Coping in a time of coronavirus

Are you finding it hard to adjust to the impact of Coronavirus policies on daily life? If so, you are not alone.

If you aren’t too saturated with top tips for wellbeing type posts, I thought I should share a little bit of basic advice compiled from my knowledge as a clinical psychologist and what I have read on science twitter, in case others are also struggling with the impact of social distancing and experiencing changes to their daily life that are causing high levels of anxiety.

Note: This blog is mainly targeted at those people who are staying at home and trying to comply with social distancing, rather than those of you who are doing the kind of essential work that has to continue to involve direct contact with others. If you are in that group, I’m incredibly grateful to you, but I don’t feel skilled enough to provide specific advice. If you have greater knowledge than me and would like to improve this blog (particularly in terms of the physical elements, which I appreciate will change as the situation and our knowledge base evolves) please let me know and I can fix things.

So, with that said, on with the blog.

It is a worrying time for many people, and there is a real threat that we have very little control over, but there are things that we can do, and you are not alone – we are all facing this together. So this is my very simple advice of where to start to ground yourself and remain as psychologically healthy as possible in these challenging times.

First the physical health stuff:

1) Do everything you can to remain safe and protect those around you. This means hand washing with soap for 20 seconds (make sure to wash between fingers, around thumbs and wrists and under fingernails if you have had any contact with someone who may be contagious), cough or sneeze into a tissue or your elbow rather than onto your hands, avoid touching your face, and follow the rules about social distancing. This means not greeting people with handshakes, hugs or kisses. Minimise your social interactions, and try to ensure you only interact with people outside your household bubble in a safe way – ideally outdoors or in a well-ventilated space. Unless you work in an essential role this means staying at home, not going to busy places or meeting up in groups, and trying to remain 6 feet away from others, especially anyone outside of your minimum necessary network. Wear a mask in any enclosed space apart from your home – try not to put it on and take it off more than you have to, and avoid touching the mask except by the strings.

2) Be aware that Covid-19 is potentially dangerous (particularly to people who are very elderly or have pre-existing medical conditions). It is worth avoiding as even if you are not in a vulnerable group you can pass it on to others, plus it makes some people feel like a very bad flu with aches and serious chest pain/breathing problems. However, for many/most people it may not be obvious that you are ill at all, let alone with a serious condition. If you have a dry cough or fever, or if you lose your sense of smell or taste, or if you feel suddenly exhausted/weak, you need to self-isolate to prevent spread of the virus.

3) Take extra care over social distancing if you have an existing health condition or are elderly, or if this applies to anyone else in your household. Ensure you have enough medication, and keep taking preventers if you are asthmatic. If you are in a high risk category, then where possible have deliveries dropped off without interpersonal contact, leave letters/boxes 24 hours before touching them and wipe plastic or metal surfaces with soapy water or sanitiser unless you can leave them for 3 days before opening. If you need to interact with others or use shared facilities, wash your hands and surfaces that others touch frequently (eg door handles, railings, keypads, taps, etc) with soap or sanitiser regularly and wash your hands after using them.

4) Remember that viral load may be important in how severely people experience the virus, and ensure that you take precautions when caring for a dependent with possible coronavirus, or if you think you have it, even if the symptoms are mild. A mask is particularly important in this situation. Anyone ill or who knows they have been exposed to someone who definitely had Covid-19 should stay separate from the rest of the family as much as possible. This needs to be for at least 7 days after exposure if you have had no symptoms, or after you stop having symptoms, but ideally 14 days or more. Where someone is ill but needs care use PPE/disposable gloves where possible, and keep washing your hands.

5) We need to both “flatten the curve” by slowing the spread of coronavirus so that we don’t exceed NHS resources (see above) and lower the baseline demand for NHS services. We can do this by avoiding preventable reasons for requiring hospital care. This means taking care of your physical health and existing health conditions (eg taking preventative medication/inhalers, following dietary advice for diabetes or high blood pressure), being mindful to reduce risk of accidents (eg drive slowly in built up areas, be extra cautious on trampolines or when climbing on ladders/chairs to reach things) and improving your respiratory and cardiovascular health (eg give up smoking, increase exercise, eat healthily, and attempt to lose weight if you are obese).

Politicians and NHS managers also need to act to grow the capacity of the right services (eg by postponing non-urgent treatments, discharging anyone able to manage at home, calling in staff who have recently retired or left the NHS, reprovisioning staff to where they are most needed and building field hospitals in case we need extra capacity). But each of us can play our part by reducing our risk of spreading the virus or adding to NHS demands in other ways.

But importantly you need to care for your psychological health too.

6) Connect with loved ones (physically if you are in the same household and nobody has symptoms, but virtually or with social distancing precautions otherwise) so that you do not feel alone. Hug your kids or your partner if you are together, or speak to them as frequently as possible if you are apart, and listen to how they are feeling. Keep in touch with your relatives and usual network via phone, social media, email or video chat. Make the effort to speak to your colleagues even if you are all working from home, keep in contact with your friends even if you can’t gather in person. Confide in the people that you trust.

7) Acknowledge that what we are going through is tough, even if you feel lucky not to be having to deal with it face on like those working in health and social care or doing supply chain or deliveries. Change is challenging, the perceived threat is intangible and unknown, so it is hard to reason with the anxiety it provokes, and uncertainty is stressful. The changes imposed on us to manage the outbreak take away some of our comforting routines and our expectations of the immediate future, and it is normal to worry about the impact on ourselves and loved ones. It is absolutely normal to feel shock, denial, anger, fear, grief, or a mixture of feelings and for these feelings to ebb and flow or change unpredictably (think about the Kubler-Ross stages of grief). You might find yourself literally shaking and/or crying, or you might feel nothing at all. Be kind to yourself, and give yourself time to adjust.

8) Manage your own anxiety. First and foremost, breathe (there are some good little graphics and apps about). Then make sure that you take care of yourself by doing all the basic things that we need; eat, sleep, exercise. Try to avoid increased use of alcohol or drugs, including smoking. Give yourself a routine. Confide your feelings in those you trust, or seek out support if you need it. Join in online mindfulness or therapy groups, or seek out personal therapy from a suitably qualified professional. If you have a garden or safe outside space, get out there and appreciate the elements. If you don’t, try to sit near a window and let some fresh air in when the weather isn’t too cold. Exercise and relaxation are both important. The former can burn off negative neurochemicals and produce more positive ones, and the latter can help you to soothe yourself (so indulge in a long bath, or listen to a relaxation video). Likewise sex (or masturbation) is good for our neurochemistry, can maintain intimacy in a relationship through a stressful period and/or help you to sleep.

9) Limit news consumption and stick to reliable sources. If you are feeling anxious you might want to learn everything about Covid-19, but whilst this can bring some temporary relief, too much focus on the potential threat can be counterproductive and increase your anxiety. So try to limit how much time you spend on news sites or social media, and ensure that you check the sources of what you do read as there are many seemingly plausible articles and posts that are not true doing the rounds. The BBC, World Health Organisation, official government sources or a trusted newspaper (for me that means the Guardian or the Independent) are probably more trustworthy than celebrities, social media influencers or some politicians. Don’t get your information about the outbreak from social media unless you have personal connections with medical/epidemiology experts and are very skilled at evaluating the quality of the sources and understanding the limitations to individual studies. You might wish to use your preferences on social media channels to tune out posts on coronavirus and covid, so that you can focus on more positive content.

10) Keep busy. Give yourself small goals and structure your time into small chunks, rewarding yourself for small achievements. Be mindful about what you are doing, and give it your full attention. Don’t let yourself ruminate, or slouch about in your pajamas all day. If possible, make sure that you sleep when it is dark and are awake for natural daylight. Stick to routines of mealtimes and maintain as many of your normal activities as possible. If you have less work to do, see this as an opportunity to do things you wouldn’t otherwise have time for. Try to find enjoyable activities or those that keep your mind occupied, whether that is arts/crafts, reading, gaming, sorting/tidying, decorating, programming, writing, making or listening to music, watching films/telly or learning something new (there are loads of fab free courses online).

11) Turn your focus towards the practical things you can do. For me that means trying to increase my cardiovascular fitness and lose some weight, because my pre-existing conditions mean I’m at greater risk, and my lack of fitness compounds this – so I’ve been trying to run up and down the stairs first and last thing each day, and each time I feel particularly anxious. This gives me a sense of doing something positive – and I can see that I am making progress. I started with sets of 2, but I can now run in sets of 3 and I am catching my breath faster afterwards than I was 10 days ago. You can choose an activity that suits your starting level of fitness, get out and walk or cycle or there are fantastic exercise videos of all sorts on youtube, so why not try some zumba or yoga or calisthenics. Or improve your living environment, or create or improve a garden or vegetable bed. These kinds of things will give you a tangible feeling of achievement and improve your quality of life.

12) Be kind to others. Manage your anxieties before you speak to children, answer any questions they might have and help them to feel safe and loved. Try to be kind and patient if children are off school, and don’t put too much pressure on to do academic work until they are in a calm enough emotional state to do so. Listen to loved ones and empathise with their experiences, even if they feel differently or are responding in a different way to you. Try not to buy more than you need, so that others can get some of key items too. Thank delivery workers, supermarket staff, carers and other essential workers, and don’t pass on frustrations about lack of stock or panic buying to them as they are doing their best. Reach out and make connections via notes, email, phone, social media, or video chat. If you are young and healthy try to be particularly considerate towards those who are not – keeping in touch with older relatives and friends or those with disabilities and/or health conditions whilst keeping them away from contagions. Join neighbourhood networks or the NHS volunteers list. Leave a note with contact details for vulnerable neighbours in case they need help with shopping or collecting prescriptions, or someone they can speak to on the phone or through the window if they feel isolated. Donate to food banks and local charities if you can afford to do so. Shop with smaller companies and local traders where possible.

13) Take time to be grateful for what we have. If you have people who love and care about you, appreciate them. If you have pets that share your life, pamper them. If you can access nature, take time to enjoy that. If you have had the opportunity of education and can continue to learn, value that. Remember that we live lives of relative plenty. Most of us have relatively secure places to live in locations with relatively good health services to fall back on if we need them. Many of us have meaningful work to be involved in, and live in developed nations with some form of social security to fall back on and/or within networks that would support us in a crisis. So although there are greater challenges in our daily lives, we still have a lot to feel grateful for. Focusing on the positives helps you put the challenges into perspective.

14) Know that we’ll solve this in time. So many brilliant people are working together to address this new disease. Health care professionals are doing brilliant work all around the world. Scientists are hard at work exploring faster and more effective tests and treatments. Potential immunisations are being tested. Antigen tests will soon show who is contagious. Antibody tests are being developed that will show who has already had and defeated Covid-19 and can no longer be a vector for transmission. These people can then step up to key roles caring for the most vulnerable, and their antibodies can be used to treat the most sick. UVC has been shown to kill the virus, and robots are being built to sanitise rooms and equipment to increase hygiene. Advances are being made all the time.

15) We all know the bad things that are happening or likely to happen, but some good things will come out of this too. Pollution has been reduced by the decreased travel and factory activity, saving lives of vulnerable people, especially in the developing world, as well as helping the environment. Reduced car journeys might mean reductions in accidents. Political recognition of changing public perceptions should lead to greater investment in health and social care, as well as increased funding for medical research and response-readiness for the future. The pandemic has also shown that all nations face the same threats, and all people are the same, so (with the exception of some racist idiots) it has increased international cooperation and the knowledge that we are all interconnected. This has the potential to allow greater collaboration on international issues in future, and this may help resolve conflicts and address environmental issues. Mass working from home has shown that it is possible for more people to work remotely, meaning there are likely to be reductions in travel and more adjustments for people who need it available in the future. It has also highlighted the value of essential workers in supply chains and delivery as well as in health and social care, raising their status and priority in public perception. The economic impacts have shown the value of universal health coverage, social safety nets, and minimum income guarantees. It has reduced the mindless consumerism of recent years, and made us conserve resources and reduce food waste. So hopefully we will come out the other side having learnt some important lessons.

What to do when you can’t do it all

There was an interesting little discussion on the forum this week about the perceived pressure to do everything, and to do it all right now. That fits with the concept of the insecure overachiever that is actively sought out for certain high demand jobs (and was the topic of a recent radio 4 show) and also the concept of Imposter Syndrome, where you constantly feel like a fraud who might be found out and identified as inadequate for the job. There is a widely perpetuated narrative in modern society that people should be willing to work longer and harder, and there is always a mythical person who is doing more than you. Whether that is more revision before exams, or more prep for their clinical application or assessment day, or more voluntary work, or managing to juggle more things in their working week, it always makes you feel a bit guilty and inadequate no matter how much you are doing or how hard you are trying. The truth is we are in a profession where demand for our services will always exceed supply. The early stages of the clinical psychology career path are competitive, and there are lots of people who claim impossible workloads and huge amounts of experience that can make you feel like you’ll never measure up. So how do we tackle this pressure to do more?

There are probably lots of layers to the answer. Some are political, as this culture springs from job insecurity, underfunding, and the focus on attaining wealth and status – so the ideal is to change the game, rather than trying to win a game that is rigged against us. Another layer is to communicate with others and band together, as this undermines our personal insecurities that see it as our own personal failings, and allows us to normalise our experiences and work together to resolve the systemic issues that underlie them. But even at a personal level, there are things that we can do.

So this blog is about my top ten suggestions to tackle that feeling of having too many plates spinning and not enough time, and the cognitive distortions that maintain the belief that we should do more. I’m not saying I’ve got all the answers, or that that I’ve resolved all these issues in my own life. Far from it! I’ve mentioned many times that I’m not a good role model in this regard. I think I am a bit of a workaholic, and whilst other people say I’ve achieved a lot, I always feel like there is more I could/should be doing. However, the things that have started to help me change my own patterns are:

1) Know when you are taking on too much. Having had a minor car accident, the physical repercussions made me cut down my work to a more manageable level. They remain a good reminder if I’m overdoing things, as I get aches and pains in my ear/jaw and shoulder. Obviously, I’d not recommend having an accident as a self-care strategy to others! The bit worth sharing is to be aware of your own physical and mental state, and to learn to recognise your own signs of stress as early as possible. Then you can be responsive to your own needs, and learn to stay within your own limits. It is also a good reminder to ensure that you build self-care and exercise into your routine.

2) Fit in friends and fun. Giving higher priority to the people and things you enjoy and are recharged by. We all need to have support networks, and family and friends need to be given enough time and priority in our lives to perform that role. I can’t persuade myself to “do less work” or to leave gaps in my diary, but I can put in commitments to the people and activities I value in my life that compete with work. I make it a personal rule that I finish work at 4pm on Mondays to take my kids to their swimming lesson and do my 30 lengths. Every evening the 7.00-8.30pm slot is time I always give to my kids’ bedtime routine, and 8.30-10.30pm is time I always spend with my husband. I’m also trying to cook with the kids twice a week, to fit in a creative activity each month and not to work on weekends. My advice is to start small, commit to something for at least a month and then build on good routines once they are established. Once in a while make time for fun or frivolous things like having a spa day, or sneaking out for a cinema or lunch date with my husband, or booking a holiday.

3) Sleep. No matter what else is going on, make sure to get enough sleep. For me that means eight hours per night. I’m a night owl, so I often work until the task is done, even if that means resuming work after everyone else in my house is asleep and working through until the small hours. Then I often have to get up and fulfil work commitments the following day. If I could stop doing those extra bits of work after everyone else is asleep and get a proper sleep routine where I sleep during the hours of darkness and get out into the sunlight more in the daytime, that would have positive knock-on effects on my energy levels, mood, appetite and attention span. You can see from the fact I’m drafting this post at 2am that I’m not managing that yet, but for now allowing myself to have at least one lie-in on the weekend is a lifesaver.

4) Use your time better. Stack commitments together with similar content, that involve particular colleagues or that you can do in particular locations. Get the right kit to do the job efficiently. Travel less. Use video chat rather than meeting in person. Minimise your commute, or use it for something relaxing like reading a novel or listening to music or audiobooks. See if you can work from home even if it is just a small proportion of your time. Work out what the blocks or bottlenecks are in your process, and how you can solve them, For me having templates of common reports and letters was one helpful step. According to where you are in the power structure, you can also look at how you can draw in support or what you can delegate to others.

5) Diarise the in between stuff. Don’t just fill your calendar with the face to face stuff and expect to fit in the admin and support tasks in the cracks, because they either escape into non-work time or don’t get done. If you have to write a report between appointments, give yourself a diary slot to do it in. Need to read the papers before a meeting? Book the hour beforehand for that task. Want to write up a paper? Diarise three days for it. Then make sure that you keep that time for that sole purpose. Book an admin slot at the beginning or end of each day, or a half day at the beginning or end of the week. Check out how much time you need and when you are most productive. If that is a time that is earlier or later than other people work, make sure that you take the time back somewhere else*.

6) Prioritise, then focus on the key tasks. Isolate yourself if you need to get something important or time critical done. Turn off your phone and your email alerts, ideally unplug from the internet, and prevent distractions. Then give it your full attention. Work out what is interrupting you, and then stop it so you can get work completed in one steady sprint, rather than having to come back to it again and again after dealing with phone calls, emails, other people interrupting, or diverting onto the internet. Deal with the quick stuff straight away. But then make yourself a task list and work down it. Prioritise the important stuff over the seemingly urgent but unimportant. Try to check email and messages at the beginning and end of the day, not every few minutes. When you need to get something done turn off social media, email alerts, etc. Turn your phone onto silent and then put it out of sight.

7) Clarify your goals, and how to reach them. Envisage where you are trying to get to, what the steps you need to take are, and what barriers are preventing you getting there. If you wanted to lose weight you could picture yourself thinner and see how it would play out in your life, then think about what you need to do to consume less calories or burn off more. Then see what is stopping you. You could identify that you aren’t getting to the gym if you go home from work first, or that you are always tempted when there is cake in the office, or buy unhealthy snacks when you don’t take a lunch to work. Once you recognise them, you can then make an informed choice, and if the benefits are worth the extra effort you then need to address the barriers. One of my goals is to make my business self-sufficient enough to continue even if I went off long-term sick, and could provide me an income in retirement. So I have been thinking about how to recruit and train others to sustain the business, and create products that can utilise my skills and knowledge without me having to deliver everything in person (eg can I train others to deliver training, deliver it as a webinar, or make videos of the training available to subscribers).

8) Get a better bubble. They say that we are the average of the five people we spend most time with, and whilst that isn’t a scientifically validated concept, I think that it has some merit to it. We are all normed by those we spend most time with, so I’ve actively chosen to seek out the company of people I admire and want to learn from, and who will challenge my assumptions and habits. More specifically, I’ve been trying to spend more time with other social entrepreneurs, rather than the long-term NHS, education and social care professionals I already know, so that I move away from the common assumptions of this kind of work, and can be more creative and less risk averse in how I look to create impact. You also need to enlist the support of the key people in your life so they reinforce your goals, rather than unwittingly draw you back into old habits.

9) Get reflective. Use your supervision, your trusted confidants or keep a journal. If you want to take it one step further, why not seek out therapy, or coaching, or personal development opportunities. Give yourself time to think and regroup, particularly after stressful or emotional experiences. As well as the benefit of some wonderful supervisors, I’ve had various coaches and mentors since I left the NHS, and I’ve attended various groups and training programmes. Each one has helped me understand myself better, and helped me to refine my plans to make them more likely to succeed. It is really good to take time outside the pressure of spinning all the plates to look at why you are spinning them, which are most important, and how they make you feel. It can help you to consider the pros and cons of different options, and to identify goals and actions.

10) Be kind to yourself. Remember that you need to attach your own oxygen mask before you can help others with theirs. Take time out when you need to, and find the things that replenish you. Be realistic about what is possible or what you have capacity for, and learn to say no to unreasonable demands. Don’t be too self-critical. Seek out and remember the positive feedback, and the things you have already achieved. Take the time to note the positives and be grateful.

And above all: Enjoy the journey. There is no rush to get to the destination. Dance whilst the music is playing.

 

*with the agreement of your manager, of course.

Solve for happiness: Some thoughts on big data/AI and mental health

We are hearing a lot about the use of big data at the moment, mostly that it has been an underhand way to manipulate people politically, that has been used by those with no ethical compunctions to get people to vote against their own best interests*, and in favour of Brexit and Trump. Cambridge Analytica and AIQ seem to have commercially exploited academic research and breached data protection rules to try to nudge political behaviour with targeted messaging. Whether or not that was successful is up for debate, but to the public the narrative is about big data being bad – something technocrats are exploiting for nefarious reasons. I can understand that, because of the associations between gathering data on people and totalitarian political regimes, and because of concerns about privacy, data protection and consent. There is increasing awareness of what had previously been an unspoken deal – that websites harvest your data and show you targeted advertising, rather than charge you directly for services, and the new GDPR means that we will be asked to explicitly consent to these types of data collection and usage.

But what about the potential for big data to do good? I know that DeepMind are doing some data crunching to look at whether AI algorithms can help identify indicators that determine outcomes in certain health conditions and point doctors towards more effective treatments. Their work to identify warning signs of acute kidney injury was criticised because of breaches to data protection when they were given access to 1.6 million medical records without individual patient consent, but whilst the data issues do need to be sorted out, the potential for projects like this to improve health and save lives is undeniable. Computers can look through huge amounts of detailed data much more quickly and cost-effectively than humans. They can also do so consistently, without fatigue or bias, and without a priori assumptions that skew their observations.

Research often highlights findings that seem counterintuitive to clinicians or human researchers, and that means that using the data to generate the patterns can find things that we overlook. One example I read about today was the fact that admitting offending behaviour does not reduce the risk of recidivism in sexual or violent offenders (in fact those who show most denial offend less, whilst those who demonstrate more disclosures and shame are more likely to reoffend). But this is also true about telling people they are being given a placebo (which will still produce positive placebo effects), using positive mantras to enhance self-esteem (which seem to trigger more negative thoughts and have a net negative impact on mood and self-esteem) or about expressing anger (rather than this being cathartic and leading to a reduction in anger, it actually increases it). Various fascinating examples are listed here. There is also the well-known Dunning Kruger effect, whereby ignorance also includes a lack of insight into our own ignorance. As a population, we consistently overestimate our own ability, with people in the bottom percentiles often ranking themselves well above average.

I often refer to the importance of knowing the boundaries of your own competence, and identifying your own “growing edges” when it comes to personal and professional development. We talk about the stages of insight and knowledge developing from unconscious incompetence to conscious competence, and finally to unconscious competence where we can use the skill without conscious focus. Confucius said “Real knowledge is to know the extent of one’s ignorance.” And it may well be that when it comes to solving some of the big problems we are limited by our own frame of reference, what we think of as relevant data, our preconceptions and our ability to build complex models. Using giant data sets and setting technology to sift through and make sense of them using various paradigms of AI might help open up new possibilities to researchers, or find patterns that are outside of human observation. For example, certain medications, foods or lifestyle traits might have significant impact on certain specific health conditions. I am reminded of a recent article about how a third of antidepressants are prescribed for things other than their primary function (for example, one can seemingly help with inflammatory bowel disease that has very limited treatment options). A computer sifting through all the data can pick up both these unintended positive effects and also rare or complex harmful side-effects or interactions that we may not be aware of.

What difference could this make in mental health? Well, I think quite a lot. Of course many predictors of mental health are sociopolitical and outside of the control of the individual, but we also know that some small lifestyle changes can have very positive impacts on mental health – exercising more, for example, or having a healthy diet, or getting more sleep, or using mindfulness, even just getting outdoors more, learning something new, doing something for others, or spending more time with other people (and less time on social media) can have a positive impact. There are also many therapy and therapist variables that may make an impact on mental health, for people who engage in some form of talking therapy, although variance in outcomes seems to actually boil down to feeling heard and believed by a therapist who respects the individuality and cultural context of the client. And of course there are many medical treatments available.

So is there a way of using big data to look at what really works to help people feel happier in their lives? I think the potential for apps to collect mass data and test out what makes impact is enormous, and there are a proliferation of apps in the happiness niche and more that claim to help wellbeing in a broader way. They seem to have found a market niche, and to offer something positive to help people make incremental life changes that are associated with happiness. What I’m not sure of is whether they reach the people that need them most, or if they are evaluating their impact, but presumably this is only a matter of time, as real life services get stripped back and technology tries to fill that gap.

I think there is huge need to look at what can make positive change to people’s wellbeing at a population scale, and I think we need to be tackling that at multiple levels. First and foremost, we need to make the sociopolitical changes that will stop harming the most vulnerable in society, and encourage greater social interconnectedness to prevent loneliness and isolation. We need to increase population knowledge and tweak the financial incentives for healthy lifestyle choices (eg with much wider use of free or subsidised gym memberships, and tax on unhealthy food options). And we need to invest in preventative and early intervention services, as well as much more support during pregnancy and parenting, and in mental health and social care. But I can also see a role for technology. Imagine an app that asked lots of questions and then gave tailored lifestyle recommendations, and monitored changes if the person tried them. Imagine an app that helped people identify appropriate local sources of support to tackle issues with their health and wellbeing, and monitored their impact when people used them. As well as having a positive immediate impact for users, I’m sure we’d learn a lot from that data that could be applied at the population level.

*I think the evidence is strong enough that the demographics who voted for these people/policies in the greatest numbers are the very people who have come out the worst from them, so I am just going to state it as a fact and not divert into my personal politics in this blog, given I have covered them in previous topics about Brexitmy politics, “alternative facts”, Trump, why and what next, the women’s march, and Grenfell and the Manchester bomb.

What is wellbeing?

A typical GP appointment is 7-10 minutes long. Therefore it was no surprise to me that when I started talking to my GP about my blood pressure a couple of months ago and diverted to talk about my lack of energy, I was referred to the “wellbeing worker” linked with the practise. There was a five week wait for an appointment. I sat in the waiting room at the designated time wondering if this was a new name for a practise counsellor, or an offshoot of IAPT linked to physical health, or whether it was a specific scheme designed to get people eating better and doing more exercise. When she invited me in the wellbeing worker introduced herself and said her remit was to work with people about “diet, exercise, smoking, drug use or to improve your wellbeing”. She asked me to rate my wellbeing on a likert scale for six variables.

So I diligently explained that since being rear-ended by a lorry 2 years ago, I have not been able to make a full range of movement with my left shoulder. This meant I had been unable to continue weight lifting. I also had to have 3 teeth removed and then had a very severe ear infection, causing some other health complications I detailed in an earlier blog. I told her that I have had intermittent earache, headaches, and a feeling of being underwater, which are exacerbated by changes in pressure or getting my ears wet so I had stopped swimming. I have also had ripples in my peripheral vision and a general lack of energy and motivation. I explained that the combination has meant that I had stopped my three times a week gym-and-swim habit and reduced to a fairly sedentary lifestyle with occasional longer walks.

I mentioned that been overweight for my whole adult life, and I had drawn some psychological links to the root of this. I explained that I am fairly comfortable with the idea of being overweight but that stress may have contributed to my more recent problems. I was of the opinion that there is clearly a significant physical component to my health issues, as it has transpired I am anaemic and vitamin D deficient as well as having high blood pressure. But I acknowledged that there is also a lifestyle component, as I had reduced activity and gained weight over the preceding months, and I acknowledged a substantial stress component too.

I noticed that the wellbeing worker had not taken any notes beyond “weight” and “exercise”, so I paused and tried to clarify her role. I asked what professional background she came from, expecting to hear she was a nurse, health worker or psychology graduate. “I’m an admin” she said, and explained that she had taken the job during a reorganisation, having been told that it was predominantly administrative. She said she had initially worried about what she would do if told about problems she didn’t know the answer to, but her manager had been reassuring that it wasn’t her job to solve everything and she could report any concerns to the appropriate person.

It turned out that her job was to identify which pathway to put people onto, from a choice of weight management, exercise, smoking cessation, drugs or alcohol and then fill in the paperwork to make it happen. She booked me in for the weight management group, and gave me a referral to the local council run leisure centre for 12 weeks free membership.

Don’t get me wrong, those things are good low-level interventions. The weight management group is friendly and non-shaming, even though it is pitched at a simplistic level, and I completely endorse exercise on prescription schemes for improving physical and psychological wellbeing. But where was the space to actually talk about what was going on my life? The website for the wellbeing service says:

‘Wellbeing’ means feeling happy, healthy and content in life. Our wellbeing can be affected by our physical and mental health, the people around us, the place that we live, the money that we have and how we spend our time. Our Wellbeing Workers can help you to identify and prioritise changes you might want to make to improve your overall health and wellbeing. They offer lots of support to help inform, motivate and empower you [including through] … Support with confidence issues and to improve self esteem

They offer services to reduce social isolation and assistance to address issues such as debt, housing and education (though this branch appears to prioritise people who have an intellectual disability or socio-economic deprivation) but the only mention of mental health or psychology is in relation to the specialist branch of the weight management pathway for people with BMI over 45 and those considering bariatric surgery. There are also leaflets linked from the weight loss section of the website which talk about “finding happiness” (helpful habits) and “mastering your thoughts” (basic CBT intro) and “relaxation and stress relief” (mindfulness, visualisation/anchoring, breathing exercises). But I was never even told these existed, and even when on the website I had to use the search feature to find them, and as far as I could tell there was no connection to the local IAPT service.

Six weeks later the wellbeing worker rang me up again, to see how I was doing. But again, she didn’t really want to know how I was doing psychologically in any meaningful sense. She wanted to know if I had followed the pathways she had offered. She asked me to give the six ratings again. It felt pretty hollow giving more positive scores, as I didn’t feel like the services provided by the wellbeing service were responsible for the changes – I had lost 10lb in weight before I joined the weight management group (and 2lb since), and feel better because I have more iron, more vitamin D, lower blood pressure, more energy and less pain.

So I was left feeling that it was a service that I was glad existed, but it seemed to tackle symptoms in isolation to their causes, and didn’t seem to connect physical and mental health. I’m guessing that is because public health is still local authority commissioned, whilst mental health is within the NHS. Wouldn’t it be nice if there was a single point of entry to this kind of wellbeing service and IAPT? Surely that would reduce stigma and mean that both symptoms and cause could be addressed, and patients would be able to tackle the interwoven issues of mental and physical health together.