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Mental Health Advice

For FRONTLINE WORKERS Please keep a copy of this

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Frontline workers are providing the most critical care to their community during the COVID-19 pandemic. This undoubtedly comes with enormous challenges. Over the weeks you may have noticed a significant increase in the levels of stress you are experiencing following the outbreak. It is essential that the different psychological responses to stress are explained to frontline staff. This pack will break down the ways in which stress can contribute to the development of stress disorders, and mood problems that may be commonly experienced by healthcare professionals during the COVID-19 response. This is not a self-diagnostic tool; the aim is to provide educational material that may help facilitate relief and support in managing your mental health. We appreciate you and we are all extremely thankful for everything you are contributing to our Island. Thank you to each and every one of you.

Contents Page

Stress  Post-Traumatic Stress Disorder 3 ‘In order for you to look after us, you also  4 need to look after YOU’  Watchful Waiting 4  Moral Injury 4  Resilience 5 5  Coping Mechanisms

Anxiety  COVID-19 and Anxiety 6  Generalised Anxiety Disorder (GAD) 6  6  Obsessive Compulsive Disorder (OCD) 6  Coping with Anxiety 7

Depression

and Low Mood 8

 Signs of Depression 8  Productivity 8  Coping with Depression 8

Grief

and COVID-19 9  Stages of Grief 9  Anticipatory Grief 9  Coping with Grief 9

Resources

10  Useful self-help Materials  Isle Of Man Local Services 10

11  Ways to Wellbeing

Created by: Mathew Drewy (Assistant ) Assisted by: Antonia Molyneux (Assistant Psychologist) Alyssa Isaac (Assistant Psychologist) Stress for over one month. Delayed expression of PTSD Stress is a of emotional and physical can occur if symptoms arise six months or more tension that arises during an event or thought following the onset of trauma. about an event that makes you feel frustrated, Individuals with PTSD will often re-experience angry, or nervous. Stress is your body's reaction to parts of the traumatic event especially when they a challenge, threat or demand. In short bursts, are exposed to events or objects reminiscent of stress can be positive, such as when it helps you the trauma. If you think about your current perform well at work or meet a deadline. working environment this may be more likely. Prolonged exposure to stress can have adverse Symptoms: effects and become harmful in a variety of ways. 1) The Stressor: when an individual is exposed to During COVID-19 you will be under more stress as death, threatened death, actual or threatened the demand on the health service increases, serious injury or sexual violence. This is through therefore it’s important to understand the ways in direct exposure to a traumatic event (it happened which stress may present itself and effective ways to you), witnessing the trauma, indirect exposure of coping. Stress can contribute to a variety of to aversive details of the trauma (this is common mental health problems… in a hospital settings) or learning that a relative or close friend was exposed to a trauma.

2) Intrusive Symptoms: that the event is being re- experienced though unwanted distressing memories, nightmares, flashbacks, emotional distress or physical reactivity.

3) Avoidance Symptoms: individuals make a concerted effort to avoid thoughts, conversations or relating to the event. It’s also common Post-Traumatic Stress Disorder to avoid people, activities or places associated Post-Traumatic Stress Disorder (PTSD) is a trauma with the traumatic event. and stress-related disorder that may develop after exposure to an event or ordeal in which death or 4) Changes in mood: people feel detached, numb severe physical harm occurred or was threatened. and have difficulty with memories associated with Hospital staff and essential workers all over the the event. A lack of in social activities, world represent the frontline against COVID-19. depressed mood and negative thoughts may also It’s commonly documented that due to this be present. disease, health care professionals are finding themselves overwhelmed with the numbers of 5) Symptoms: People notice heightened sick patients and COVID-19 related deaths anxiety, hypervigilance (being on high alert), alongside the about medical equipment outbursts of , being easily startled and sleep shortages. The additional risk of exposure to the disturbances. pandemic within your professional duties will Following a traumatic experience it is very normal undoubtedly be a challenging psychological for your body to enter a state of heightened experience as you are looking after sick patients, awareness. As you have been subject to a the health of yourself, colleagues and loved ones. threatening event, it makes sense that your brain and body feel the need to protect you. You will PTSD is often accompanied by depression and notice the physical sensations of stress due to the anxiety. Symptoms that develop immediately after cortisol levels in your body. This also changes your exposure to a traumatic event and persist for up perception and you may find yourself scanning for to a month, may be related to a condition known danger. Understanding that this is a biological as ‘Acute Stress Disorder’. PTSD is diagnosed when response that will subside naturally is very the symptoms following exposure have persisted important. 3

Acute Stress Disorder The acute stress response consists of a surge in rate, blood pressure, sweating, breathing, An acute stress disorder can develop following a metabolism and a tensing of muscles. person’s exposure to one or more traumatic Psychologically, is concentrated on the events. Symptoms may develop after an individual threat. After people experience a trauma, they either experiences first hand or witnesses a may be more vigilant for new threats and perceive disturbing event involving a threat of or actual constant threats in their environment based on death, serious injury, physical or sexual violation. assumed danger (due to intrusive memories or Symptoms begin and worsen after the trauma dreams) and therefore experience the acute stress occurs and can last from three days to one month. response more frequently than before. This is a Due to the nature of COVID-19, frontline staff are natural response that reduces naturally subject to distressing experiences as described over time (usually 2 weeks). above more often than usual. Acute Stress Disorder was originally referred to as ‘shell shock’ Watchful Waiting which was discovered when soldiers returned Although the changes in your mind and body feel home from World War 1. Our frontline staff are very distressing, every 2 in 3 people notice a viewed in a similar fashion. reduction in their symptoms within a few weeks and do not require treatment for PTSD or ASD. If Symptoms: you are experiencing mild symptoms of PTSD for Symptoms last a minimum of three days and no less than four weeks, monitor them carefully to more than one month after a traumatic see whether they improve on their own. You could experience. If symptoms persist, it’s possible that do this by writing down your experiences and you are experiencing PTSD. recording your stress response levels on a scale Acute Stress Disorder symptoms fall into five from 0-100%. If you would like a monitoring form categories: for watchful waiting, check the resources on page 10. There are techniques to manage stress 1) Intrusion symptoms: involuntary and intrusive responses on the following page. distressing memories of the trauma or recurrent distressing dreams. Moral Injury Moral injury is defined as the psychological 2) Negative mood symptoms: a persistent distress which results from actions, or inactions, inability to experience positive , such as which violate your moral or ethical code. Moral or love. injury can occur when a person is committing, failing to prevent, witness to, or learning about 3) Dissociative symptoms: time slowing down, acts that contradict deep moral beliefs and seeing oneself from an outsider's perspective, or expectations. This can be highly related to stress being in a daze. and due to the current COVID-19 outbreak, frontline workers may be at increased risk of 4) Avoidance symptoms: avoidance of memories, exposure to moral injury due to the pressures on thoughts, feelings, people, or places associated the healthcare system. Moral injury can cause with the trauma. strong emotions including stress, , anger and . These emotions can lead to increased 5) Arousal symptoms: difficulty falling or staying psychological distress. Moral injury is not a mental asleep, irritable behaviour, or problems with illness although it is important when considering concentration. People with acute stress disorder other mental health problems, such as PTSD. may also experience a great deal of guilt about not Those who experience moral injury may have having been able to prevent the trauma, or for not extreme negative self-evaluations, which being able to move on from the trauma more maintains psychological problems. You need to quickly. Panic attacks are common in the month consider the external pressures you are under at following a trauma. present and try not to internalise them or blame yourself. The next page will help you with this.

Resilience essential in promoting resilience. This means Psychological resilience is a skill that gives you the reminding yourself of what is important to you and ability to mentally and emotionally cope with the type of person you wish to be. stressful challenges. Resilience is increased when An Example: a patient may act aggressively a person uses mental processes and behaviours towards you whilst you are caring for them. that promote personal growth and self- Understanding that your patients will be stressed preservation. Learning how to manage situations and anxious may mean that they act in an in ways that promote effective recovery from undesirable way at times, it does not make you a them is essential in all health care professionals’ bad professional or them a bad person. Keeping work. When negative situations happen to us or calm and being kind are values you can remember around us, people begin to feel stressed, anxious that you have as a healthcare professional. This or notice mood changes. When we experience may promote internal appreciation for yourself such changes in our body, we don’t feel our and also have a positive impact on your patient. ‘normal’ selves. Our minds tend to start blaming ourselves, finding faults and flaws in the things we Other Coping Mechanisms: do. This is a common experience among people. 1) Spot the signs early: notice when you are Resilience skills teach you alternative ways of feeling more stressed and put things in place viewing situations, which allows you to bounce throughout the day that are likely to reduce stress. back more effectively from challenges. Working in Plan your breaks before your shift. your profession is a challenge and don’t Eat, sleep and drink the usual amount in order to get it perfectly right every time. Skills that will help maintain your body’s natural rhythm, it’s easy to promote personal growth and effective recovery forget this when you are stressed and doing long include: shifts. Meet with management and colleagues regularly 1) Thinking flexibly: there is something to be to ensure you are all getting the right amount of learned from negative situations when they arise, professional support/supervision and breaks. such as - what would you do differently in the Communicate with friends and about how future? Understanding there is more to a negative you are feeling. This will help with moral injury. situation than yourself, such as the wider context Talking to others gives you some perspective and e.g. the pressure you are under, the circumstances provides relief. you are in, the breakfast you skipped or the Any form of exercise helps relieve stress. awkward conversation you had five minutes ago.

There are tools in the resource section on page 10 2) Avoid Negative Coping Strategies: The use of to help with flexible thinking. alcohol, illicit drugs, or excessive amounts of prescription drugs, which all interfere with sleep 2) Acknowledging your success: there will be cycles and prolong recovery from stress. Other many times you have done great work and been negative strategies include: given feedback. When people are stuck in Negatively assessing work contributions. their emotions they don’t think of their Keeping too busy. achievements and find it hard to do so. In order to Viewing others as more important than self-care. promote effective recovery from negative Negative self-talk: “It would be selfish to take time to situations, looking at your achievements will help rest.” or “Others are working around the clock, so relieve the psychological pressures and judgments should I.” that people place on themselves. 3) Breathing and : this helps regulate 3) Finding purpose and meaning: Being able to stress . For more tips on this view the make sense of what is happening and to find resources page on page 10. meaning in it is critical if you want to able to manage the feelings that arise in a crisis. 4) Cognitive Behavioural Therapy (CBT) can help Responding to a crisis through your values is with ASD and PTSD, for CBT self-help materials see page 10. 5

Anxiety Anxiety shares similarities with stress in terms of Symptoms: the physical symptoms people experience. Both 1) Psychological: Inability to control excessive can lead to sleepless nights, exhaustion, , worries. Catastrophic thinking and difficulty poor concentration and . Stress is a concentrating. response to a threat in any given situation, 2) Physical: Headaches, fatigue, muscle tension, prolonged stress can lead to the stress related sweating, rapid , nausea, breathing conditions described above. Anxiety, on the other difficulties, light headedness and stomach hand, is a sustained mental health disorder that problems. can be triggered by stress. Anxiety doesn’t fade once the threat is mediated. Anxiety is a long term 3) Behavioural: Avoidance of places or people. condition and can cause significant impairment in social, occupational and other important areas of Anxiety disorders are complex and result from functioning. various factors including genetics, behaviours, development and other social, cultural and COVID-19 and Anxiety environmental factors. Risk factors for developing Frontline staff may be experiencing anxiety, GAD include a family history of anxiety, and recent therefore knowing ways in which to manage or extended periods of stress throughout life. anxiety is essential. As you are routinely exposed Right now is a very stressful period for you all. On to various risks and responsibilities you may notice the next page are effective tips for managing excessive amounts of tension and worry about anxiety. different things. Example of Anxiety: Panic A panic attack is when your body experiences a Anxiety Cycle ‘’I won’t know what to say and I of intense mental and physical symptoms will look stupid’’ associated with and anxiety. It can start very quickly and for no apparent reason. During times of intense pressure and threat, panic attacks can Avoid speaking Anxious occur. Most panic attacks last for between 5 and to colleagues Embarrassed 20 minutes. Although panic attacks are frightening, they're not dangerous. An attack won't cause you any physical harm and it's unlikely that you'll need hospital care as the symptoms Generalised Anxiety Disorder (GAD) subside naturally. You may be diagnosed with Generalised anxiety disorder is a chronic state of if you experience recurrent and worry and tension. People who are with unexpected panic attacks followed by at least a GAD regularly anticipate danger and worry in month of continuous worry or concern about relation to various things including health, money, having further attacks. family or work. Frontline staff are exposed to COVID-19 daily which comes with the risk of Obsessive Compulsive Disorder (OCD) infection, you may need to isolate and not see COVID-19 may impact OCD symptoms as people your family. Some of your family members may try to reduce the risks of infection through not be working which creates financial struggles handwashing, cleaning and social distancing. The and so on. It’s important to know the distinction media coverage of COVID-19 means we are between worry and GAD. Worrying more than subject to distressing information which reinforces usual is natural when faced with the challenges our need to protect ourselves. Frontline workers you are presented with at present. may put an inordinate amount of pressure on Six months or more of chronic, exaggerated worry themselves to protect themselves, their patients, and tension that impairs social and occupational and other colleagues. Obsessive functioning could mean you are experiencing GAD. compulsive disorder (OCD) is a common mental health condition where a person has obsessive thoughts and compulsive behaviours. For example, if you think about becoming infected 2) Reframing Thoughts: when you feel anxious and causing harm to others, you may engage in and worried, your thoughts can be more relentless behaviours to try and prevent harm to exaggerated. This is a survival mechanism, as others, such as cleaning, disinfecting and checking people may believe that thinking the worst for symptoms in various ways and so on. This could protects them from experiencing it. However inadvertently increase and maintain anxiety. thinking the worst itself leads to unhelpful emotional and behavioural responses. If you look Perfectionism: remind yourself that no one can at the ‘anxiety cycle’ on the previous page this protect themselves “perfectly” from COVID-19 explains that process. Pay attention to your within a hospital environment and no one expects thoughts and ask yourself questions such as: you to. Setting yourself overly high expectations  Is this thought entirely true? increases pressure and anxiety which you do not  Is this thought based on anxious feelings? need to add to yourself right now. Times like these  Am I seeing the full picture? call for you to be realistic with yourself, try to These questions will help you reframe the realise your remit of control instead of jumping to thoughts and help change the way you feel and perfectionistic extremes. OCD seeks for certainty, behave. For more resources on reframing comfort, and control which is highly unrealistic thoughts, check the resources page 10. during a pandemic. Anxiety Cycle: ‘’I have something helpful Harming others: Be mindful that OCD may take to contribute’’ advantage of COVID-19 fears by telling you that you might have infected someone or that you are Content going to infect someone in the future, whether Speaks to colleagues Satisfied accidentally or on purpose. If you’re noticing these intrusive thoughts, or that you’re doing 3) Let go of the need for certainty: this situation is compulsions related to these thoughts, use the techniques on this page to help reduce the scary because of the unknowns, however you have intensity of them. huge muscles for tolerating uncertainty already. The profession you are in already comes with a Coping with Anxiety level of uncertainty. You drive a car every day and 1) : Anxiety is not an enjoyable that’s one of the most dangerous and uncertain experience and it’s normal to wish you didn’t feel activities people do. You willingly accept that anxious. Anxiety is a very natural human function uncertainty without even thinking about it. While that comes from a place of fear and protection. we have some control of our actions, we have Labelling your anxiety as ‘bad’ or ‘threatening’ almost no control over results. We can follow means you may try to get rid of it. Fighting anxiety guidelines such as practice social distancing but we means our brains perceive anxiety as a ‘threat’ and could get sick or spread coronavirus to others. produces more stress chemicals into your body Beyond our immediate actions, the outcome is out which makes you feel more anxious. of our control. Accepting this lack of control is empowering instead of exhausting yourself trying

Notice when you feel anxious and describe it to micromanage everything you do and then without judgement. ‘I feel anxious, I am noticing blaming yourself when things go wrong. butterflies in my stomach, this is a normal response that many people experience, and I’m not 4) Self-: do not get this confused with the only one’. When you identify it, do something self-. Self-compassion are the skills you already to help ease the feelings. Place your hand on your have practiced on yourself. Would you speak to stomach or imagine breathing into the areas your patient, friend or family member the way you where you feel tension and releasing it. Talk to a talk to yourself? For more tips on developing friend or colleague about your experiences with compassion see page 10. anxiety, they probably feel it too! If you have time 5) Breathing Techniques and Relaxation: see on your breaks during shifts, give it a try! more of these techniques on page 10.

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Depression and Low Mood maintain normal, everyday life. If you feel your mood is effecting your productivity at work, speak Most people feel sad or depressed at some point to a trusted member of the team about how you in their . It’s a normal reaction to loss or life's are feeling. Ideally, you want to be carrying out difficulties. Depression can be more common your duties as effectively as possible. When you among frontline workers as they may experience a are feeling low and you notice you are struggling, high levels of stress. In its mildest form, depression try not to force yourself and increase the pressure, can mean just being in a state of low mood. It this may exacerbate the problem. Spot the signs doesn’t stop you leading your normal life, but early and use the methods already described on makes everything harder to do and seem less page 5 and 7 to help you intervene early. worthwhile.

At its most severe, depression can be life- Coping with Depression and Low Mood threatening, causing you intense , 1) Acceptance: as described on the previous page, including feeling helpless, hopeless, and changes in mood are a natural response to stress. worthless. Depression is a mood disorder that Acceptance doesn’t mean liking these mood affects the way you think, feel, and behave, with changes, it means being ok with them because psychological, social, and physical implications. they happen. Our emotions fluctuate all the time. Acceptance comes from being with the experience Signs of Depression of your emotions and mood without judging Common Thoughts Common Feelings yourself. “I’m messing it up” Down 2) Self-compassion: when people struggle with “People don’t understand” Upset low mood, they may find it difficult to be kind to “I don’t enjoy anything” Lonely themselves. Compassion is the ability to find a way “I can’t do things right” Guilty to respond appropriately to yourself during times “I’m not worth anything” Worthless of discomfort. Simple acts of self-care “Everything is hopeless” Empty demonstrate towards oneself; so treat “Things will never change” Numb yourself to some ‘you’ time! Stop judging yourself Common Physical Signs Common and think about how you would respond to your (Brain and Body) Behaviour best friend or family member if they were Concentration difficulties Isolate self experiencing the same. Don’t be afraid to talk to

Loss of libido Avoiding social others about how you feel. See the compassion Thinking changes events resources on page 10. Sleeping too much (or little) self-care 3) Behavioural Activation: There are certain More or less appetite Drink & Smoke behavioural exercises for low mood and Weight changes Drug use depression that you can employ in order to Aches and Self-harm improve how you feel. When completing a task that gives you a sense of and

achievement, this will lift your mood. Activities A combination of interacting factors contribute to that give you this sense can be anything that works the development of depression in an individual. A for you. Exercise, home tasks, personal goals or biological or genetic predisposition is triggered by family time are some examples. For more an event or external factors or a combination of resources on behavioural activation and activity external factors that ‘build up’ over time. scheduling check the resources on page 10. Repeated stress can cause depression as stated 4) Reframing thoughts: as mentioned in the earlier, when we don’t feel our ‘normal’ selves, we ‘coping with anxiety’ section, reframing thoughts tend to find the faults and flaws within ourselves is essential to improving our mental health. and our behaviour which reinforces the low mood. Thoughts are automatic and we often sit with Productivity them instead of exploring them. Find reframing Frontline staff may be more at risk of developing thoughts exercises on the resource page 10. low mood or depression because of the exposure to death and moral injuries (such as lack of time and resources) whilst having to balance and COVID-19 and Grief Sadness: This happens when sets in, you The global coronavirus pandemic has created a may notice that it took some time for you to feel sense of grief and loss for many people, firstly sad about all of this. People can feel helpless and because of the sheer number of deaths the virus disempowered when coming to terms with all they has caused. However, death is not the only type of have lost. This can cause low mood and loss that can lead to people experiencing grief. depression. People have suffered losses in different aspects of their lives, such as their jobs, normal routine, Acceptance: this comes from the travel plans, celebrations, school events and acknowledgement of the facts and the realisation finances etc. This has created a sense of that this is reality in the present. When you feel and individual grief for the things people had and acceptance, you are no longer fighting and the way things were before the pandemic. increasing your suffering. It helps you deal more effectively with what has happened and what is Stages of Grief happening. Acceptance looks like ‘I can’t control Grief is a complex state that encompasses lots of the pandemic, but I can do my part’ or ‘perhaps we different emotions and behaviours. People react will be kinder to each other when all this is over in many different ways following a loss and their and appreciate each other more’. reactions can change over time. There are several components to grief that people may experience Meaning: this is where people can turn their at any given time, the stages are not linear and you experience into something that they learned from may fluctuate through them at different times. which helps create a more meaningful life. This instils peace and for the future and builds on The fluctuating stages of Grief: (David Kessler) psychological resilience. Denial: This is the intellectual and emotional rejection of something that is clearly happening. Anticipatory Grief Emotional can be denied as a form of This type of grief is an anxiety that centres on protecting ourselves from the emotional pain death. If you are on the frontline working with itself. You may say things like ‘this whole thing is a people who are infected with COVID-19 you may scare mongering tactic’. be experiencing this type of grief. This could also occur if a close friend or family member receives a Anger: When something is taken away from a diagnosis. Collectively there is a loss of safety and person, they feel the need to ‘bite back’ and can this creates a natural sense of fear. For helpful tips become hostile, blame others (particularly those on how to manage this type of grief look back at making the most difficult decisions) and the ‘coping with anxiety section’ and check the sometimes refuse to comply with the rules. Anger resources on page 10. may look something like a post or comment on social media. It could also be going against the Coping with Grief advice you have been given. It is important to remember that you need not judge your emotional experiences. The stages of Bargaining: This occurs when people see the grief can happen at any time to anyone. If you feel reality in what is happening and realise that they you are going through this try to harness have no control. This can cause anxiety and you acceptance, this is where the power lies. You can may find you start to compromise with yourself to also take the time to look at what you have ease the emotional pain. Such as telling yourself learned as a result of the pandemic, has it helped ‘this will be over soon’ or ‘I know when people look you realise your personal values or goals? Is there sick’. something you will appreciate more when things improve? Finding meaning in the situation helps relieve negative feelings. Please use the other methods of coping techniques throughout the booklet. Check the resources on page 10.

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Thinking Flexibly and Reframing Thoughts Resources: Online and Local Support Monitoring Thoughts: Stress Resources https://www.oxfordclinicalpsych.com/view/10.1093/m PTSD and the brain: ed:psych/9780195327908.001.0001/med- http://www.brainblogger.com/2015/01/24/how-does- post-traumatic-stress-disorder-change-the-brain/ 9780195327908-interactive-pdf-005.pdf

Watchful waiting monitoring forms: Rational Thought Replacement: https://www.oxfordclinicalpsych.com/view/10.1093/m https://www.oxfordclinicalpsych.com/view/10.1093/m ed:psych/9780195327908.001.0001/med- ed:psych/9780195327908.001.0001/med- 9780195327908-interactive-pdf-006.pdf 9780195327908-interactive-pdf-002.pdf https://www.oxfordclinicalpsych.com/view/10.1093/m Challenging thoughts: ed:psych/9780199917532.001.0001/med- https://www.talkplus.org.uk/downloads/Cognitive%20 9780199917532-interactive-pdf-002.pdf Restructuring.pdf

https://www.oxfordclinicalpsych.com/view/10.1093/m 10 Common reactions to Trauma: ed:psych/9780195311341.001.0001/med- https://www.oxfordclinicalpsych.com/view/10.1093/m 9780195311341-interactive-pdf-004.pdf ed:psych/9780199334513.001.0001/med- 9780199334513-appendix-9 Understanding CBT: https://www.getselfhelp.co.uk/cbt.htm

Behavioural Activation Local Services and Useful Contacts Activity Log: Staff Welfare: https://www.oxfordclinicalpsych.com/view/10.1093/m 01624 687027 / [email protected]

Staff Welfare is for all government employees to access ed:psych/9780195327908.001.0001/med- 9780195327908-interactive-pdf-001.pdf if they need support with a work related or personal problem. Exercise Log: https://www.oxfordclinicalpsych.com/view/10.1093/m Victim Support: ed:psych/9780195382266.001.0001/med- Tel: 01624 679950 / https://www.victimsupport.im

9780195382266-interactive-pdf-015.pdf Victim Support is an Isle of Man , which offers free and confidential help to victims and witnesses of Daily Planner: crime. They provide support for people affected by https://www.oxfordclinicalpsych.com/view/10.1093/m Crime, Death by Road Traffic Collisions, Unusual Death ed:psych/9780195382266.001.0001/med- or Domestic . 9780195382266-interactive-pdf -017.pdf Motiv8: Tel: 01624 627656 / https://www.motiv8.im Breathing and Relaxation Exercises Motiv8 are a dedicated team of highly qualified and experienced counsellors who specialise in addiction. Relaxation Practice record: https://www.oxfordclinicalpsych.com/view/10.1093/m ed:psych/9780199917532.001.0001/med- CRUSE Bereavement Care Isle of Man: 9780199917532-interactive-pdf-004.pdf Tel: 01624 668191 / https://www.cruseisleofman.org

Cruse Bereavement Care exists to promote the well- YouTube Breathing Exercises: being of bereaved people, and to enable anyone https://www.youtube.com/watch?v=nmFUDkj1Aq0 bereaved by death to understand their grief and cope https://www.youtube.com/watch?v=SEfs5TJZ6Nk with their loss.

Self-Compassion Exercises Hospice: Tel: 01624 647400 / www.hospice.org.im https://www.getselfhelp.co.uk/docs/Compassion.pdf Our aim is to improve the quality of life for those

affected by cancer and other life threatening illnesses https://self-compassion.org/wptest/wp- by meeting their physical, emotional, social and content/uploads/self_compassion_exercise.pdf spiritual needs.

Local Services and Useful Contacts Simple Steps to Wellbeing

Isle of Man COVID-19 Support Lines: Eat Well and Stay Hydrated Tel: 687005 for emotional support  Ensure you have the means to get food and Tel: 686262 for practical non-medical advice supplies for yourself.

 You can go to the shop or ask a friend to help Police domestic abuse officer: you, you can also arrange a delivery. Tel: 631495  Try to get your 5 a day!

 If you don’t have the right amount of nutrition Help Out Isle of Man: you won’t feel yourself and may not perform at Tel: 033 00 88 7224 /Email: [email protected] your best. Web: https://helpout.im/wellbeing/  Keep hydrated, this helps maintain focus. Not drinking enough can make it difficult to Mental Health Services: concentrate. Web: https://www.gov.im/categories/caring-and- support/mental-health-service/ Hold Regular Check -INS Crisis Response and Home Treatment Team (CRHTT)  If you are a senior member of staff, arrange Tel: 01624 642860 team meetings regularly in order to help you all The crisis team is accessible if you feel an urgent need feel supported by each other. Staff wellbeing is to contact someone due to worries about your mental a priority. health and wellbeing.  If you are not a senior member of staff, recommend this to your manager. Community Wellbeing Service  Checking in regularly with your team with Tel: 01624 642540 boost morale and improve communication. This service is specifically for those experiencing mild to  Regular check-ins give you a space to talk and moderate mental health problems. reflect on your experiences.

Community Mental Health Team for Adults up and ‘’ Tel: 01624 616313  Although you cannot see your friends directly, This is a high intensity specialist service for those with you have access to different media platforms severe and enduring mental health conditions. that can increase connection.  It’s important you still communicate with your friends to provide a space for yourself where you can talk to them about how you are feeling and what’s been going on for you.  Remember it’s at the touch of a button.

Get Out  Although there are restrictions in place, try to get out of the house when you can. Fresh air and some sunshine are mood lifting.  Take yourself for a walk, a bike ride or a run.

Sleep Routine  Go to bed at the same time.

 Remove distractions from the bedroom.

 Have a similar routine before bed.

Thank you!