their role when exhausted can make them vulnerable and increase the possibility of compassion fatigue and secondary trauma.  In a crisis or disaster people often feel buoyed up with extra energy and drive but this is not a state that can continue for long and whilst there may be a belief that their efforts are indispensable and they are invincible this is a false belief and can lead to long term mental health problems. 

Setting Boundaries

A good leader will organise their resources to ensure that their teams are taking care of themselves by taking breaks, time off, getting enough sleep, eating a healthy diet and taking exercise.  Team leaders should also be setting good standards by setting boundaries for themselves and ensuring that they are not working excessively long hours.  There are no benefits from supervisors and employees wearing themselves out due to inadequate personal care.

Maintaining Routines

Starting each day or shift with a briefing creates a sense of normality and control.  The briefing helps to make sure that everyone is aware of what is happening and avoids gossip and rumour.  The briefing should be two way providing an opportunity for the team to talk about their experiences, to discuss and identify solutions to problems.  During the chaos of a disaster or crisis it is the front-line personnel who are the first to notice issues as they arise, and it is also them who have the knowledge and awareness to find solutions (4).

Creating a Sense of Coherence (5)

Some people are more resilient than others in any situation.  The questions many psychologists have asked themselves are:  How do some people, regardless of major stressful situations and severe hardships, stay healthy, while others do not? How do can some people manage their inability to control aspects of their lives and continue to prosper and perform? Aaron Antonovski, a sociologist with a keen interest in positive psychology developed the Sense of Coherence theory and questionnaire to show that people with the capacity to fully utilise their personal resources are healthier and much less likely to develop mental health problems.  The Sense of Coherence involves three beliefs or attitudes:

  • Is my life and work meaningful: Does it give me a sense of purpose?
  • Is what I am doing comprehensible: Can I anticipate what might happen next and do I understand where I fit into the larger plan?
  • Is what I have been asked to do manageable: Do I have the skills to manage the task and is the size of the task reasonable?

Whilst some people are good at working these things out for themselves, supervisors and organisations can be helpful in re-enforcing these attitudes by explaining the purpose and benefit of the tasks to be performed. Making requirements understandable and relevant to all workers and using appropriate language to create a common understanding. Providing training and learning opportunities to develop skills and the time to carry out the tasks without causing undue stress.

Reaching Out

The future is uncertain and providing comfort through false hope and unrealistic promises is not a good strategy.  What is needed from supervisors is an openness, closeness and accessibility to respond and soothe through difficult times.  This is important for those at work but also for those who are ill, in quarantine or laid off, for despite not being in work this group also need to feel they are involved and have a place where they belong so that when circumstances change they can return to work feeling they were part of the effort.

The Future

The proverb that “necessity is the mother of invention” is never truer than during a crisis.  Dealing with a crisis means that new ways of working must be tried, and old systems challenged.  Some of the changes will be shown to have long lasting benefits such as self-managing teams, flexible working, home working to name a few.

What can the Team Do?

The role of the team and teamworking is critical in reducing stress and achieving goals.  Successful teams are mutually dependent and work together for shared goals, results and wellbeing.  Teams need to have good leaders and a willingness to collaborate and co-operate.  

Humour

Together a team can motivate each other and provide peer support, they can also use their shared sense of humour to provide emotional distancing from distressing events.  Laughter releases tension and binds teams together, however, humour should never be used at a customer or service user’s expense or in a way that belittles the risk of the disease or other people’s reaction to the situation.

Change 

Teams need to be prepared to change habits and ways of working where it has been shown that other approaches might be more successful or efficient. They also need to be prepared to work with and support other team members particularly new starters who may be volunteers or inexperienced colleagues who lack the knowledge or self-confidence to do the job. 

Role Sharing 

In any organisations some roles are more tiring, boring, demanding and less popular than others.  Role rotation within the team is important so everyone gets the opportunity to do the interesting as well as the less popular or more demanding roles.  

Peer Support (6)

It is well established that social support is a very powerful tool in increasing resilience, whether that be a friendly chat, an offer of help or a hand on the shoulder at a time of distress.  When people come together with a shared purpose the powerful hormone oxytocin is released.  This hormone can increase social bonding, reduce stress and improve mental health (7). Therefore, recognition needs to be given to allowing for team-time where the team can relax with each other as a way of improving their mood and wellbeing.

What can Essential Workers Do for Themselves?

We all have a personal duty to take care of ourselves and our health and wellbeing.  People are different in the way they like to de-stress but there are some general pointers:

  • Think about what you have found helpful in making you happy or relaxed (avoiding the harmful crutches such as the excessive use of alcohol or drugs) 
  • Spend time with the family playing games or eating meals together
  • Take exercise, even if it is only in your front room
  • Listen to music, read a book
  • Pick up an old hobby 
  • Rest and relax

Use others around you to talk if you are feeling exhausted, worn out or worried.  You may not want to share your thoughts with a partner but perhaps there is someone at work you trust.

Compassion Fatigue and Secondary Trauma

The concept of parallel process is well known in therapy and occurs when therapists, through their empathetic attunement to their client, begin to absorb and enact the emotions and responses of their clients (8).  Essential workers can develop these responses when dealing with those suffering from Covid-19 or working with distressed and bereaved families and friends.  Other Essential Workers may find that over time they become overwhelmed by their feelings of emotional exhaustion, detachment  and a lowered of self-esteem – some of the signs of compassion fatigue and secondary trauma

Traumatised Organisations

Parallel process is also present in organisations where the traumatised employees transfer their responses to the organisation.  The impact of this process is magnified in under-resourced organisations where unreasonable targets and expectations increase the likelihood of organisations to becoming traumatised (9).  The symptoms of a traumatised organisation are similar to those found in individuals, namely: hyper-reactivity to information, avoidance of decision making and a repeating of ineffective responses to issues.  Traumatised organisations behave as if every piece of information or question is a threat and respond with heightened arousal and instead of resolving issues, they overreact.  The organisation may begin to ignore or remain silent over disturbing information or events creating a whole range of topics which become “undiscussable” and the elephant in the room no one is prepared to name.  Communication becomes one way with the essential feedback loops are lost.  In traumatised organisations decision making becomes centralised driven by impulses with a narrowing of attention to focus on the current threat rather than the broader picture.  

For organisations to meet the needs of their workers and those they support during the Covid-19 crisis organisational management should recognise their vulnerability to becoming traumatised.  The response should be to adopt a culture which engages management with workers in a way that creates an environment where it is a possibility to offer to share responsibility and mutual respect.

(1) Youssef, C.M., Luthans, Y. (2007) Positive Organisational Behaviour in the Workplace: the impact of hope, optimism and resilience, Journal of Management, 33 (5) 774-800.

(2) Bartone, P.T. (2006) Resilience under Military Operational Stress: can leaders influence hardiness? Military Psychology, 18:sup1, S131-S148, DOI: 10.1207/s15327876mp1803s_10.

(3) Health & Safety Executive (2017) Tackling Stress: The Management Standards Approach, https://www.hse.gov.uk/pubns/wbk01.pdf.

(4) Stacey, R.D. (1992) Managing the Unknowable: strategic boundaries between order and chaos in organisations, San Francisco, Jossey Bass.

(5) Antonovsky, A. The structure and properties of the Sense of Coherence Scale, Soc Sci Med, 36(6) 725-33.

(6) Watkins, J. (2017) The value of peer support groups following terrorism: reflections following the September 11 and Paris attacks, Australian Journal of Emergency Management, 32 (3) 35-39.

(7) Olff.M. Frijling, J.L. Kubzansky, L.D. et al (2013) The role of oxytocin in social bonding, stress regulation and mental health: an update on the moderating effects of context and interindividual difference. Psychoneuroendcrinology, 38, 1883-1894.

(8) Wilson, J.P. (2004) The Transmitting Unconscious of Trauma, 1, 1-16 In Wilson & Brynwyn-Thomas, Empathy in the Treatment of Trauma and PTSD, New York, Brunner Routledge.

(9) Bloom, S. (2011) Trauma-organised systems and parallel process, In Tehrani Managing Trauma in the Workplace, London, Routledge