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Guidance for the public on the mental health and wellbeing aspects of COVID-19

Yokel

LE
Seen on the workplace advice pages, but I thought that it deserves a thread of its own.

Guidance for the public on the mental health and wellbeing aspects of COVID-19

What you need to know​

The coronavirus (COVID-19) outbreak is having an impact on everyone’s daily lives, as the government and the NHS take necessary steps to manage the outbreak, reduce transmission and treat those who need medical attention.

It may be difficult, but by following government guidance, you are helping to protect yourself, your family, the NHS and your community.

During this time, you may be bored, frustrated or lonely. You may also feel low, worried, anxious, or be concerned about your health or that of those close to you. These are all common reactions to the difficult situation we face. Everyone reacts differently to events and changes in the way that we think, feel and behave vary between different people and over time. It’s important that you take care of your mind as well as your body.

Most people will find strategies that work for them and the difficult feelings associated with the outbreak will pass. Some people, especially those with pre-existing mental health problems, may need extra support.

Background​

This guide provides advice on how to look after your mental health and wellbeing during the COVID-19 outbreak[footnote 1].

For other guidance on how to protect yourself and others, and actions to take if you think you may have contracted the virus, see the guidance on this page.

This guidance will be updated in line with the changing situation.

What can help your mental health and wellbeing​

Think about your new daily routine. Life is changing for us all for a while and you will have experienced some disruption to your normal routine. Think about how you can adapt and create positive new routines – try to engage in useful activities (such as cleaning, cooking or exercise) or meaningful activities (such as reading or being in touch with friends). You might find it helpful to write a plan for your day or week.

Consider how to connect with others. Maintaining relationships with people you trust is important for your mental wellbeing. If you can’t meet in person, think about how you can stay in touch with friends and family via telephone, video calls or social media instead – whether it’s people you normally see often or connecting with old friends.

The NHS Volunteers Service can also provide a telephone ‘check in and chat’ for if you have mental health issues and are feeling isolated. Call 0808 196 3646 (8am to 8pm) or visit the website.

Help and support others. Think about how you could help those around you – it could make a big difference to them and can make you feel better too. It is important to listen to and accept other people’s concerns, worries or behaviours. Could you message a friend or family member nearby? Are there community groups that you could join to support others locally? Remember it’s important to do this in line with guidance on COVID-19 to keep yourself and everyone safe.

Talk about your worries. It is quite common to feel worried, scared or helpless about the current situation. Remember that this is a difficult time for everyone and sharing with family and friends how you are feeling and the things you are doing to cope can help them too. If you don’t feel able to do that, there are people you can speak to via NHS recommended helplines.

Look after your physical wellbeing. Your physical health has a big impact on how you are feeling emotionally and mentally. At times like these, it can be easy to fall into unhealthy patterns of behaviour which, in turn, can make you feel worse. Try to eat healthy, well-balanced meals and drink enough water. One You has a lot of advice and ideas for healthy meals you can cook at home.

Where possible, exercise at home and/or outside as often as you wish. If you can’t exercise outside, you can find free, easy 10-minute workouts from Public Health England (PHE) or other exercise videos to try at home on the NHS Fitness Studio. Sport England also has good tips for keeping active at home.

If you are able to go outside, there are lots of easy ways to get moving like walking or gardening.

Seek advice and support if you smoke or use drugs or alcohol. Smoking or using drugs or alcohol to cope in times of stress and disruption can make things worse, including your mental health. NHS Smokefree provides information and advice on quitting smoking and One You has resources to help with cutting back on alcohol. You can also call Drinkline for free on 0300 123 1110 for advice and support and Down Your Drink provides interactive web-based support to help people to drink more safely. If you are concerned about drugs use, FRANK offers information and advice, including where to get help, and has a free advice line – 0300 123 6600. You can also reach Marijuana Anonymous and participate in their weekly online meetings to receive support from other peers.

Look after your sleep. Feeling anxious or worried can make it harder to get a good night’s sleep. Good-quality sleep makes a big difference to how you feel mentally and physically, so it’s important to get enough.

Try to maintain regular sleeping patterns and keep good sleep hygiene practices, including avoiding screens before bed, cutting back on caffeine and creating a restful environment. The Every Mind Matters sleep page provides practical advice on how to improve your sleep.

Try to manage difficult feelings. Many people find the news about COVID-19 concerning. However, some people may experience such intense anxiety that it becomes a problem. Try to focus on the things you can control, such as managing your media and information intake – 24-hour news and constant social media updates can make you more worried. If it is affecting you, try to limit the time you spend watching, reading, or listening to media coverage of the outbreak. It may help to only check the news at set times or limiting yourself to checking a couple of times a day.

It is okay to acknowledge some things that are outside of your control right now. The Every Mind Matters page on anxiety and NHS mental wellbeing audio guides provide further information on how to manage anxiety.

Get the facts. Gather high-quality information that will help you to accurately determine your own or other people’s risk of contracting COVID-19 so that you can take reasonable precautions. Find a credible source you can trust such as GOV.UK, or the NHS website, and fact-check information you get from newsfeeds, social media or other people.

Think about how inaccurate information could affect others too. Try not to share information without fact-checking with credible sources.

Do things you enjoy. When you are anxious, lonely or low, you may do things that you usually enjoy less often or not at all. Focusing on your favourite hobby, learning something new or simply taking time to relax indoors or outdoors (in line with the guidance) should give you some relief from anxious thoughts and feelings and can boost your mood.

If you can’t do the things you normally enjoy because you are staying at home, try to think about how you could adapt them, or try something new. There are lots of free tutorials and courses online and people are coming up with innovative online solutions, such as online pub quizzes and streamed live music concerts.

Set goals. Setting goals and achieving them gives a sense of control and purpose. Think about things you want or need to do that you can still do at home, such as watching a film, reading a book or learning something online.

Keep your mind active. This can help you feel in control and less low or worried. Read, write, play games, do crossword puzzles, sudokus, jigsaws or drawing and painting, whatever works best for you.

Take time to relax and focus on the present. This can help with difficult emotions, worries about the future and generally make you feel better. Relaxation techniques can also help some people to deal with feelings of anxiety. For useful resources, see Every Mind Matters and the NHS mindfulness page.

If you can, get outside. If you can’t, bring nature in. Spending time in green spaces can benefit both your mental and physical wellbeing. If you can’t go outside, you can try to still get these positive effects by spending time with the windows open to let in fresh air, arranging space to sit and see a nice view (if possible) and get some natural sunlight, or get out into the garden if you can.

Challenges you may be facing​

You may be experiencing challenges in your life at the moment that are affecting your mental health. The following advice may help you to think about potential challenges you may encounter and make a plan for them. Making these plans could help to protect or improve your mental health during these challenging times.

Essential supplies. If you are not able to go out, think about how you can get any supplies you need, such as food, medication or other essentials. You might be able to phone or email your local shops to get a food delivery, or get food online, or get friends, family or neighbours to help. If there’s no one to help you get essential supplies, find out if you can get help from a volunteer through the NHS Volunteer Responders programme.

If you’re finding it hard to afford food, find out if you’re eligible for Universal Credit. If you have a child, find out if they can get free school meals. Apply for Healthy Start vouchers if you’re 10 or more weeks pregnant or have a child under 4. Get more information on accessing food and other essential supplies.

Financial concerns. You may be worried about work and money – these issues can have a big impact on your mental health. For guidance on what your rights are at work, what benefits you are entitled to and what further support is available, see guidance for work and support or advice from Citizens Advice or the National Debtline.

If you care for other people. You may be worried about how to ensure care for those who rely on you – either your dependants at home or others that you regularly visit. Let your local authority know if you provide care, or support someone you don’t live with. Further advice on creating a contingency plan and sources of support are available from Carers UK.

If you are being treated or taking medication for existing conditions​

Continue accessing treatment and support where possible. If you have been requested to stay at home, let relevant services know you are staying at home, and work out how to continue receiving support during this time:

  • ask about having appointments by phone, text or online. For example, this could be with your counsellor, therapist or support worker, nurse, care worker or befriender
  • if you use care services that will be affected by staying at home, you should let your local authority and care provider know so alternative arrangements can be put in place
  • tell your care services that alternative arrangements are required if any of the usual support can’t continue. This may include things like carers visiting, day centre sessions, or friends and family coming over to help
Keep taking your medication. You might be able to order repeat prescriptions by phone, or online using an app or website if your doctor’s surgery offers this.

  • ask your pharmacy about getting your medication delivered or think about who you could ask to collect it for you if you are self-isolating or shielding. The NHS website has more information about getting prescriptions for someone else and checking if you have to pay for prescriptions
  • continue to order your repeat prescriptions in your usual timeframe. There is no need to order for a longer duration or larger quantities
  • your GP practice (or clinical team) may move your prescriptions to repeat dispensing arrangements, so you only have to contact your pharmacy to get a repeat of your medicine rather than your practice
  • be careful about buying medication online. You should only buy from registered pharmacies. You can check if a pharmacy is registered on the General Pharmaceutical Council website
  • you can contact NHS 111 in England if you’re worried about accessing medication
 

Yokel

LE

Advice for groups with additional mental health needs or facing specific issues​

Existing mental health problems​

If you already have a mental health problem, then you may be finding the COVID-19 pandemic particularly challenging. The advice above should help, but here are a few extra things that you may want to think about. This is based on fuller guidance provided by Mind. Rethink has also created an online hub to provide practical support and information that is useful for people living with or supporting people with mental illness.

Speaking to your mental health team​

If you are already receiving mental health care, contact your mental health team to discuss how care will continue, and to update safety or care plans.

If you have an existing mental health problem, but are not currently receiving care from a mental health team and feel that you can no longer adequately manage your condition yourself, discuss options for accessing further support with your GP.

Managing difficult feelings or behaviours to do with hygiene, washing or fears of infection​

Some mental health problems can cause difficult feelings or behaviours to do with washing or hygiene. If you experience this, you might find it hard to hear advice about washing your hands.

It is important to follow government advice on helping to avoid the spread of COVID-19, but if you find you are going beyond the recommendations, if this is making you feel stressed or anxious, or if you are having intrusive thoughts here are some things you could try:

  • let other people know you’re struggling, for example, you could ask them not to discuss the news with you
  • breathing exercises can help you cope and feel more in control. You can find a simple breathing exercise on the NHS website and Mind’s pages on relaxation have some tips and exercises you can try
  • set limits, like washing your hands for the recommended 20 seconds
  • plan something to do after washing your hands, which could help distract you and change your focus
  • it could also help to read some of Mind’s tips in their information on obsessive compulsive disorder (OCD) or advice from OCD UK

Managing panic and anxiety​

If you have panic attacks or flashbacks, it might help to plan a ‘safe space’ in your home that you can go to.

You can also find ways to comfort yourself if you’re feeling anxious. For example, Mind has games and puzzles you can use to distract yourself, and breathing exercises that may help.

Managing feelings of being trapped or claustrophobia​

You are probably spending more time than usual at home so try to get outside if you can. You could also open the windows to let in fresh air, find a place to sit with a view outside, or sit on your doorstep or in your garden if you have one. It can also help to regularly change the rooms you spend time in, if possible, as this can help to give you a sense of space.

Managing eating disorders​

If you have an eating disorder, you may find aspects of the current situation particularly challenging, for example, the reduced availability of specific foods, social isolation and significant changes to your routine.

The eating disorder charity BEAT provides a helpline for people with eating challenges and some guidance on managing treatment, mealtimes, exercise and change to routines and socialising. Also reach out to your GP or your local NHS community eating disorder team for support and advice, where possible.

Support for NHS or social care workers​

Specific mental health support is available for NHS and social care workers:

  • text FRONTLINE to 85258 to start a conversation. This service is free on all major mobile networks and is a direct support for those who would like to receive support. You can also contact Hospice UK for bereavement and trauma support on 0300 303 4434
  • Samaritans also has a specialist Wellbeing Support phoneline, which is free to access and available from 7am to 11pm, 7 days a week. You can get support signposting and confidential listening from trained professionals in a number of areas, from coaching and bereavement care to mental health and welfare support on 0300 131 7000
  • special access has been arranged for you to certain wellbeing apps such as Silvercloud, Sleepio and Daylight, for advice on how to cope with stress, improve sleeping patterns and suggestions for mindfulness
Further details of the support available can be found on NHS People for NHS staff, and through the CARE workforce app for adult social care staff.

People with a learning disability​

If you have a learning disability, you may be finding the COVID-19 pandemic stressful. You may be worried about changes that might happen because of it, including staying at home more. You may also be worried about your family or those close to you.

Public Health England (PHE) has easy read guidance on COVID-19, how it may affect you and what you need to do to keep yourself safe and well. There is also other information available about COVID-19 from Mencap and how to manage difficult feelings you are having.

There are ways you can take care of yourself and prevent spreading the virus:

While it is important to be aware of COVID-19, it is important not to forget about any other health conditions you might have. Make sure you take any medication you have been prescribed, keep any hospital appointments you have (unless you have been told otherwise by the hospital) and tell people if you can’t attend appointments.

Supporting someone with a learning disability. The help they need will depend on the nature of their disability. People with a mild or moderate learning disability may need additional accessible information and more time to understand what they might need to do to keep themselves safe and well at this time. People with severe or profound and multiple learning disabilities will need more help to ensure they are able to follow the advice on COVID-19 (for example, handwashing) and to make sure the right communication aids are available. This will be specific to each person. It will also be important to keep a degree of normality where possible, doing things that are enjoyable and enabling people to talk about how they are feeling. For useful tips for talking about feelings, see Skills for Care advice.

People with autism​

Some people with autism will be finding the coronavirus COVID-19 outbreak stressful and may be worried about getting the virus or changes that might happen because of it, including staying at home more. There are ways you can take care of yourself and prevent spreading the virus.

Understand what is happening​

Keep up to date with information about COVID-19 from sources you can trust, such as the NHS website.

Help to stop the virus from spreading​

There are 4 easy steps you can take to reduce the risk of getting COVID-19 or spreading it to others:

  • wash your hands regularly for at least 20 seconds with soap and water
  • use a tissue for coughs and sneezes and bin it safely and wash your hands
  • avoid touching your face, including your mouth and eyes
  • get up to date information about what you can and cannot do, or what to do if you feel unwell on the NHS 111 website. If you are unsure about your symptoms, speak to someone you trust about them, like a support worker

Plan to keep mentally well​

Think about how you can adjust your routines to staying at home and keep doing the things you would usually do to keep well. That might include eating food you enjoy, finding ways to keep doing your hobbies and interests online and getting exercise, once a day in your home or outside if you can. You know what strategies have helped you in difficult situations in the past, so use them again now.

If you have support from others, plan with them how you can remain well and relaxed. There are also other things you can do to help to manage your emotions if you feel you are losing control, such as:

  • keeping a diary
  • learning relaxation techniques
  • creating a plan with your carer for when you feeling anxious

Get help if you are struggling​

Hearing about COVID-19, and the changes it causes in your daily life, might make you feel like you don’t have control, or make you worried or scared about your health. These feelings are common. Try to speak to someone you trust such as a friend, family member or supporter.

If you do become unwell and need medical treatment, share your hospital passport or autism diagnosis so staff know the best way to support you. You may find it helpful to create an autism passport. It can be filled in easily and presented in any situation, to social, health or employment professionals.

If you are still feeling worried and want more help. You can call the Autism Helpline on 0808 800 4104.

In addition to the advice above, if you are supporting a person with autism, bear in mind they may struggle to identify physical symptoms of COVID-19, as well as having difficulty talking about the emotions it creates. Try to be aware of changes in behaviour that may help you to identify their emotional state, as well as physical symptoms.

It is important to be clear when communicating about the situation, how to stay safe and the symptoms of the virus. Try to avoid language that can be taken literally or definitive statements, as this is a rapidly developing situation and a person with autism may be more distressed if things change when they were told they would not. Keep up to date with reliable and safe information about COVID-19 from with government-issued guidance on this page.

Older people​

Government guidance is that people 70 years of age and older are at increased risk of severe illness from COVID-19 and need to be particularly stringent in following government advice, including social distancing and staying at home if you think you have COVID-19. Given this, if you are in this age group, and particularly if you have pre-existing medical conditions, it is natural for you to feel concerned or affected by changes you have to make to your daily life. The following suggestions may help you with any difficult feelings and to look after your mental health:

Stay connected. Draw on support you might have through your friends, family and other networks. Try to stay in touch with those around you, this might be over the phone, by post, or online. If you have been advised to stay at home, let people know how you would like to stay in touch and build that into your routine.

Get practical help. If you need help, for example with shopping or running errands, ask for it and let those around you know what they can do. If you need help but you’re not sure who to contact, Age UK runs an advice line (0800 678 1602 – lines are open every day, 8am to 7pm) that can put you in touch with local services.

People with dementia​

For people with dementia, and their carers and families, COVID-19 is making daily life particularly challenging and may cause additional distress. Staying connected, maintaining a routine and making sure to keep active and entertained as much as possible are all essential to supporting the mental health and wellbeing of people with dementia and their carers.

If you are supporting someone with dementia, they may have difficulty understanding instructions about self-isolation, social distancing or handwashing. It is important to take time to make this information as simple and accessible for them and repeat it as appropriate. People with dementia may also lack awareness of, and be less able to, report symptoms because of communication difficulties – you should be alert to the presence of symptoms of the virus.

The Alzheimer’s Society has published information on COVID-19 for people affected by dementia.

If you’d like to connect and talk with other people affected by dementia, you can visit the Alzheimer’s Society online community Talking Point.

A range of information on information on dementia is also available from Alzheimer’s Research UK.

If you are still feeling worried and want more help you can call the Alzheimer’s Society Helpline on 0300 222 11 22.

You can also speak to a dementia specialist Admiral Nurse on Dementia UK’s Helpline, on 0800 888 6687.

Experiencing grief or bereavement​

Over our lifetime we’re all likely to experience the loss of a loved one. Whenever it happens, it can be an extremely difficult and challenging time. This will also be true if you are experiencing bereavement and grief during the COVID-19 pandemic.

You might be struggling with the shock not just of the bereavement, but that you may not have been able say goodbye in the way that you would have wanted. If you are isolating alone this could be particularly hard and it may be harder to connect with your usual support networks.

When you are bereaved, you are likely to feel waves of intense emotions as you come to terms with loss. These can include sadness, guilt, shock and anger. All are common and there is no right or wrong way to feel. Grief affects us all in different ways, but the important thing is to grieve and to have the right support to do this.

You can learn more about grief and support available through the NHS. Cruse Bereavement Care offers advice and support on dealing with bereavement and grief during the COVID-19 outbreak, or At a Loss.org provides signposting to services across the UK.

 

Yokel

LE

If you have a problem with drugs or alcohol​

Drug and alcohol use can contribute to poor mental health. Equally, poor mental health can lead to increased use of drugs and alcohol, and the stress of staying at home can make these habits harder to control. Cutting down or quitting drugs and alcohol use can help you take back control of your moods and emotions.

If you are reducing your drinking, remember it can be dangerous, and even fatal, to stop too quickly without proper support. If you have physical withdrawal symptoms (like shaking, sweating or feeling anxious until you have your first drink of the day), you should seek medical advice before cutting down. This is especially important if you drink more than 30 units a day (1 bottle of spirits, 3 bottles of wine, 12 pints of normal strength beer, 7 cans of 9% super lager or 4 litres of strong cider), have epilepsy, have had seizures (fits), or have seen and heard things (delirium tremens) when stopping drinking in the past, as you will be at higher risk of serious complications.

It can also be dangerous or very unpleasant to stop using some drugs too quickly or without proper support. Get medical advice before you cut down or stop using drugs, especially if you have withdrawal symptoms. If you or your household members continue to use opioids such as heroin and you don’t already have naloxone, get some and make sure it is immediately accessible in case of an overdose.

You can find more information in our guidance for providers and commissioners of drug and alcohol services.

All local areas have services to help people with drug and alcohol problems, and you can find more information on what is available in your local area using the NHS drug and alcohol service finder.

If you are currently in drug and alcohol treatment, you can speak to your drug and alcohol service about any concerns you have about attending appointments or getting any medication they may be prescribing to you. The current situation may mean that you are unable to access your usual support networks. Online mutual support is still available from organisations such as SMART Recovery, Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous and Marijuana Anonymous.

Where to get further support​

For advice on COVID-19 and any symptoms see the NHS website.

If you are experiencing stress, feelings of anxiety or low mood, you can use the NHS mental health and wellbeing for self-assessment, audio guides and practical tools. Every Mind Matters also provides simple tips and advice to start taking better care of your mental health.

If you are still struggling after several weeks and it is affecting your daily life, please contact NHS 111 online. If you have no internet access, you should call NHS 111. If you feel you need someone to talk to, speak to a GP or support is available through the NHS or mental health charities – NHS mental health services have remained open for business throughout this time, including delivering support digitally and over the phone where possible. You can find further information on how to access mental health services and search what is available in your area.

If you have an existing mental health condition and you need help collecting shopping, medication or would like a telephone ‘check in and chat’, visit the NHS Volunteers Service or call 0808 196 3646 (8am to 8pm) to arrange volunteer support.

In a medical emergency, call 999. This is when someone is seriously ill or injured and their life is at risk. A mental health emergency should be taken as seriously as a physical health emergency.

If you do not feel safe at home​

There is help and support available to you. Abuse is unacceptable in any situation, no matter what stresses you or others are under. You can also leave your home or be outside to access critical public services, or to move home, in line with the government’s guidance on moving home.

If you are in immediate danger, call 999 and ask for the police – the police will continue to respond to emergency calls. If you suspect that your neighbours or others in your community are victims of domestic abuse, do report it to the police.

Further support during the coronavirus outbreak for those who feel at risk of abuse is available.

Where to get urgent help for mental health​

If you have urgent mental health needs and need to access support now, visit the NHS.UK Every Mind Matters urgent support to find local options for support.

  1. Some of the links to guidance, resources and services are specific for England. For the devolved administrations, specific guidance can be found on the following pages for Scotland, Wales, and Northern Ireland.
 

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