Coping with Covid-19: A self-care guide for Ludlow Street Healthcare staff

Coping with COVID-19

A self-care guide for staff

Coping with COVID-19

Introduction These are unprecedented times and it is normal to feel anxious at the moment.

We are all feeling worried about the coronavirus and how it could affect us and our families. It is common for people to feel frustrated or scared because of the impact coronavirus is having on all our lives. These are natural reactions.

We are all trying to carry on as normal and we worry that we may be letting ourselves down or our colleagues; but letting stress build up and not recognising and managing it can impact on our mental health and our relationships.

Our new ‘Let’s Support and Help’ plan will be encouraging activities that will let you recognise and express your concerns and will be offering everyone personal support.

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Let’s Support & Help recognises that our greatest source of support is our peers and it aims to: Give everyone an understanding of how to recognise when someone is struggling and how colleagues can help support each other

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Create facilitated forums where teams can come together and share their concerns and get advice and support. We will also use these forums to help us learn: What we should STOP doing, what we should KEEP doing, what we could START doing

S upport our managers so that they have the skills to ensure we maximise all the support opportunities in each service

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This self-care guide is the first element of the Let’s Support & Help plan and it will help: • y ou recognise the signs of stress not only in ourselves but in our colleagues, our friends and our families.

• provide you with ideas for personal coping strategies • suggest ideas to allow us to all support each other Whilst the guide has many ideas we hope you will find useful, it should be remembered that the best way of dealing with a concern is to share it. Don’t feel you need to deal with it on your own, speak to your manager or your colleagues who are there to support you.

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Coping with COVID-19

Contents How are you feeling?

Recognising common symptoms of stress

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Recording your personal feelings

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Dealing with Challenging Situations

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Coping with things you can’t control

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Focusing on things you can control

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Staying connected

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Managing close relationships

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Coping with money worries

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Self-care

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Top tips for self-care

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Physical self-care

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Sleep habits

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Do more of what you enjoy

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Self-compassion

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Creating your own self-care plan

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Prioritising what’s important to you

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Building new routines

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Staying positive

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Further resources and self-help apps

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Coping with COVID-19

How are you feeling?

Living through a challenging time or crisis situation can be unsettling and distressing. Suddenly having to adjust, both psychologically and at a practical level, to strange circumstances can put a strain on you and your mental health. This is a normal reaction to exceptional circumstances.

It’s important to manage your stress.

Stress can accumulate and overwhelm you if it’s not managed.

Make sure to regularly check-in with yourself and monitor how you’re feeling. It’s important to manage both your physical and mental health at this time.

It’s okay not to be okay.

Remember that feeling stressed is a normal response to the exceptional circumstances we are now living in. It’s important not to pressure yourself to keep going as you manage changing guidelines and circumstances.

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You are human and you’re doing your best!

You may feel like you are not doing enough, or that you’re not fit for the challenge. Remember that being stressed or overwhelmed simply shows you are human. It doesn’t mean you are not up to the job.

Some stress can be helpful.

Healthy levels of stress can energize you and help you stay motivated. But you must manage your stress, so it does not become overwhelming.

Uncomfortable emotions are normal.

You may experience a range of unpleasant and unwelcome emotions about yourself or your patients’ behaviour. You may feel angry or powerless at times as you witness first-hand the damage done by non-compliance with social distancing or other safety measures. It may impact your ability to be compassionate towards patients, colleagues and those around you. However, you must reach out for support if these feelings start to become unsettling.

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Recognising common symptoms of stress Below you’ll find some common reactions to these types of stressful situations:

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Emotions

Behaviours

• • • • • • • • • • • •

• • • • • •

Anger Numbness Anxiety/Fear Guilt Lack of pleasure Hopelessness Overwhelm Boredom Loneliness Sadness Distress Feelings of loss (grief)

W ithdrawal from activities Irritability Conflict with others Avoidance Overeating C onsuming more alcohol, tobacco or other drugs

Physical Sensations

Thoughts

• • • • • •

• • • • • • •

Insomnia Headache Agitation Physical pains Loss of appetite Loss of energy

Problems with memory Difficulty concentrating Feeling disoriented/confused Denial Feeling less worthy Loss of confidence Worry

Recording your personal feelings It can be helpful to take a moment to slow down and tune in to what is going on for you at the moment.

Pick the questions that relate to your situation and fill in any thoughts you have.

What challenges are you facing in the current situation?

How are you feeling?

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What thoughts and worries are going through your mind?

How does your body feel?

What have you been doing or avoiding recently?

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Dealing with Challenging Situations Challenging situations can be frustrating and stressful, particularly when you feel like you have no control over what is happening.

Tip

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The first step in working through challenging situations is to separate the things you can control from the things you have little or no control over.

Things you can’t control In an ongoing emergency situation it is hard to predict how things will develop and circumstances can change very quickly. Worrying about what might happen is understandable, but it is not very useful. In fact, it can make us feel more distressed.

Things you have no control over include the actions and reactions of other people, how long the situation will last, and what might happen to things like your job in the future. This type of worry can drain a lot of your time and energy if you are not careful.

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The key to managing worries about things you have no control over is to focus on coping strategies. This includes finding ways to manage the feelings that you are experiencing (e.g. stress, worry, anxiety).

Things you can control The one key thing you can control in this situation is your own response to it. Your response includes the way you think about the situation and your own behaviour in relation to it.

For example, you can limit your exposure to the constant stream of negative information from the media, which may be causing you to become more anxious. You can also follow official guidelines about washing your hands and maintaining a safe physical distance from others, to ensure that you are giving yourself, and those around you, the best chance of staying healthy.

Most situations are made up of a mixture of things you can and can’t control, so working through them will usually involve both coping and taking action.

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Coping with COVID-19

Coping with things you can’t control Here are some suggestions to help you cope with distressing feelings and worries during this challenging time:

Accept negative emotions You are likely to experience some strong ‘negative’ emotions at this time. Emotions, even negative ones, communicate important information about the world around us. They are like an internal compass, helping us to make decisions and understand what we need to do.

While some emotions such as fear and anxiety may feel unpleasant, they are helpful because they motivate us to take action and keep ourselves safe: Fear and anxiety • These are normal and natural responses to danger and threat. They let us know that we might be in danger and that we need to take steps to keep ourselves safe.

• They are linked to the fight, flight or freeze response in the body.

This involves physical changes such as increased heart rate (to pump blood to the arms and legs) and muscle tension (allows you to move more quickly).

• For example, in the current situation you might feel afraid that you or your loved ones will get sick, which motivates you to adhere to the recommended health guidelines (e.g. regular handwashing), which in turn helps to protect you from getting sick.

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Sadness • Sadness is a natural response to loss and setbacks, which are an inevitable part of life.

• Sadness gives you the space to pull back and process what has happened, and it can signal to others that you may need support and comfort.

• At the moment you might feel sad at the loss of your sense of safety, your familiar routines or you might be missing loved ones.

Anger • Anger occurs when we feel that we, or the people we care about, are being hurt or wronged in some way.

• Anger motivates us to take action to address these wrongdoings and set things right. It can also be associated with destructive behaviours like shouting or aggression. It’s important to separate our possible responses to anger from the emotional message itself.

• In the current situation you might be angry about the pandemic itself and the unfairness of it all. You might also feel angry about the responses of other people or your government towards the situation.

Guilt and shame • Guilt and shame occur when we feel that we have done something ‘wrong’, i.e. something which goes against our morals or what we feel is expected of us.

• These emotions prompt us to address the situation and make amends, e.g. by apologising. They also allow us to learn from the experience and move forward.

• For example, in the current situation, you might experience guilt or shame if you sometimes forgot to follow the recommended guidelines around social distancing and later became unwell.

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Journalling Journalling can be a useful and therapeutic coping method in times of distress. You can use your journal to sort through jumbled thoughts, to solve problems or to manage difficult feelings.

Which emotions have you been feeling lately? You might like to make a note of these in a separate journal or jot them down in the space below.

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Use the Worry Time technique You probably already know that telling yourself to stop worrying or to stop thinking about something usually doesn’t help. In fact, it can make you think about it more! A more useful way to manage worry is to set aside time for worrying. Take ten minutes on a regular basis, where your only task is to worry. We call this Worry Time.

How to set up your Worry Time: 1. Set aside a ten-minute period once or twice a day, at a regular time.

Schedule worry times in advance and put them in your diary.

Choose a time when you can devote all of your attention to thinking about the things that are worrying you.

2. As your worries and concerns arise during the day quickly write them down and set them aside for your Worry Time.

Writing worries down on paper helps to make them clear.

Many people find the act of getting worries out of their heads and onto a piece of paper to be comforting.

What to do during your Worry Times: • Categorise the worries you have written down into worries about things you have no control over, and worries about things you can control.

• Brainstorm different solutions or actions you might take to deal with any of the worries that you do have some control over.

• Think about how you would like to cope with the worries that you can’t control. How can you let go, learn to accept, or live with aspects you cannot change?

• Make a plan to address both types of worries.

• Spend the full ten minutes worrying, even if this means repeating worries over and over. Repeating worries can often take the power out of them.

• Finish worry time - Once you have made a plan, make sure to end “worry time”.

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Coping with COVID-19

Try a grounding exercise Focusing on what is going on for you right now can help you to reset and find calm in moments of distress. Grounding exercises involve reconnecting with your senses and what you are feeling in your body.

Try some of these grounding exercises to bring you back to the here and now: • Take ten slow breaths Focus your full attention on each breath. Notice how it fills up your lungs as you breathe in. Observe what it feels like as you breathe out.

• Splash some cold water on your face Notice how this feels and how the towel feels as you dry your face.

Try to describe these sensations.

• Listen and try to name the sounds around you Start with the closest or the loudest sounds and then gradually move your awareness outwards and into the distance.

• Step outside or open a window Notice the temperature of the air and how it is different or similar to the air inside. What new things can you smell?

• P ut on a piece of music and take a piece of paper and a pen Start drawing a line as the music plays, following the music with the pen.

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Relaxation ideas When we are experiencing stress we can easily start feeling overwhelmed, disconnected and tense. Relaxing your body is a simple way to calm yourself and feel more anchored during stressful periods. Relaxation exercises can be a helpful way to reconnect with yourself, and find a place of calm amidst everything that is going on.

Relaxing is easier said than done, particularly if you are often tense or on edge, but you can learn to relax.

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Relaxation is a skill and, like any skill, it improves with practice.

You don’t need to spend hours practicing relaxation; five minutes a day can make a huge difference and significantly lower your stress levels.

To get used to the relaxation techniques, try practising them when you are feeling calmer to start with, as this will help you to be able to use them most effectively during times of stress.

Popular methods for relaxation include breathing, visualisation and progressive muscle relaxation exercises.

There are some great relaxation and mindfulness activities listed in the resources section at the end of this booklet.

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Focusing on things you can control

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The most effective way of managing challenging situations is to focus your energy on the practical things that you can control.

Here are some suggestions for how to do this and there is more detailed advice on many of these suggestions later in this guide.

Keep a structure and routine Your usual routine may have been disrupted recently. This can add uncertainty and stress to an already challenging time. Creating a new routine can bring structure back into your life.

Limit your media usage We are facing a situation that is rapidly changing, so it is understandable that you might want to check social media or the news frequently, to keep up to date. However, the amount of information available can be overwhelming and can make you feel more stressed and anxious.

Stick to reliable sources of information As well as limiting how much time you spend reading about the current crisis, it is important to identify reliable sources from which to get your information. Most media coverage is designed to engage its audience, so facts can often be taken out of context or sensationalised. Check The Public Health Wales (PHW) or Public Health England (PHE) websites for the latest information and guidelines.

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Reinvent your self-care Your usual self-care activities may not be an option at this time. However, it is at times of increased stress and anxiety that looking after yourself becomes even more important. You can find help with this in the Self-Care section. Self-care also means watching out for unhelpful coping strategies that could feel like they are helping, but might be making things worse, e.g. increased alcohol or food consumption.

Stay connected to others Having a supportive social network of friends, family and the wider community is essential for maintaining well-being and resilience. This is especially true in a time of crisis, as this network can provide you with valuable support for whatever challenges come your way.

Prioritise your time Facing a challenging situation can prevent you from carrying out your various roles and responsibilities in the way that you normally would.

You may now find yourself in a situation where you are having to do it all at once. Prioritising your time will ensure that you are making time for the important things, while being realistic about what you can achieve.

Be kind to yourself When times are tough and we are under stress we often fall into negative patterns of criticising or blaming ourselves. Being actively compassionate towards yourself involves being aware of your needs and knowing when things are getting too much.

Take action to keep yourself safe Another thing you do have control over is following the official health guidance for your particular location, e.g. washing your hands regularly and maintaining a safe distance from people outside your home.

These actions allow you to maintain your own wellbeing, but they also contribute to the safety of your community. Posters are available around all our services and details on how we should be implementing these routines in the services are included in each service’s Standard Operating Guidelines which are available for everyone to check.

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Coping with COVID-19

Proactively solve problems Problem solving helps you to define exactly what you are worrying about, and it helps you to work out the best way of dealing with a problem, with a simple step-by-step approach. Problem solving can be an effective way of working through worries about things you do have control over.

Problem solving involves the following steps: 1. Define the problem.

2. Think of as many solutions as possible, no matter how silly they may seem.

3. Consider the pros and cons of each solution.

4. Choose a solution to try.

5. Plan how you are going to implement the chosen solution.

6. Carry out the solution.

7. Review how it went. Were there any problems? Was it the right solution to choose? What did you learn?

8. Repeat the process if your chosen solution does not solve the problem.

Use the space below, or your journal if you are keeping one, to work through any problems you might be facing at the moment.

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Staying Connected At our core, we are social beings. Connecting with others, whether it’s family, friends or new people, has been shown to be very important for our well-being.

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In a time of crisis staying connected to your social network is especially important. However, during such times maintaining this network can be challenging.

Depending on the personal circumstances you are facing, you could be separated from your loved ones, or it might be necessary to physically distance or even isolate yourself from others. The challenge then becomes how to stay connected with other people, while keeping yourself and others safe?

The solution requires flexibility and some creative thinking. But it is possible to keep your relationships and connections strong, even in this trying time. Having to find alternative ways of connecting with people could even give you the chance to rediscover old friendships or to deepen existing relationships.

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Connections in the community While it is challenging to maintain your existing connections during difficult times, you may find that your current situation provides you with new connections to your wider community.

Communities and organisations are potential sources of social support.

They could include formal groups such as your sports club or book club or informal groups such as your neighbourhood. Building connections with people around a shared experience or common purpose can be a major contributor to your well-being and resilience.

Communities can lift you when you are down. They can provide you with a network of support for dealing with whatever challenges come your way.

Strong communities work together. They sustain people through the hardest times.

Supporting others As well as relying on your friends, family, colleagues and wider community for support in a time of crisis, remember that you can also be an important source of support for them.

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Research suggests that the happiest, most satisfied people are those who regularly support and help others.

Even the simple act of making eye-contact and smiling at a passer-by can brighten their day and yours. Remember, we are all in this together.

Don’t underestimate your ability to provide comfort and reassurance to those you are in contact with. Reaching out could involve caring for someone who is ill or in need. It could also include smaller, everyday acts of kindness, such as calling someone when you think they might need to hear a kind voice.

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The tools below will help you to identify people you can support or be supported by, and give you ideas on how to connect with them during challenging times.

Backup and Support Networks There are always people in our lives we can reach out to Supporters can be friends, family, housemates, local doctor, work colleagues, and managers.

One person might help with difficult tasks, another might be a great listener if you’re feeling down, and another might just be good fun to talk to!

Why not make a list of people you would call on for support?

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Ideas for staying connected In these strange times you might be required to observe social distancing measures or you might need to self-isolate for a period of time. If so, a bit of creativity (and some technology) might need to be employed for you to connect socially, while maintaining physical distance. Here are a few ideas of ways to do this.

• J oin an online group or forum centred around your interests • Start a WhatsApp group for one of your communities e.g. your colleagues • Ensure that the older people in your life have the technology they need to reach out e.g. phones, tablets, etc.

• Move some of your real-world groups online. Instead of meeting your mates in your 5-a-side team have a virtual catch-up instead • Set-up group video calls • Start a virtual games night with some friends/family/colleagues • Write letters or send cards • Order flowers or a present online for someone who you think needs cheering up • Text someone out of the blue to share your favourite memory of them • Have video catch-ups with your workmates • Call someone who lives on their own to see how they are • Leave a meal or a cake on the doorstep of an elderly neighbour • Think of ways that you could help someone in need e.g. doing their shopping • Place signs or messages of support in windows, so they are visible to passers-by • Set up a gratitude tree where every member posts a message or texts the other members to share something they are grateful for

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Make your own list of ways of staying connected that you would consider trying out. Ensure that you include a range of different ways of staying connected. Try to include at least one way that you’ve always wanted to try but haven’t yet – and then try it!

Remember that our work teams are supportive communities. We spend a lot of our time in work and at Ludlow Street Healthcare we will probably get most of our support during this time from our colleagues in work.

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Managing Close Relationships With colleges, workplaces and childcare centres closed in areas all over the world, the COVID-19 crisis has instantly changed the living conditions of most homes worldwide. Pushed tightly back into isolated units without much outside contact, relationships have been put under pressure.

Stressed parents struggle to balance working and caring for children all day, irritated housemates grapple with shared living spaces and bored children have to manage without normal social contacts and school routines. Below are some tips for managing your close relationships through this crisis.

Attend to adult relationships Stress can have a negative impact on your personal relationship with your partner, housemates or the other adults you live with.

When affected by worry, depression or stress, we can become much more irritable with those close to us. We can even cut off from them and become distant or unavailable. Being pushed together in isolation can aggravate tensions and difficulties.

Take time to understand Take time to understand what is going on between you and your partner or housemate. Expect that relationships might be strained and that you and others may become irritable and upset at times. Remember that with a bit of thoughtful understanding, stress does not have to drive you apart.

Instead it can bring you together and deepen your understanding of each other. Rather than fighting each other over the crisis, recognise that you are in this together and work at finding solutions.

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Coping with COVID-19

Listen well The most important communication skill is listening. Listening is the best way to stay connected to the people you are living with and a crucial first step in resolving conflict. When your partner or housemate is upset, take time to understand what is going on from their perspective. If they get snappy, rather than reacting, try to pause and listen first. Give space and time for them to express their feelings and thoughts – ‘you sound upset, what is bothering you at the moment, tell me what is the matter’. This can take the sting out of stress and upset.

Taking time to understand the other person’s feelings and what is important to them is crucial to getting on better and reaching agreements.

Communicate well Equally important is to communicate your own feelings and thoughts. Rather than being angry or passive aggressive, the goal is to find an assertive, respectful way to communicate your feelings and state what you need. Using ‘I’ statements is often a good way to do this ‘I feel this when this happens’ or ‘I really need this to happen’ or ‘this is important to me’. Find your own way of assertively and respectfully communicating, that gets through to the other person.

Make agreements Rather than just winning the argument or getting what you want, you need to find ways that you both get what you want. This is the only way to maintain good relationships. The ideal is to find ‘winwin’ solutions that work for everyone. And when this is not possible the goal is to make an agreement where burdens are shared and you both get something of what you want. Making and keeping agreements is the key to building trust in relationships.

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Talk to children and teenagers about their worries Just as parents are understandably alarmed and worried about the current crisis, so too are children and teenagers. Rather than avoiding difficult conversations, it is better to be proactive and plan how and what you might say to your children. The suggestions below can help with this.

Use child-centred language for young children In talking to young children, it is important to take time to explain the message using concrete child-centred language that they understand.

For example, to explain why your 4-year old can’t visit Nana during the crisis you might say: T here is a virus, called COVID-19, that makes old people very sick.

Children can carry COVID-19 but not know they have it. So, we can’t visit Nana in case we give her the virus. The good news is that we can talk to her and see her on the phone. She misses you very much and loves when you show her pictures or when you read your books together over the phone at bedtime.

The key is to show children how they are helping others by their actions.

You are showing how your child can protect Nana and also be kind to her by keeping in touch.

You can also use pictures or drawings to explain how the virus spreads and the importance of washing hands and social distancing. There are many children’s picture books just published online, which explain all about the virus. You might be able to read one of these together.

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Use adult explanations for teenagers As your children become older your explanations need to be more adult and scientific. Teenagers appreciate being taken seriously and being treated like adults. Be proactive and find ways to raise the topic with your older children. It is always better that your children are talking to their parents, rather than depending on unreliable sources such as social media or peers.

A useful strategy might be to watch the news together and to then debate and think through the issues with them. Alternatively, you can review some reliable online health information together - this might be a good way to calmly go through the facts and to help you both think about how best to respond.

Listen carefully Make sure to listen carefully when your children raise worries and questions. If your teenage daughter talks of exaggerated facts, respond calmly and ask her ‘where did you hear that from?’ If your son worries about who might die due to the coronavirus, give him space to express his thoughts and feelings and listen to his underlying worries. Acknowledging his worries and putting them in context of reliable information is the best approach.

You want to encourage your children to talk to you and to keep communication open. You want to give them the message that you can handle their feelings and worries.

Use a positive tone Parents are often worried that difficult facts might scare children.

In reality, it is how things are explained, rather than the facts themselves, that scare children the most. Vague, inconsistent and confusing answers from anxious parents make for anxious children.

When you are talking to your children, think through what you want to say, so you can be calm and clear.

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Explore positive actions Empower your children and yourself by focusing on reasonable actions that you can take to stay safe. This can include agreeing good hand washing routines and new ways of greeting people outside the home (e.g. waving instead of hand shaking). If you have to stay at home for a period, involve them in preparing a list of what food you will need and what fun activities you can do at home.

Remember that taking safety actions does not have to be a morbid, serious affair. You can make a game of learning how to wash hands properly, and there are lots of funny videos online that describe new ways of greeting or keeping safe distances when shopping.

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Coping with money worries In the midst of this global crisis, many of us are worried about our personal finances or want to support family and friends who are struggling financially.

There are three important steps that everyone should take:

1. Accept you may have a problem The sooner someone recognises they may have a problem the easier it is to find a way of dealing with. It is natural to want to ‘put your head in the sand’ and hope the problem goes away. It rarely does; leaving the problem usually makes it harder to manage later.

2. Take stock of your finances and create a budget Before you reach out for help, it’s useful to have an accurate picture of your financial situation.

Knowing your income, expenditure and disposable income once your day-to-day expenses are covered, will give you confidence in your decisions and help you to create a budget. If your partner or spouse usually looks after the finances, be sure to talk the budget through with them, so that you both understand your financial situation.

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3. Use the help available Tackling outstanding debts might seem a daunting prospect but there are plenty of free sources of advice you can take advantage of: Employee Assistance Programme Our own Employee Assistance Programme run by Health Assured offers free and confidential financial counselling. Ring them on 0800 030 5182. They are there to help 24 hours a day, 7 days a week.

GOV.UK GOV.UK/coronavirus has specific information about the government support available to support those whose income has been affected by recent events.

Citizens Advice Citizens Advice is a good place to get information about benefits, how to deal with debt, what you’re entitled to and who to speak to if you’re at risk of losing your home. www.citizensadvice.org.uk Other organisations offering helpful advice online include: • Money Advice Service, www.moneyadviceservice.org.uk or call 0800 138 7777 from Monday to Friday, 8am to 6pm • National Debtline, www.nationaldebtline.org or call 0808 808 4000 from Monday to Friday, 9am to 8pm • StepChange Debt Charity, www.stepchange.org or call 0800 138 1111 from Monday to Friday, 9am to 5pm

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Self-care Practising self-care is hardest to do when you need it the most. But self-care is crucial during a time of crisis. You may feel that it is not a priority but looking after yourself is not a luxury, it is an essential part of maintaining your energy levels and your resilience to stress. This is particularly true if you are caring for others.

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irlines advise you to put on your own oxygen mask before helping A other people. The same idea goes for self-care - you need to look after yourself first, in order to be there for other people.

Self-care includes caring for your health and spending time on activities you enjoy. You can read about some of the different areas of self-care in the following pages.

Everyone has different needs and will find different self-care activities that work for them. Spend some time thinking about the things you need to do to look after yourself, as well as the things you can realistically do in the current circumstances.

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Top tips for self-care Here are some top tips that can help you maintain balance in your life during this challenging time: • Eat well and look after your body. Don’t skip meals or breaks, no matter how busy you are. Stretching or simply getting some fresh air can be a simple and quick way to mind yourself.

• Beware of unhelpful coping strategies. Alcohol, tobacco, over or under eating can all have a negative impact on your mental health.

• If you’re feeling overwhelmed, take a moment to ground yourself.

Try out some of the exercises mentioned earlier on in this guide.

• Get enough sleep. Sleep can be a challenge at this time, but it is essential to your ability to make sound decisions.

• Connect with your support network. You may feel excluded or isolated at this time due to work or safety restrictions. Try to stay in touch with important people in your life as much as possible (within reason!).

• Keep healthy boundaries. Avoid the temptation to overwork and skip breaks because things are so busy. These moments to yourself are essential for preventing burnout.

• Watch out for excessive stress, fatigue and sudden exhaustion.

Increasing stress levels or feeling overwhelmed can create a sense of disconnect from your work. This can make self-care harder to do as times goes on. Working on adrenaline for extended periods of times can also lead to a sudden onset of exhaustion. Remember not to blame yourself, as it is not your fault. Reach out to your line manager or team lead to get the support you need to cope in a healthy way.

• Access support. Make sure to use the supports available to you.

Make sure to reach out to loved ones and friends for support.

Your colleagues may also be a unique source of support at this time or you may want to consider counselling which you can access free of charge through our confidential, 24-hour Employee Assistance Programme.

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Physical self-care Here are some top tips that can help you maintain balance in your life during this challenging time:

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Three of the main aspects of a healthy lifestyle are exercise, diet and sleep.

It may feel strange focusing on yourself and engaging in normal activities, such as exercising, when you are living through a crisis situation. However, at this time it is more important than ever to maintain your strength and physical resilience, because stress puts a significant strain on your body and mind.

Be mindful of unhelpful coping strategies that can find their way in during times of stress, such as overeating and consuming more alcohol than normal. While these can provide some comfort, they can have a negative impact on your physical and mental health and potentially lead to bigger issues down the line.

Exercise Exercise is a good area of your health to focus on in challenging times.

Creating an exercise routine adds a positive element to your day – the endorphins generated by exercise make you feel good. Regular exercise also has a knock-on effect on other areas of your health, e.g. it improves the quality of your sleep and makes it easier to eat healthily.

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Sleep habits A good night’s sleep is essential to our physical and mental wellbeing.

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ver time, sleep problems may cause you to develop some bad O sleep habits. These habits are very common and can play a role in ongoing or worsening sleep issues.

Below are some of the habits we all can get into. Do you recognise any of these in yourself?

Not having a routine When we are children, it is very important to have a good bedtime routine to help us sleep well. We often lose the importance of this routine as we get older but it is still very important! Our bodies have internal clocks which rely on routine to help us know what time of day it is. For example, regular meal times and bed times can be important factors to help us to sleep better.

Creating a good routine of healthy sleep habits before bed, helps your body and mind to prepare for sleep and to produce lots of the sleepinducing hormone melatonin. This routine should include doing relaxing activities that help you to wind down and preparing your bedroom for sleep.

Napping It makes sense that, if you have had a bad night’s sleep and you are feeling tired, then you might want to sleep in the day to try and catch up.

But this can actually reduce the quality of your sleep that night.

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Poor bedroom environment It is important that your bedroom is a dark, quiet, relaxing and comfortable place for you to sleep. Bright lights or ‘blue light’ from screens can impact negatively on your sleep, because they make your body think it’s morning. Use warm ‘red spectrum’ lights instead. Your mattress, bedding and the temperature of your bedroom are important too – make sure you are not too warm or too cold (18°C/ 64°F is an ideal temperature for sleep).

If noise is keeping you awake, try ear plugs. Ideally, a few hours before bed, you should make sure that your bedroom is organised and that the lighting is set.

Negative associations with the bed and bedroom After having had sleep problems for a while, you can start to see bedtime and your bed as an unpleasant place to be. This is because of the amount of time you have spent in bed, not being able to sleep and feeling frustrated. When you are getting ready for bed, these negative associations can cause you to feel stressed and anxious, which means that you will be less likely to sleep well.

You might have started doing activities in bed other than sleeping, like reading, scrolling through social media or watching television. Spending a lot of time in bed not sleeping, causes you to associate your bed with being awake. This can mean that you are less likely to sleep when you go to bed.

Using substances It is common for people to start using substances to self-medicate their sleeping problems. For example, you might find yourself having a few glasses of wine before going to bed or drinking caffeine to help keep you awake during the day. Using substances like alcohol, drugs, caffeine or nicotine can actually keep sleeping difficulties going.

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Worrying about your sleep Sleep problems can cause you to become very anxious about your sleep; for example, worrying about how you will cope the next day if you have another night of not sleeping well. However, the more you worry about sleeping, the more anxious you will become, and the less likely you will be able to sleep.

If you find your mind is racing and your worries are keeping you awake, try keeping a journal beside your bed and writing down your worries.

Trying to ignore or suppress worries only makes them worse, whereas writing them down on paper gets them out of your head. You could also try a relaxation technique to help you let go of any residual anxiety or tension you may be feeling.

Do more of what you enjoy A constructive way to restore yourself when dealing with a challenging situation is to spend time doing things you really enjoy. These could be hobbies, exercise, your work or other personal or creative pursuits.

Sometimes when you become engrossed in an activity or task that you are passionate about, you can lose all sense of time. You might suddenly realise that hours have passed, when it has felt like mere minutes.

This is called flow.

Flow is characterised by an absence of emotion and self-consciousness, you are so absorbed by the task at hand that you don’t think or feel. In this sense it is similar to meditation.

Flow can be very soothing when dealing with stress, as it gives you a time-out from the strong or overwhelming emotions you might be feeling. After periods of flow, people tend to feel a sense of achievement and satisfaction, which can be welcome positive feelings during times of crisis.

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Self-compassion Stress, disappointment and setbacks are part of life and cannot be avoided entirely. What you do have control over, however, is how you treat yourself when these negative experiences occur.

Being actively compassionate towards yourself involves being aware of your needs and knowing when things are getting too much. It is not about excusing yourself from mistakes or denying your responsibility in problems. Instead, it focuses on removing negative self-judgements and learning forgiveness and acceptance.

Negative Self-Talk Negative self-talk is extremely common. We tend to criticise ourselves, put ourselves down, blame ourselves for problems and ridicule ourselves for faults. We often treat ourselves much more harshly than we would other people.

When something goes wrong, rather than seeing it as a mishap, the negative voice assigns personal blame: • What is the matter with me?

• Why do I always get things wrong?

• Why can’t I handle everything?

• I am always messing up and ruining things!

Understanding your negative self-talk is the first step towards distancing yourself from constant self-judgement.

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Compassionate Self-Talk The goal of compassionate self-talk is to create a less judgemental inner conversation, one that still describes the same reality, but in a much more compassionate way. For example, If you feel overwhelmed juggling work and minding your children, instead of saying to yourself “I can’t handle it, I’m a failure”, it is more compassionate to say: This is a really tough situation, lots of people are feeling overwhelmed. I’m a good parent and employee. I’m doing my best and its okay if I’m not perfect.

If you make a mistake and forget to wash your hands once, instead of berating yourself with “I am such an idiot, I’m going to get sick now”, it is more compassionate and helpful to say: Everyone makes mistakes, I will learn from this and try to make it a routine so I don’t forget next time.

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Creating a self-care plan What methods do you already use, or would you like to use, to help you look after yourself at this time? Tick some of the ideas you will include in your own plan, or add in your own ideas at the end.

Start an exercise routine

Do some gardening

S pend some time on an activity I enjoy

Go for a walk or sit in nature

Take up a new hobby Call someone for a chat

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S ay hello and smile at a neighbour

Practice self-compassion

Try a meditation or relaxation exercise

rite in my journal about W how I’m feeling

Learn a new skill Start a scrapbook of ideas

Listen to some music

Bake

Sign up to an online class

Repair something that’s broken

Take a bath

Read a book

Prioritising what’s important to you On any given day we carry out a number of different, important roles in our lives. These range from your role in work, being a parent or spouse, to the voluntary work you do in your community.

Managing to juggle all of these roles and responsibilities can often be a delicate balancing act. In a time of crisis, this is likely to become even more difficult.

During a crisis your life roles and routines can be thrown into turmoil.

For instance, if you carry out a job on the front line of the crisis, it is likely that the demand for your time in this area is going to increase, at the expense of your time in the other areas of your life. Or if you suddenly have to carry out your job from home, you may find that you are also having to care for your children at the same time, essentially carrying out two roles that would ordinarily have been separate.

In extraordinary circumstances such as this, it is important to recognise that it is impossible to carry out these roles in the way that you normally would.

Some things may have to take a backseat for a while and you may have to accept that sometimes “OK” is good enough.

Try not to be too hard on yourself. Maybe it’s OK for your child to watch a bit more TV so you can get a piece of work done. Maybe it’s OK for you to say no to a request from work, that would limit your time with family. In order to be realistic about what you are able to get done in each area of your life, try to prioritise the things that matter the most.

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Prioritising your tasks During challenging times, things you may previously have taken for granted, such as taking care of the basic needs and safety of yourself and your family, could suddenly become urgent needs that you have to actively prioritise above everything else.

Stephen Covey’s ‘Time Management Matrix’ is a way of categorising our everyday tasks and activities into 4 different quadrants. This might be a useful tool to help you make sure that important, but perhaps less urgent things don’t get forgotten about but also to help you see what might be things that you can let slide a bit as you manage your day to day life during a crisis.

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Important & Urgent

01

02

Important & Not Urgent

Not Important & Urgent

03

04

Not Important & Not Urgent

Quadrant 1

Quadrant 2

Quadrant 1 activities are those that are important and have to be done urgently – for example, in the current crisis scenario these types of activities include ensuring you have enough food for your family, that your children are looked after, and attending essential medical appointments, etc.

Quadrant 2 activities are important activities that aren’t pressing or urgent - for example, this may include making sure that, in spite of being pulled in a lot of different directions, you are spending time with family, listening to your partner, finding ways to do some physical exercise, keeping connected to others etc.

Quadrant 3

Quadrant 4

Quadrant 3 activities are those that appear urgent but that are not that important to you, such as chores that you have got into the habit of doing but which are not actually that important.

Quadrant 4 activities are those time-wasting activities that we all engage in that are neither important nor urgent. Some appear relatively harmless like surfing the net or engaging in idle gossip or chit-chat, or some are more serious or addictive like activities such as over-drinking.

- Important & Urgent

- Not Important & Urgent

- Important & Not Urgent

- Not Important & Not Urgent

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We can sometimes feel overwhelmed by ‘all the things I need to do’ so take this time to list below all the tasks you feel you need to manage at the moment and decide which quadrant they fit in. This should help concentrate your mind only on the things that you really need to do now, and leave some of your other tasks for another time.

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Important & Urgent

Important & Not Urgent

Not Important & Urgent

Not Important & Not Urgent

Building new routines If you need to work from home or you have to remain in the house during this crisis, you don’t have to give up on your daily routine.

If possible, you should try to get up and go to bed at the usual times, get dressed in the normal way and set regular times for meals, work periods and leisure times.

It can also be helpful to make a plan for the day, or even the week.

You could identify some of the tasks and activities you may have identified in earlier sections of this self-care guide.

In a time of crisis, sticking to your own routine can be difficult. If you have children it can be even harder to manage your family’s routine alongside your own. Each family now has to adjust to new circumstances of trying to study or work while confined in the same household, without the usual organised social activities outside the home. Structuring the day and creating a new family routine is a way to make this more manageable. The following tips can help you build a routine that suits the whole family.

Build the day around mealtimes Build your daily routine around family mealtimes. One silver lining in the crisis is the opportunity for families to have more healthy home cooked meals. Involve children as much as possible (according to their ages) in planning, preparing, cooking and cleaning up after meals. The more tasks are shared, the more family bonding and shared pride there will be. With older children you can set up a weekly schedule for meals, alternating who is cooking/ washing up and ensuring everyone gets their favourite meal included.

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Set aside parent work times Set aside spaces in the day when you can do your own thing while the children are doing their own thing (e.g. homework or play). This might facilitate you doing work projects or taking leisure time. If your children are very young and don’t easily give you space, then you might alternate child minding with your partner throughout the day. If you are parenting alone, then this time might occur when the children are watching TV, napping or asleep in the evening.

Through the course of the day, the goal is to alternate between time together and time apart. Creating individual space and time, while in the same house with others, is the key to coping.

Plan some play times Rather than responding to your children’s requests to play throughout the day, try to set aside some fun play times during the day, when you can give them your full attention. This might be doing a craft together, playing a family game in the evening, watching a family TV show or having a video call with a grandparent or relative together. Set one or two interesting goals each week that you can look forward to, whether this is trying a new game, learning something, or doing an online quiz with extended family and friends.

Relax about homework Rather than becoming obsessed with ‘home-schooling’ your children, which can lead to increased pressure and battles, it is important to relax about homework. While you might punctuate the day with one or two learning periods when screens are turned off, it is better to set small, achievable learning goals that the children are largely in charge of.

Take full advantage of whatever support your children’s schools might be offering, so you aren’t trying to take on all of the teacher role.

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Help children plan their activities Help your children create their own routine and alternate their activities throughout the day. For example, in a given day they might alternate between: 1. Screen time by themselves 2. Doing a play activity 3. Reading a book 4. Watching a TV programme with family 5. Playing in garden 6. Playing music 7. Doing a craft 8. Going for family walk, etc.

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Tip: T he key is to strike a balance between screens and other activities as well as time alone and time with the family.

Take the pressure off Being cooped up in the same house already brings a lot of pressure.

Reduce your expectations and don’t expect to be a super parent doing everything. Have a gentle start to your day, set one or two goals, let your children watch a bit more TV, and focus on enjoyment and relaxation as much as you can.

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Staying Positive Maintaining a hopeful outlook in times of fear can be difficult.

You might feel that the future is bleak, or that you have little to look forward to. You might even feel that changing your mindset and being hopeful means you are ignoring the reality of the situation.

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Thinking in a balanced, yet optimistic way allows you to hope for the best, but be prepared for the worst.

Balanced optimism is not about being positive about everything, it is about being realistic. Allowing yourself to be hopeful can help make your anxiety feel less intense. This in turn gives you the mental energy to focus on practical actions such as self-care.

Here are some tips to help you maintain an attitude of balanced optimism:

Keep a journal Writing in a journal every morning or evening allows you to process what you are feeling and reflect on your experiences. The simple act of taking a break from screens and writing with a pen and paper can be enormously satisfying. You can also use this time to try to notice your mindset.

If you are having overly negative or pessimistic thoughts, can you come up with any alternative thoughts that might be more balanced or helpful? The most important questions to ask yourself are: • How does this thought make me feel?

• Is there another thought I could have, which is realistic but will make me feel better?

• What is the most helpful way to think about this situation?

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Practice gratitude Take a moment every evening to write down something good that happened during the day, for which you are grateful. This could be as simple as a pleasant chat with a neighbour or a tasty meal.

You can use your daily journal time to note down the things you are grateful for, or you can keep a separate ‘gratitude journal’. Research shows that actively focusing on the positive elements of your life can help to improve your overall well-being and resilience.

Give yourself a break Accept that you are likely to have good days and bad days. Some days you are going to feel fed up, frustrated, anxious or depressed. On these days it will be more difficult to think or feel optimistic about the future, but this is okay. Listen to and accept these feelings, and remember that this too will pass.

Discover silver linings There are a lot of challenging aspects to the current situation, but every challenge can be looked at from multiple perspectives. Finding the silver linings in this situation can help you feel more positive and hopeful for the future.

Could the challenges you are facing be seen as valuable moments for learning, rather than as barriers to happiness or success? Reframing how you look at this situation will allow you to deal with it more constructively and with less stress, worry or anxiety. Ask yourself - what is good about what is happening? What are the opportunities here?

Perhaps it has provided you with time to slow down, to spend more time with family or to learn and do new things.

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Get in touch with your values When something unexpected and momentous interrupts the normal flow of life, it can help you to realise your deepest values and what matters most to you. Your values are the things you see as important in your life. To uncover your values and what this experience has meant to you, have a think about the following questions: • What are the most important things in your life now?

• W hat doesn’t matter as much now, that you thought was important before?

• How do you want to live your life going forward?

And try to learn from this challenge Resilience is the capacity to face, overcome, and even be strengthened by difficult experiences. It is about coping, recovering, and finding a way to grow and develop positively despite the problems we encounter. One thing you can hold onto throughout these challenging times is the fact that this experience can potentially teach you something new or make you stronger in the long term.

Resilience is something we can all develop. To recognise this, you only have to think back to challenging times in your past when you felt overwhelmed, yet were able to keep going. What kept you going despite those challenges?

As resilience is made of things we can learn, we can continue to build on this resilience and strengthen our ability to “bounce back” more easily in the future.

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The things that keep us going in the toughest times are the things that make us resilient. These include: • Our sense of humour, • Our willingness to ask for help, • Our refusal to give up, • Our support network, • Our belief that things would work out, • Our ability to work hard, and • Our problem-solving skills.

Use this experience as an opportunity to build your resilience by strengthening your connections and relationships, being kind to yourself, finding meaning and purpose in your life, and making your physical and mental health a priority. This way when another challenge comes your way, as it inevitably will, you can tackle it head on.

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Well-being Resources SilverCloud SilverCloud Health have setup a dedicated website to provide wellbeing support for staff working in social care during this time.

Access online self-help programmes for: • COVID-19 — support for the difficult emotions and situations you may face during the pandemic. Helping you to deal with worry, sleep issues, bereavement, isolation and work-life balance • Sleep — learn how to fall asleep faster and stay asleep with healthier habits.

• Stress — manage stress and learn healthy coping skills.

• Resilience — enhance your wellbeing and your ability to bounce back from challenges.

To access SilverCloud: • Got to their website: www.silvercloudhealth.com, • Click on ‘user sign-up’ in the top right of the page • Click to say you are a front line worker in the UK • View the available programmes and click on the one you are interested in • Then register using the Access PIN: SOC2020

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Daylight Daylight is a smartphone-based app that provides help you if you are experiencing symptoms of worry and anxiety using evidence-based cognitive behavioural techniques, voice, and animation.

Free access to Daylight is active now until 31 December 2020. covers all staff working in social care, including volunteers.

How to access Daylight: • Type in this web address in your browser: http://trydaylight.com/care-access • Enter your postcode and answer a few short questions to tailor the programme to you • Sign up for an account using your name and email address (work or personal) • Download the Daylight smartphone app (search ‘Daylight - Worry Less’ on both iPhone and Android) • Get started!

Sleepio Sleepio is a clinically-evidenced sleep improvement programme that is fully automated and highly personalised, using cognitive behavioural techniques to help improve poor sleep.

You have free access to Sleepio until 31 December 2020. This covers all staff working in health and social care.

How to access Sleepio: • Type in this web address in your browser: http://sleepio.com/care-access • Enter your postcode and sign up for an account using your name and email address (work or personal) • Click ‘Personalise Sleepio’ • Get started!

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Meditation and breathing apps Stop, Breathe & Think The Mindfulness app – (N.B. skip the Premium trial to access just the free content.)

Mental Health apps My Possible Self – track your moods and receive tailored insights Stress and Anxiety Companion – let’s you analyse your stress levels and suggests exercises to help manage your anxiety Woebot – mood journal, diary and tracker to help you log and improve your emotions What’s up? For when you need a little extra help getting through these tough days.

Free guided mindfulness scripts The free Mindfulness project website: http://www.freemindfulness.org/home Leaves on a stream: https://www.youtube.com/watch?v=yIlZHoiOb0s 7 minutes 57 seconds 5 minute breathing: https://www.youtube.com/watch?v=nmFUDkj1Aq0 5 minutes 22 seconds Body scan: https://www.youtube.com/watch?v=QS2yDmWk0vs 8 minutes, 38 seconds Self-soothing: https://www.youtube.com/watch?v=Xl_B45DpMLU 10 minutes 7 seconds Being present: https://www.youtube.com/watch?v=ZToicYcHIOU 10 minutes 30 seconds Visuals - Calm breathing bubble: https://www.youtube.com/watch?v=iaQed_Xdyvw 50 seconds Octagon breathing: https://www.youtube.com/watch?v=Wdbbtgf05Ek 5 minutes Sleep - Time for rest: https://www.youtube.com/watch?v=RsrYKy5aYKg 5 minutes 58

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