Community Mental Health and Social Care Approach

Design the approach going forward with community mental/emotional health, citizenship, and social care equity at the heart. It is extremely important to address the emotional crisis that is emerging, particularly those who rely on social care from a community-based perspective. All of these suggestions from our collective are from this orientation.

Why the contribution is important


This current physical health situation is also a crisis of emotional health and emotional isolation, and therefore we will need considerable psychological support for:

• Those self-isolating, or living alone
• Those who care for others in their homes
• Those experiencing domestic abuse
• Those with a history of MH problems (there will be significant disruption to the care they rely on for many months to come)
• Those with a history of childhood adversity and trauma
• Those who have become vulnerable to the risk of suicide due to economic factors, loneliness and despair

There needs to be an innovative dynamic assessment and triage process that can respond with a range of services, from initial crisis support, mental health first-aiders to ongoing relational counselling and therapy available. Measures need to be in place for an interim programme of supports, with tiered services community-based support to the most vulnerable and phasing new assessment programmes to assess those more vulnerable initially.

Teenagers are a very vulnerable age group and need to be communicated with directly on a platform they relate to. Explaining the process of easing restrictions and continued awareness as this group struggle significantly with lock down and being unable to see their friends and partners. This group is also highly vulnerable to suicide, and innovative attempts to link in with those who are more vulnerable and isolated are required. Perhaps also provide clear support and advise to those significantly self-harming.

Ultimately, the most important messages for mental health support during/post pandemic are as follows, and should come from Scottish Government communications:
• Worry, anxiety and even despair at at times is a natural response
• You are not alone - there are others who want to and can help
• It is important to understand how you feel - acknowledge and allow your feelings to come up
• Access support - it is okay and courageous to ask for help
• Self-care - look after yourself by really limiting your exposure to TV and News. Walk and move (physical regulation), breathe and meditate (emotional regulation)

Promote Good Mental Health through Physical Exercise
• Ease lockdown to enable participation in more outdoor activities - solitary ones could be unlimited, those with other people such as hiking, hill walking to either be done with friend/family bubbles or with household members
• More than one period of exercise each day encouraged
• Organised outdoor activities that also support the wider community - for example berry picking

Promote Good Mental Health through Human Contact
• Extend family unit contact beyond household – for example grandparents to see children and grandchildren should they choose (this could include childminding). This would not only help mental health of grandparents but will also provide much needed support to parents who are working from home and looking after children

Proactive Mental Health Support
• The paper refers to the drop in numbers using NHS. Should explore proactive mental health support to vulnerable or those that are shielding – more agency to local councils to support this

Support to use Technology to Reduce Isolation
• The use of virtual communication packages can go some way to ease the impact of isolation. Financial support would help those who do not have access to the necessary technology such as tablets. Perhaps community initiatives could be established to offer support to people with this

Balancing Other Effects of Social Distancing
• Unintentionally, many people will have registered the social distancing guidance from a place of fear. Language should be changed to refer to physical space as opposed to social space. Some citizens tend to operate from a fear-based hostility while getting exercise, or shopping etc. To address this, active encouragement in government communications should be made for citizens to look at each other in the eyes and engage with fellow citizens when outside of the home, and engage with extra warmth and kindness, while keeping safe space.
• Facemasks, particularly homemade cloth facemasks, also are unnecessary for those who do not have any symptoms as the virus is not airborne, and can also create a sense of collective subconscious un-ease. No studies highlight benefits of community members of wearing masks for disease prevention. To ensure mask availability for those who need it e.g. emergency workers, masks should be voluntary from now on


Resuming Care and Support
• If people needed care and support prior to lockdown they will almost certainly be in more need of it now. This needs to be a priority to prevent the further deterioration of mental and physical health (given the lower baseline some people went into lockdown with) but also for the sake of family members who are thrown into caring roles they feel unprepared and ill equipped for. The timescale of lockdown might make carers of people with dementia or severe learning disability or chronic mental health problems feel that they have been abandoned as much as their loved ones. It is very easy for people who cannot access any respite (not even to go for a walk on their own if their loved one needs 24 hour care) to go into a downward spiral of hopelessness and despair which might be difficult to get out of. During these uncertain economic times many vulnerable, ill and disabled people and their carers will have experienced, or be fearful of experiencing, cuts to their benefits and care packages. Reassurance (if possible) that appropriate levels of financial and other support will be reinstated in a timely fashion would be helpful to many. Lockdown is definitely more challenging for some sectors of society than others and guidance needs to be flexed sensibly and on a case by case basis.

Social Care Packages
• Many social care packages rely on access to community centres and local amenities which are not available yet. Individual circumstances need to be taken into account and proactive work should be introduced to support social care providers to deliver a service within the current restrictions.
• Often care packages for people with learning disabilities, autism and dementia are costed on the basis that the person’s social contact will be provided in a group setting, thus reducing the cost. As group contact is not currently an option, the most vulnerable people will require adjustments to their care plan to reduce the impact of isolation, such as increased one to one time with social care workers. Social care funding needs to be reviewed and adjusted to accommodate this.

People Living in Care Homes
• Similarly, if social distancing continues, greater consideration should be given to the impact this will undoubtedly have on the mental health of those living in care homes. Clear guidance and support should be given to ensure care home staff have the necessary resources to ease the burden of imposed isolation and ensure that those living in care homes have an acceptable quality of life.
• For those working and living in residential care settings, testing for COVID-19 should be voluntary and available on the basis of contact tracing, rather than testing only those displaying symptoms. This might reduce the rapid spread of infection within care homes and go some way to reduce stress levels of care workers and relatives.


Test, Trace, Isolate and Support
• We are concerned that some people in society will really struggle with the need for potentially repeated periods of 14-day isolation which come out of the blue. People on the autism spectrum, people with learning disabilities and people with dementia are likely to struggle to understand the rationale for severe restrictions to their freedom and changes to their care and daily routines. This has a huge impact on carers who will bear the brunt of frustration and fear whist trying to contain and care for their loved ones. Testing should be prioritised for some sectors of the population who voluntarily sign up to contact tracing so that they know immediately whether the 14 days of isolation need to be borne or not.
We are keen to hear more what the support provided to people during their isolation might look like. Could it be that the most vulnerable people, (perhaps those with other illnesses, mental health issues, without access to outdoor space) “decant” for their period of isolation to places with more space and a garden?

Current Restrictions
• Specific guidance from government on the What, Why and When around the loosening of restrictions would be very helpful to citizens who want to be responsible and stick to the rules but who also know that they and their loved ones cannot abide by current lockdown measures indefinitely. If specific guidance isn’t issued people will begin to flex the rules in their own way, hoping not to do harm, but doing it anyway as they try to balance their civic duty with the loneliness of their elderly relatives and the needs of their children and young people to play and interact with their peers. Bubbles seem like a sensible option but only if suggestions are made available so that people can operate them sensibly. Simple things might make a difference; such as suggesting that family groups or bubbles walk in single file in public places where they are likely to be passing people, clarifying that bubble gatherings are best to place in gardens or outdoor spaces, specifying the suggested maximum no of people who are to group together at any one time.

by Trapeze on May 11, 2020 at 08:14PM

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Based on: 4 votes


  • Posted by LauraMac May 11, 2020 at 20:37

    An excellent and comprehensive suggestion. The mental health side effects and consequences of lockdown are severe, and have so far been completely ignored the the Scottish and Westminster governments.
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