Doing Lockdown 2.0 case management-style

A guide for professionals

Just when you feel you’ve already done a long-distance ride…

This weekend, we heard Bojo announce a second national lockdown for England. Did anyone see that coming? Of course we did! Nonetheless, did you still feel that pit-of-your-stomach immediate “oh no” response in your stomach that overtook over everything despite you being proved right? If you’re like me, you probably had a similar reaction, too.

While we might have been anticipating this government announcement for some time now, I was surprised how anxious I felt and I immediately started communicating with my team regarding planning the weeks ahead. The urge to spring into action as if this was a brand new experience is a classic health professional move. We know that our clients are vulnerable and complex with complicated systemic elements that require thinking really hard about. And we have learnt, armed with the knowledge that lockdown was tough for a lot of individuals and communities, that this is a time to put our foot down.

The pressure of needing to respond to client needs while also managing one’s own family’s reactions to another lockdown can be immense and I suppose there’s an expectation that we should know what we are doing by now. The fact is, I’m not sure anyone knows what to do in a pandemic lockdown, but I can guarantee that those working with high-risk clients will be amongst those who will give Lockdown 2.0 a good go. But, will we ever be relieved of the anxiety associated with this government intervention?

There is a very good reason we may be feeling anxious and possibly overwhelmed at the prospect of another lockdown: it’s about trauma and how trauma is processed. The April lockdown for many has been traumatic and threatening, threatening to life, our livelihoods and futures — for many, it was a deeply distressing emotional experience which needs to be acknowledged.

What trauma does to those who experience it is fall into autopilot mode. It is a survival response to effectively help us stay alive. It is not until things become calmer that the mind realises what has happened and that is when the waves of anxiety can flow over needing some address to process the events. When the distress is not adequately processed, we can get stuck in these feelings which affect our mood on a more long-term basis.

Start with yourself

If you are feeling the anxiety or even panic, I urge you to stop and take a moment to pause and reflect. This brings to mind the “eye of the storm” mindfulness exercise idea in which you are encouraged to focus inwardly while the threatening factors are perceived to loom outwardly.

As a Case Manager, you are likely to be the first port of call for your worried clients and the care teams so it is important that you feel you are responding from a place of as much calm and groundedness as possible. You cannot help someone when you yourself are not in the best place you can be in the circumstances. So, take some time to sort your own house out first, metaphorically-speaking. Have you got your and your family’s needs sorted? Is there anything you need to do to make the next month easier? Can you revisit those activities and strategies that helped you through the last lockdown? Can you mobilise your support network to help one another through this next period? Can your loved ones be asked to consider the impact the last lockdown had on you and ways that you together can make it easier for each other?

Selfish or as irrelevant as it might seem, taking this time to regroup with yourself and family is core to the sustainability of anything more that you take on professionally. Your mental wellbeing needs this investment because the ride may well get bumpy at times, as much for you personally as well as professionally. Do look after yourself, too.

Learnings from last lockdown — you may not know that you probably already have your own toolkit

In keeping with this reflective theme, when ready, shift the focus to clients on your caseload. In the thick of it, it can be really tricky to remember everything that was helpful and avoid everything that was unhelpful during the last lockdown. You’re less likely to get the best out of the situation if you’ve not had a chance to think about it beforehand. Maybe this ‘shifting reflective’ process will be helpful to your preparation and practice to help you reconnect with what made sense at the end of the previous lockdown chapter.

Write down each client’s initials in a table on a piece of paper and do a rough, broad analysis using these guiding questions:

• What was helpful last time?
• What worked? What did not work?
• Did any discussions happen that made you think “I’m remember that for next time!”?
• What feedback did you get from the care team?
• Were there any comments from fundholders?
• What did/does your client/family say about the previous arrangement?
• Did you come across any particularly important resources?
• What might the barriers be this time?

Develop a culture of focusing on achievable and controllable goals

One thing I noticed during the last lockdown was how unaccepting some people were of the restrictions and how they were probably the most stressed of all of us. It’s a classic human response to focus on things we can’t change which leads to uncomfortable feelings of frustration, annoyance and hopelessness. These feelings are really destructive in a care team environment because they charge up colleagues in an unhelpful way or result in a sort of resignation about the whole situation. As professionals involved in the management of clients’ needs, we are often asked to “fix” these intra-team problems in a fire-fighting way, knowing all the while that the issues will resurface.

Research also tells that the paradox of surrender is at play here: in order to gain control, we have to let go of control. Fostering a culture of taking responsibility for how we feel and focusing on what we can do in the short term for our clients/ families will help us feel more in control of our mental health, which is empowering and strengthening. Try some of these ideas for yourself and with your care teams:

• Set small, achievable goals that are focussed on improvements to the wellbeing of your family, clients or teams in some way.
• Co-create a structure during lockdown with your family or client and care teams that will consider all needs in a realistic way. Once approved (if requiring financial assistance), communicate it often and perhaps even visually on the fridge at home or in the care plan folder, if at work.
• Share the successes from the new regime and feedback positives regularly.

Keep talking to your clients, care teams and legal professionals

We know that by talking to others, we put ourselves in a space that protects us from isolation and shutting down emotionally. So, a different side of the same coin is that by talking, we also help bring people out of their potential withdrawing to remain connected with us. The double-impact of helpful Oxytocin release becomes a win-win situation for all and allows us a better chance to survive any challenges ahead.

In Case Management, continually talking to our clients, their families and care team can do the same for them. We help build trust, care and support at a time that we need it the most. From a systemic perspective, we know that traumatic responses can negatively affect dynamics and communication which put any group of people (families, care teams, colleagues etc) at risk of developing disconnect, stress and burnout. Using strategies that mitigate some of these responses would be beneficial to your client, family and care teams.

Some known helpful ideas include:

• Consistent support is usually associated with better outcomes. Are there ways that you can provide consistent support that is manageable?
• Taking a systemic approach is also known to improve outcomes. Are you in touch with the different groups around your client? This is particularly important for high risk clients.
• Direct time is associated with stability. Consider holding weekly team meetings to check in with your client and the care team, via online videocalls.
• Ensure your therapy and care goals are reviewed with the client/family/care team and any changes have buy-in from your clients and their therapist.
• Keep the legal teams informed of plans and make clear the aims.
• Make space for regular reflections and learning including for yourself (it’s a very powerful intervention for openness and growth when a manager is able to share their own limitations within a team).

Self-care and maintenance for yourselves and those we work with

Given the topic in the first idea above, self-care had to feature. There are a lot of psychological ideas that we can consider in this section, but I’m keeping in simple to remind us of two basic things we can do for ourselves.

Diet

We all know of the benefits of a good diet and keeping hydrated and positive impact these building blocks have on energy levels. This will probably always remain the case and will probably always be true! Feeling energised is crucial in pushing us through this next lockdown so we come out the other end less exhausted. Encourage you and your care teams to make just one healthy change to or maintain one healthy habit in their diet that will allow them to feel in control and aware of the impact of Covid on them. Even if you/they don’t manage it for the duration, some values-based living opportunities might be adopted better in the future.

Exercising

As we remain indoors not moving too much, our endorphine levels tend to drop, our thinking can seem less clear and our mood can plummet. Movement is key to upping those necessary hormone levels to allow us to perform better at our job, but also to ward off low moods. We typically hear of 20 minutes of exercise a day as being enough to have a positive impact so consider encouraging yourself and those you work with to adapt their daily routine to include an exercise feature — be it online or just going for a walk outdoors.

Hindsight and second chances can be wonderful things and perhaps 2.0 can be seen as an opportunity to revisit the good, the bad and the ugly aspects of the last episode with an open mind and revised ideas to get you and your clients through this time, too. I have every faith.

For more advice and support, visit the NHS website for national and local organisations and helplines. However, should you, your clients or care teams need some additional input, feel free to be in touch with us at PsychWorks Associates, a specialist psychology service for case management.

Wishing you, your clients and their families and care teams the very best wellbeing.