Nicky Lambert, an expert on mental health, reveals how people can take several simple steps to improve their personal self-care
It is World Mental Health Day on Tuesday 10 October. This year’s theme – set by the World Foundation of Mental Health – has been called ‘mental health is a universal human right’.
It is a day that reminds all of us to make positive changes to increase our wellbeing and to raise awareness of mental health issues more broadly.
Pressures related to the ongoing fallout from the pandemic and cost of living crisis continue to impact mental health.
According to the World Health Organization (2020) more than 264 million people experience depression globallyand it is the leading cause of disability. In addition to rising numbers of people with mental health problems, there are ongoing staffing and funding shortages and despite nurses’ best efforts mental health service provision can be limited, with long wait times.
Whilst there have been significant strides forward in public understanding of mental wellbeing, the stigma around many mental health conditions remains and can form a barrier to people seeking support and reaching out to help others. It’s important that we are all aware of the indicators of when we need help and that we know how best to support our own psychological wellbeing.
Raising awareness
Signs that professional help may be needed include:
Feeling constantly overwhelmed and unable to cope or see a way forward.
Significant personality changes or an increase in agitation, anger, anxiety or other mood changes.
Withdrawal or isolation from others, poor self-care.
Talking and thinking a lot about suicide or feeling you can’t go on
Or uncharacteristic engagement in risk-seeking behaviour
If you or someone you know needs help – which can range from a supportive conversation and counselling through to more formal care, please tell someone. There are university systems (Counselling and Mental Health – CMH) that are designed to help and offer guidance on emotional wellbeing and mental health. Please come forward when you first notice something amiss and don’t wait for a crisis before reaching out.
Promoting self-care
There are some misconceptions about self-care that we should address before looking at ways to support wellbeing. It is not indulgent or a luxury to look after our mental health – in the same ways that we have to be mindful of our physical health the same is true of our emotional and psychological wellbeing. Also, there is no right way to do it. Everyone is individual in their needs and what they find nurturing, however there are aspects of our lives that can offer us prompts to action:
Mental aspects of self-care – Set realistic goals and priorities and learn to say no without feeling guilty – boundaries help you place your energy where it is most needed.
Physical aspects of self-care – Move more! Just 30 minutes of walking every day can help boost your mood and improve your health. If it’s raining find somewhere you can be free to be by yourself and dance like no one is watching to your three favourite songs!
Environmental aspects of self-care – Spend some time outdoors every day, develop an awareness of nature, grow something at home – it can be anything from a house plant or herbs to liven up a meal.
Spiritual aspects of self-care – Reassess your purpose in life, think about what makes you happy and try to align yourself better to your goals. It may take time to make changes (if they are needed), but it is important to live a life that is meaningful to you and to identify things that you are feel grateful for.
Recreational aspects of self-care – Being creative takes many forms, perhaps you are a great cook, or you love making music or gardening. We can forget to play sometimes and remembering to prioritise times when we experience joy and the calm focus of being in a state of ‘flow’ is essential to our wellbeing.
Social aspects of self-care – Many bonds linking us have been placed under strain over the last few years. Even if you are at a distance from the people you care about, a regular zoom call with old friends or sharing a WhatsApp group with family or a local community keeps us stay connected.
About the author
Nicky Lambert
Nicky is an Associate Professor at Middlesex University, she is registered as a Specialist Practitioner (NMC) and is a Senior Teaching Fellow (SFHEA). She is also a co-director of the Centre for Coproduction in Mental Health and Social Care. Nicky has worked across a range of mental health services both in the UK and internationally supporting staff and practice development in acute and mental health trusts, councils, businesses, charities, HEE and the CQC. She is active in supporting mental health and wellbeing with the RCN and Unite. She is an editorial board member for Mental Health Nursing, and on the education and policy committees of MHNAUK. Nicky engages with local trusts and with the RCPsych to support sexual safety in mental health services. She is also a Trustee for The Bridge a charity supporting women to make positive choices, and encouraging improvements to fitness, health & well-being.
Dr Elena Martellozzo, Associate Professor and Criminologist at MDX, presents some of the key issues that were raised during the UKCIS webinar by high-level experts from research, policy and practice.
The risk to children of online sexual abuse, alongside other forms of online harm, is likely to have increased as a result of isolation measures, with children being educated and spending more time online.
Whilst we do not know the true impact of COVID-19, and the harm inflicted to children by offenders during lockdown, it is recognised that it’s an increasing problem and, as a result, needs to be addressed.
It’s important to acknowledge that there are enormous benefits for children from being online. In fact, it is only through acknowledging those benefits that “we can better understand the potential for harm to children and seek to mitigate risk through robust research and through safeguarding policy and practice,” said Professor Julia Davidson OBE, Director of the ICC at the University of East London.
Supporting this ethos, Dr Jeffrey DeMarco, Senior Fellow with the Centre for Abuse and Trauma Studies (CATS) and a Research Director at NatCen Social Research, said that “understanding offending, victimisation and the impact of child sexual exploitation and abuse on wider society is important in forging the best preventative measures moving forward.”
What’s being done to prevent this?
A number of vital changes are taking place in the digital environment to protect children and young people. Early this year the UN Committee on the Rights of the Child has adopted General Comment 25, which now extends children rights to the digital environment.
Furthermore, in the UK, the Online Harms Legislation is due to be passed imminently, which places responsibility on companies for their users’ safety online, especially children and other vulnerable groups. This is the opportunity for companies and cyber safety technologies to step in and provide protection to its users.
In January 2021, the Home Secretary published the Child Sexual Abuse Strategy, which sets out the government’s vision for preventing, tackling and responding to child sexual abuse in all its forms, whether it’s committed in person or online, in families or communities, in the UK or overseas.
The aims of the strategy were set out clearly at the webinar by Victoria Jepson, Head of Strategy, International and Knowledge in the tackling exploitation and abuse unit at the home office. Jepson claimed: “We have also made commitments around providing victims and survivors, with the support needed to rebuild their lives.”
Clearly a lot of work is taking place in this area, not only to support victims and survivors but also to prevent young people from further victimisation.
Has online abuse become the norm for digital children?
Dr Jo Bryce, Senior Lecturer at the School of Psychology, University of Central Lancashire, presented some of the findings from De-Shame, a project co-financed by the European Union. Bryce argued that whilst the internet plays an essential role in their lives, for many young people, online sexual harassment, unfortunately, is embedded in their digital lives and to some extent normalised and too often not reported to an adult.
Projects such as De-Shame are vital bringing voices of children to the surface. As Tink Palmer, CEO of the Marie Collins Foundation pointed out: “It is difficult for children to report what has happened to them.” There is evidence to suggest that often children fear the consequences of reporting such as being prohibited by their parents to access their devices and being online.
Dr Victoria Baines, a Visiting Fellow at Bournemouth University, highlighted the importance of utilising evidenced based data, as some sources are unreliable and do not provide “the true picture” of whether online grooming has increased in the UK due to COVID-19. Baines argued: “We are assuming that being online is an inherently risky business, that more time online increases the risk of children, and as a consequence of spending more time online during lockdown, grooming in the UK has increased.” Whilst there has been an increase of online child sexual abuse, we cannot yet establish whether this increase is because of the lockdown.
Child sexual abuse is on the rise, offline and online
Talking about the increase of online child sexual abuse, more generally, Simon Bailey, the National Police Chiefs Council lead for Child Protection and Abuse Investigations, offered frontline reports of the problem and presented some very strong evidence stating how “in 30 years we’ve moved from 7,000 to 17 million CSA images”. It was also highlighted that more than 850 offenders are being apprehended a month, and that more than 1000 children have been safeguarded each month through coordinated activity led by professionals like Mr Bailey.
This webinar highlights that online child sexual abuse is a crime that is not going to reduce any time soon. In her closing comments, Mary Aiken, Professor of Forensic Cyberpsychology in the Department of Law and Criminology at the University of East London, argued: “Online CSA is a big data problem in terms of variety, velocity and volume of this content and we will need artificial intelligence solutions to tackle the problem.”
There is some good news, Aiken claims: “There is a thriving emerging online safety technology sector in the UK.” However, cyber security focuses on protecting data, networks and systems and not what it is to be human, online. Therefore, events such as this webinar bring together experts working in the field of child protection to present the research evidence and the reliable data needed to fully understand this complex phenomenon.
Some of the evidence, advice and recommendations presented in this webinar cannot be ignored. The fact that more than 700 hundred people registered for this event demonstrates that people are willing to be involved in this subject, want to learn good practice, raise awareness and contribute to the online safety of children and young people.
Indeed, we need to work together to create a safer cyber space for us all, but specifically for those young people whose lives are digital by default.
The UKCIS Evidence Group provides expert advice to the UKCIS Board and reviews key research in the Internet safety area. They produce a research highlights series which summarises research findings.
About the author
Dr Elena Martellozzo is an Associate Professor in Criminology at the centre for Child Abuse and Trauma Studies (CATS) at Middlesex University. She has extensive experience of applied research within the Criminal Justice arena and her research includes exploring children and young people’s online behaviour, the analysis of sexual grooming and police practice in the area of child sexual abuse.
Dr Martellozzo is a prolific writer and has participated in highly sensitive research with the Police, the IWF, the NSPCC, the OCC, the Home Office and other government departments. She has also acted as an advisor on child online protection to governments and practitioners in Italy (since 2004) Bahrain (2016) and the Rwandan Government (2019) to develop a national child internet safety policy framework.
Dr Elena Martellozzo and Paula Bradbury of the Centre for Abuse and Trauma Studies examine the impact OnlyFans has had on young women during the coronavirus pandemic.
The existence of OnlyFans predates the COVID-19 pandemic lockdown of 2020, but its popularity and notoriety increased significantly over the last year. OnlyFans came to our attention through celebrity endorsements, other social media platforms, and apps. Notably, there was also the BBC Three documentary entitled Nudes4Sale.
This British investigative documentary revealed how thousands of people across the world – including celebrities, ordinary members of the public and, more concerningly, teenagers – are making a healthy profit from selling self-generated sexual content for cash through the platform OnlyFans. On OnlyFans you earn money by gaining member subscriptions and by generating content that people want to pay for. The girls featured in the documentary reported to be earning as much as £35,000 in a single month. We now know that potential earning figures go way beyond this.
But these kinds of successes are unique, and only experienced by the few – leaving a significant number vulnerable to a darker side of OnlyFans, and the manipulative and predatory behaviours of individuals that operate within it.
With a fast-growing subscription of more than 200,000 new members every 24 hours, it’s easy to see how enthusiastic endorsements by the likes of Beyoncé and Cardi B make OnlyFans an attractive site for young women.
What the endorsements don’t show, though, is that OnlyFans is a fiercely competitive market where young women fall into a cycle: they are compelled to raise their game by sharing more and more of their bodies, and perform sexual acts requested by subscribers to maintain their interest, increase their popularity and earn more money.
The women in the Nudes4Sale documentary had all received messages from subscribers asking them to participate in offline sex acts. One of the girls interviewed in the documentary, Lauren, admitted that she received messages offering £5,000 for sex. While Lauren can afford to say no, many less successful young women – potentially young teenage girls – cannot. And so, they’re lured into danger with the promise of money.
And during a pandemic, having an income is more crucial than ever.
“It’s impossible to say precisely how lockdown is impacting our behaviour and what the side effects will be”, said Anne Marie Tomchak, in her recent piece in Glamour, “but there are already indications that more nudes are being requested and sent during this time as people increase their digital interactions while staying at home, and OnlyFans reports a spike in activity.”
OnlyFans sparked a global media response to rising concerns of adolescent online risk-taking, and the legal ramifications of creating, distributing and possessing sexual images of a minor – laws which children themselves are no less impervious to.
A 2020 report published by the IWF revealed that they have identified a 44% increase (of all intercepted content) in the number of self-generated indecent images produced by children, of which the most prolific age group is girls between 11 and 13.
COVID-19 and child protection
The COVID-19 global pandemic has not only revealed our vulnerabilities to biological viral threats, but also to our ability to protect our children online.
In the midst of lockdown, COVID-19 has facilitated a greater opportunity for digital immersion. While the internet opens up a plethora of positive opportunities for individual growth and self-acceptance, there is also the potential for great harm to be caused against the most vulnerable in our communities; children and young people.
Immature cognitive development and reduced capacity to self-regulate has left children at risk from criminal accountability, sexual predators, and the dark side of the online sex industry (Naezer, 2018). With the easy opportunity to view pornography and violent content at the click of a button, there’s also the easy opportunity to produce it, and sell it to those with a sexual predilection in children (IWF, 2020).
In 2021, the online marketplace for sharing sexual images for cash is no longer dominated by the sex industry and adult sex workers. It is a phenomenon that goes beyond regulation, and is being dominated by teenagers as purveyors for their self-production of nude, semi-nude, on-demand kink images and videos for online clients.
Andy Burrows, head of child safety online policy at the NSPCC, said: “We are concerned that there are risks to be associated with user-generated explicit abuse content sites, such as Only Fans, which are worthy of substantive academic focus. This relates to children being readily able to access inappropriate and sexually explicit content, both on the site itself but also as a result of user generated content being posted as ‘trailers’ to social networks.”
What can parents do?
We would encourage all parents to familiarise themselves with social media, particularly those platforms which are popular with young people. Don’t assume that your teen will not visit sites such as OnlyFans.
Parents need to be aware that social media apps such as Instagram, Facebook and Snapchat are the most commonly used platforms for sex offenders to target and groom children, at a rate of 37% of recorded cases for Instagram alone (NSPCC, 2020).
Tiktok has aggressively responded to the high volume of Onlyfans members who prolifically use their platform to advertise links to their accounts and content by introducing stricter community guidelines, but as the authors have seen, a large volume falls beneath the radar which includes sexually explicit information about sex acts, fetishes and violence. Many Onlyfans members simply create a new account once removed.
If you discover that your child is actively engaging with such sites, don’t make them feel guilty. It’s not your child’s fault. Children often visit such sites through peer pressure, general curiosity or simply by accident. However, do prevent them from accessing it in future. It may not make you a popular parent, but it’s what needs to be done to keep your child safe, online and offline. We recommend the following:
If you don’t have a filter on your child’s laptop or home computer already, make sure you get one as soon as you can
Browse your teen’s tracking history. If you see OnlyFans on there, that’s a red flag
Scan your credit card for any charges that look like they may be from OnlyFans
If you suspect your teen has been on the site, have an honest discussion with them about online safety
Make sure your child understands that they never know who they’re talking to online, and that by sharing personal information they’re putting themselves at risk.
Martellozzo et al (2020) found that stumbling across inappropriate content can have significant adverse impacts for children and young people. This includes distorting their view of sex and relationships, and potentially having a desensitising effect for some young people.
Online pornography is increasingly widely identified as an influence on children’s and young people’s sexual lives (Crabbe & Flood, 2021) . Whether we like or not, pornography is recognised as an important part of young people’s sexual socialisation and deserves to be addressed with young people. The existence of sites such as OnlyFans should be included in the discussions.
About the authors
Dr Elena Martellozzo
Dr Martellozzo is an Associate Professor in Criminology at the centre for Child Abuse and Trauma Studies (CATS) at Middlesex University. She has extensive experience of applied research within the Criminal Justice arena, and her research includes exploring children and young people’s online behaviour, the analysis of sexual grooming and police practice in the area of child sexual abuse.
Dr Martellozzo is a prolific writer and has participated in highly sensitive research with the Police, the IWF, the NSPCC, the OCC, the Home Office and other government departments. She has also acted as an advisor on child online protection to governments and practitioners in Italy (since 2004), Bahrain (2016) and the Rwandan Government (2019) to develop a national child internet safety policy framework.
Paula Bradbury is a Criminology Lecturer and Doctoral Researcher within the School of Law at Middlesex University, exploring the appropriateness of current policy and practice relating to adolescent sexual offending and sexual behaviour between peers. She is passionate about researching online sexual offending behaviour and child abuse.
Paula is an active member of the CATS team engaging in multiple research pathways to combat child sexual abuse both online and offline as a mixed methods researcher proficient in both quantitative and qualitative analysis, and project management. She is also the National Child Sexual Abuse Lead for Victim Support, serving as a project manager developing online support content for adult survivors or child sexual abuse.
Tom Dickins, Professor of Behavioural Science, explores the notion of social capital in the context of the COVID-19 pandemic.
People are a resource for one another. Groups therefore have social capital as a consequence of network structures and the properties of individuals. Bonding social capital refers to networks of highly similar individuals and bridging social capital is found in networks of dissimilar individuals. Finally, linking social capital is a property of networks formed between individuals and institutions.
Social capital can facilitate disaster survival and recovery [1], positive environmental interventions [2] and resilience during pandemics [3].
A pan-European study of the COVID-19 pandemic of 2020/21 revealed the following:
First, we find that high-social-capital areas accumulated between 14% and 40% fewer COVID-19 cases between mid-March and end of June. Likewise, high-social-capital areas also exhibit between 7% and 14% less excess deaths in Great Britain, the Netherlands, Italy, and Sweden. A one standard deviation increase in social capital could have prevented between 459 deaths in Sweden and 8,800 deaths in Great Britain.
Second, we find qualitatively similar patterns across all independently analysed countries, which we regard as strong evidence for the robustness of our empirical results.
Third, we show a consistent dynamic pattern – the number of COVID-19 cases is initially higher in high-social-capital areas. However, as information on the virus spreads, high-social-capital areas start to show a slower increase in COVID-19 cases in all seven countries. The role of social capital diminishes as soon as national lockdowns are enforced. [4]
One interpretation is that in highly bonded social networks SARS-CoV-2, the virus responsible for COVID-19, will have been able to spread with ease. But once the risk was exposed, those same groups who by definition have well-established norms of cooperation, are more likely to organise to protect themselves by considering the community situation, prior to the imposition of lockdowns.
Challenges to social capital
Inequality impacts negatively upon health [5,6] and the most serious outcomes of COVID-19 will be unevenly distributed across socio-economic strata [7,8].
In a systematic review, Uphoff and colleagues found that lower socio-economic status was associated with lower social capital and poorer health outcomes [9]. But bonding social capital could act to buffer low socio-economic status people against some of the worst effects of somatic and mental poor health. However, being poor reduced bridging and linking capital and this was also linked to poor outcomes.
Poverty under inequality amounts to irregular and low value resourcing where futures are unpredictable. This makes it hard to stabilise extended reciprocal interactions over time as any failure to repay a debt outweighs the minimal benefits of help further down the line.
Trust is more likely to form within a close group of similar people with whom values can more easily be communicated and norms for processing what is owed can be readily established: if you see each other all the time there is less opportunity for defection from social contracts.
Forming such alliances with dissimilar people and institutions is a riskier proposition. It is known that distrust of authorities by socio-economically isolated groups prevents uptake of public health interventions [10]. We might therefore predict that individuals with reduced bridging and linking capital will be more resistant to current public health messages about COVID-19 and perhaps more likely to violate restrictions and less likely to engage with subsequent recovery plans including vaccination.
That resistance might be socio-economically distributed, as suggested, but we should also note that prolonged social isolation will increase everyone’s reliance upon bonding capital whilst measures are in place. Any distrust of institutions will be magnified by this isolation and further compounded by changing messaging as a complex pandemic unfolds.
Social capital in a digital age
It is not only health interventions that rely upon bridging and linking capital. As we remain at home we increasingly rely upon digital technologies but access to devices that can deliver on all tasks is unequally and socio-economically distributed.
For example, home schooling has put delivery of our national curriculum into the hands of parents. The plethora of online material to support this is impressive but not all families have the relevant or sufficient technology to teach their children. There are schemes to help but they are not well advertised and they require brokering by parents with schools, thereby relying upon linking capital to make them work. Given that poorer groups within the UK are likely to have less experience of linking, of negotiating, of simply asking for help, it is likely that not everyone who should be will be supported.
A full strategy would take account not only of missing technology, due to inequality, but also of the way people will seek help; poverty will heavily weight bond social capital and stop broader search strategies.
Pitas and Ehmer [3] state that the US Government should invest in growing social capital in order to facilitate management of and recovery from the current pandemic. But they suggest mobilising digital technologies to do this for bridging capital, without recognising that this is potentially excluding.
One thing this crisis reinforces is the idea that digital connectivity is a human right due to our reliance upon it to manage the quotidian and the extraordinary. That right must be extended to all, and public health spending on the distribution of tablet technologies and internet access to all could facilitate social capital gains and improve resilience.
A similar lesson should be drawn at the global scale where there are marked inequalities and outcomes.
Conclusion
The social resources we have are affected by socio-economic realities, and both impact upon our health and resilience. Existing inequality will affect outcomes during the current COVID-19 pandemic but interventions will also impact upon social capital in ways that might exacerbate existing risks of disengagement.
More generally, bridging and linking social capital will prove important for managing other aspects of the crisis. Policy makers should attend to these effects and think about how interventions will be accessed by those with relatively reduced social capital.
To attend to social capital is to attend to our ghettos and to break down their walls. Doing so will reduce inequality, improve health, and increase creative engagement with the problems of the world.
We need to do this now because we will face future disasters together.
References
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Bartscher AK, Seitz S, Siegloch S, Slotwinski M, Wehrhöfer N. 2020 Social Capital and the Spread of Covid-19: Insights from European Countries. SSRN Electron. J. (doi:10.2139/ssrn.3616714)
Marmot M. 2010 Fair society, healthy lives. Public Health126 Suppl, S4-10. (doi:10.1016/j.puhe.2012.05.014)
Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. 2020 Health Equity in England: The Marmot Review 10 Years On. London: Institute of Health Equity.
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Uphoff EP, Pickett KE, Cabieses B, Small N, Wright J. 2013 A systematic review of the relationships between social capital and socioeconomic inequalities in health: A contribution to understanding the psychosocial pathway of health inequalities. Int. J. Equity Health12, 1–12. (doi:10.1186/1475-9276-12-54)
McConnell BB. 2016 Music and health communication in The Gambia: A social capital approach. Soc. Sci. Med.169, 132–140. (doi:10.1016/j.socscimed.2016.09.028)
An online webinar brought together leading clinical and academic experts to discuss the impact in the rise of technology on the mental health of children and young people. This event, which was chaired by Middlesex University Criminologist Dr Elena Martellozzo, was organised by the UK Council for Internet Safety Evidence Group (UKCIS) and supported by the UKRI Mental Health Network (eNurture) and the Department for Culture, Media and Sport (DCMS).
“The last decade has seen a startling level of technological innovation,” said Professor Sonia Livingstone OBE, eNurture Network Deputy Director.
“We’ve moved, I’d suggest, from seeing technology as a valued addition to our lives, to seeing technology as its vital infrastructure and as COVID-19 has made that really clear now, for young people especially, life is digital by default.”
As technology becomes a crucial part of our everyday, what is the impact on the mental health of children and young people? The COVID-19 pandemic and subsequent lockdowns have seen children and young people off school for large periods and spending even more time online, either learning, playing or socialising.
“Being online can be a hugely positive experience for adults, children and young people, however it is also presents a risk of harm and there is growing concern about the relationship between technology and the mental health of children and young people,” explained Rachel Bishop, the Deputy Director of Online Harms Policy at DCMS.
“The pandemic has brought this into sharp focus with children’s screen time averaging nine hours per day during lockdown which is nearly double the average prior to COVID-19 (according to the Pandemic Parenting Report).
A study by Ofcom has found that children were lacking structure and routine, and were instead spending a large amount of time online often unsupervised. While screen based online platforms can support learning, social networks and reduce feelings of loneliness, they can also impact mood, self-esteem and body image as a result of extended or prolonged time engaged with screens.”
Mental health crisis among young people
Dr Bernadka Dubicka, Chair of Faculty of Child and Adolescent Psychiatry, Royal College of Psychiatrists presented some insightful data on the mental health crisis among young people in the United Kingdom. She argues that this is rising significantly alongside the growing reliance on technology.
In 2020, one in six children aged five to 16 were identified as having a probable mental disorder increasing from one in nine (10.8%) in 2017, according to The Mental Health of Children and Young People in England 2020 report. The increase was evident in boys and girls. The rate has risen in boys aged 5 to 16 from 11.4% in 2017 to 16.7% in July 2020 and in girls from 10.3% to 15.2% over the same time period.
Negative impact of social media
The Good Childhood report, 2020 concluded that among 24 countries reviewed UK adolescence between 10 and 15 years are doing least well. The NHS Digital Prevalence Survey, 2018 of children aged 11 to 19 showed those with disorders were much more impacted by social media.
For example nearly 42% with mental health disorders compared to 25% without compared themselves to others; 27.2% with disorders compared to nearly 14% without admitted that likes, shares and people’s comments affected their mood; 66.6% with disorders compared to 52.8% without spent more time than they meant to online.
Children and young people with mental health problems are often turning for help because of content on social media.
Victoria Hornby, CEO of Mental Health Innovations which runs the 24-7 crisis helpline Shout, said suicide deaths of celebrities “spark anxiety among young people” so they share support services. “Within 15 minutes of the death of Caroline Flack we were beginning to see a significant increase in volume on our platform,” she argued.
The negative impact of too much screen time on young people’s development has also been well documented. The review paper the Online Brain, How the Internet maybe changing your cognition concluded “excessive Internet use impairs brain and verbal development”, “mass acceptable/rejection/social comparisons affects self-esteem” and “media multi-tasking affects attention and memory”.
The World Health Organisation recommends limiting screen time for children aged one to four to one hour per day, stating the “potential benefit of reducing sedentary screen time outweighs the possible harms/costs & may increase health equity”.
This may seem extreme but technological use starts at a very early age. A third of patients referred to NHS England’s National Centre for Gaming Disorders started gaming aged six years or younger, according to its founder Dr Henrietta Bowden-Jones, OBE. She said many of the patients were “very thin or obese”, with “poor eating habits, self-care and little exercise”, and suffered from loss self-esteem, social anxiety, low mood, poor regulation of boredom and attachment issues, with gaming providing “escapism, connection, communication and acceptance, achievement”.
“Half of the children turned violent, sometimes very violent when things were taken away which stopped them from gaming, in some families the police were called 20 or 30 times. I had underestimated the terrible impact on families,” said Dr Bowden-Jones.
What happens next?
What can be done to tackle the detrimental effect of too much screen time and technology on the mental health and wellbeing and children and their families?
Rachel Bishop of DCMS said its plans for online harms legislation will ensure companies are more “responsible for people’s safety online, especially children” alongside the Government will publish its response shortly to the white paper – the Adult Online Hate, Harassment and Abuse assessment – with legislation following next year, which will be accompanied by non-legislative initiatives including a media literacy strategy and safety by design framework.
To the question If there was one thing that you would change about the digital world, what would that be? posed by Dr Graham Richard, Psychiatrist & Clinical Director, Good Thinking, Dr Dubicka answered:
“Global togetherness on technology, regulation, safety and responsibility from the tech companies, as we have seen for climate change.”
Research and guidance is essential
Victoria Hornby also provided an insightful response: “We need to have much clearer signposting of safe sources for help. We have young people who regularly contact us saying ‘I did an online quiz to see if I have depression or an eating disorder’ and the random searching with completely unfiltered content can be damaging for children.”
Literacy on the impact of technology on mental health is crucial. “The digital world will not go away and it’s only when we get guidance and knowledge which helps parents, professionals and young people directly, that we will advance this whole debate,” commented Professor Gordon Harold, Professor of the Psychology of Education and Mental Health at the University of Cambridge and eNurture Director.
Further research into the impact of technology on mental health is also essential. The Nurture Network (eNurture) is a UKRI funded programme, which supported this event and has seven associated networks, is funding start up research projects and practical interventions designed to examine how the digital world is changing and its impact on young people.
The academic and clinical experts all agree that there must be an onus on technological companies as well to address concerns about the impact of their technology on young people’s mental health.
Dr Mark Griffiths, the Director of the International Gaming Unit at Nottingham Trent University, said structural characteristic such as the ‘Like’ button on social media or the event frequency in gambling, are really important in determining whether someone will have a problem.
“If you’ve got a product and you know a small minority of your clientele are going to have a problem with it, you have to take responsibility,” argued Dr Griffiths.
“The great thing about technology, is we can actually harness that technology to help treat those people who unfortunately do suffer from problematic or addictive behaviours.”
Written by Paul Harper, Middlesex University Press Officer, and Elena Martellozzo, Middlesex University Criminologist.
Professor Laurent Pech, Head of the Law and Politics Department at Middlesex University, has been researching a worrying issue he has described as ‘Rule of Law backsliding’ for more than ten years.
Here, he claims there are signs suggesting that a process of Rule of Law backsliding which, in the EU, first began in Hungary before spreading to Poland, is getting underway in the UK.
Since the early 2010s, the EU has witnessed a startling breakdown in compliance with the rule of law, as some Member States’ governments systematically dismantle checks and balances in order, incrementally, to establish de facto one-party states.
My research has examined these systematic and coordinated efforts by some national authorities to undermine the rule of law, with my work especially concerned with the deteriorating situation in both Hungary and Poland.
In the last three years, we have witnessed a number of developments in the UK which are reminiscent of what we have seen in both Hungary and Poland.
For instance, the ‘will of the people’ appeal has often been used as a way to justify violations of the rule of law. The first signs of an unhealthy rhetoric in the UK could be seen too with judges and academics, and more recently lawyers, increasingly subject to abuse and intimidation tactics.
‘Enemies of the People’
In the wake of the Miller case, the attack on the judiciary and the ‘enemies of the people’ headline in the Daily Mail in November 2016 can be considered a hallmark of autocratic regimes as only an independent judicial system can enable individuals to vindicate their rights.
Similarly attacks on ‘pro-remain’ universities was another way to ensure that a counter, in the case of the UK anti-Brexit, discourse is muted.
No voices are thus left to proffer arguments against governmental policies which some may be tempted to justify in the name of ‘the will of the people’ regardless of whether they violate the rule of law or not.
A third parallel one could draw as early as 2016/17 was the attack against George Soros and his Open Society Foundations, both in Hungary as well as in the UK where Nigel Farage sought to investigate Soros funding. The anti-Semitic overtones of the anti-Soros rhetoric can be viewed as an attempt to garner the support of autocratic and nativist forces.
It would be unwise to assume that the UK legal and constitutional system will be strong enough to withstand the ongoing process of rule of law backsliding which seems to be gaining strength in the UK.
Attacking the judges and lawyers
Indeed, the election of Boris Johnson has been followed not only by worrying rhetoric but also, and more crucially, actual steps which could lead to an autocratisation by stealth of the UK.
One may refer here, for instance, to the repeated and dangerous attacks against so-called “activist lawyers” by the Home Office Secretary and the British PM himself. This kind of attacks on the legal profession not only undermine the rule of law but endangers the personal safety of lawyers.
In this context, let me quote Sir Anthony Hooper, a retired Court of Appeal judge: “Once you’ve lost the independent legal profession, once the judges have become enemies of the people, the future health of this liberal democracy is very much at stake.”
And indeed, under the cover of this rhetoric characteristic of autocratic regimes in the making, we have also seen the unbecoming politicisation of the offices of the Attorney General and of the Lord Chancellor.
Legalising law breaking
In addition, as if this was not enough to worry you, the British government unlawfully prorogued Parliament under a false pretext and most recently, the British government, including the AG and Lord Chancellor, have defended the legalisation of lawbreaking via the UK internal market bill.
As the Select Committee on the Constitution of the House of Lords put it last month:
“Setting out explicitly to break international law in this way is without precedent. It jeopardises international obligations the UK recently ratified, undermines domestic law and is contrary to the rule of law.”
Yet more deliberate undermining of the rule of law is on the way with ongoing governmental work on judicial review and the announced review of the Human Rights Acts should be understood as further deliberate attempts to make the executive power in the UK unaccountable.
COVID-19 has changed the rules
It’s important not to overestimate the resilience of the UK’s constitutional arrangements to the authoritarian gangrene which first began in Orban’s Hungary, especially in a COVID-19 context which has made it easy for governments everywhere to bypass normal law-making procedures on a grand scale.
To avoid a process of what I have called in my research “constitutional capture” by the current political majority in the UK, it is crucial that judges, lawyers, academics but more generally all citizens, realise what the ongoing demonisation of legal professionals and dangerous legislative steps previously mentioned may lead to, that is, the progressive transformation of the UK into an electoral autocracy where authoritarian practices are hidden behind the institutional facades of representative democracy.
While multiparty elections will continue to be regularly organised, these will no longer be fair due to the systemic undermining of most democratic and rule of law minimum standards by the ruling party.
In 2021, Professor Pech and Dr Joelle Grogan, a Senior Lecturer in UK and Public Law, will submit a REF impact case study entitled “Challenging Rule of Law Backsliding in the European Union”.
Tom Dickins, Professor of Behavioural Sciencediscusses the social risks surrounding the new Rule of Six.
It is September 2020 and the world is still firmly in the grip of the COVID-19 pandemic. Here in the UK, as in many other parts of the world, we have undergone a full lockdown that brought the reproductive rate (R) of the SARS-CoV-2 virus down to just below 1. This undoubtedly enabled much-needed breathing space for our health services.
But now R is rising, and with it, rates of infection, and soon it is predicted that the number of deaths will begin to increase significantly also.
One solution to this rise in cases is to enforce local lockdowns in areas with particularly high infection rates. This form of targeting has been on-going since the easing of national level lockdown procedures in the U.K.
Another solution, implemented from 18 September 2020, has been to impose the rule of six. The rule of six has proved contentious, in part due to many exemptions, differences in its rendition across all countries in the UK, and the fact that the number six appears to have been arbitrarily chosen.
Putting to one side these possible inadequacies, it is worth inspecting just what the rule of six is.
At first pass it seems to be a legal requirement. Thus it may simply be a permitted entailment of the COVID 2020 act (but see this discussion for other thoughts). However, it may also be understood as an attempt to engineer new social norms within UK society.
Social norms
Social norms, or just norms, are shared beliefs about the kinds of behaviours that are appropriate in various situations [1]. But they can also simply be understood as what the majority of people do – a purely behavioural measure.
Norms have been categorised as descriptive, whereby people are able to simply state what most people do, and injunctive, whereby some kind of punishment structure is used to shape behaviours to a desired outcome [2].
It is into this last category that the rule of six fits.
The rule of six states that people cannot gather in groups of 6+n individuals, either inside or outside, and if they do, the police services have the power to disband such groups and fine individuals if they refuse to disband.
Whilst this leaves the police to enforce the norm of small group sociality, some government ministers have suggested that peer engagement with norm enforcement is also useful; we should report our neighbours if they violate this rule.
The rule of six differs qualitatively from the safeguards associated with lockdown, because it is to be followed in the context of a largely reopened society; children are still going to school, students are about to start at university, employees are returning to work and we can go out for a meal and a drink.
The idea behind the rule seems to be to make salient the idea of controlled sociality, of offsetting the other risks that may be taken in order to keep society running (see here for a related argument). As such, this rule, whilst hopefully transient, is designed for a reasonably long period of time.
New norms
What do we know about norm change within society? Two major contributors to norm research, Elias [3, 4] and Inglehart [5–7], have made related arguments.
Elias has argued that for Western Europe, we have seen an increase in the number of norms, thus norms have become more restrictive or stricter. He particularly focused upon hygiene and violence norms. He argued that as societies shifted away from more ancient power structures, toward increased interconnectedness between individuals brought about by the emergence of central governance and monopolies in industry, people were able to take on more self-regulation and norms began to increase within society.
Inglehart makes related claims around autonomy. As societies managed to control or remove existential threat (such as disease and conflict) their reliance upon collectives, and subservience to power such as organised religions, dwindled. This enabled people to become more autonomous and self directed. For Inglehart this means that norms can become more inclusive, and more flexible than those sustained under more controlling situations.
Both Elias and Inglehart are reflecting upon a trend toward collectivism, where individuals connect more through innovation and locally shared needs, enabling economic diversification. These things are possible when crucial threats are removed and breathing space is created. The law-like normative structures of feudal power and organised religions may have worked in such existentially dire times, but their relevance is reduced when the world is effectively safer. An outcome of this may be the creation of many more norms within the collective, but also different norms reflecting different local practices and requirements.
Here and now
The COVID-19 pandemic is clearly a grave existential threat, but in the UK this threat is to be understood against a backdrop of a long but recent history of reducing dangers.
For example, we can make a case for increasing safety and collectivism in the years following WWII [8], with marked economic and technological growth and an increasing sense of self-regulation accompanied by diverse and coexisting norms operating within subpopulations. This means that the UK population as a whole (and similar populations elsewhere) are now having to come to terms with norms about social interaction that are imposed by a third party, rather than norms that have naturally emerged through collective action.
Legislation, through central governance, is designed to keep core existential threats at bay and to engender the kind of collectivism that encourages economic growth. But this is more usually achieved at arm’s length, and without imposing directly upon the interactions of citizens. Instead, the law acts to create and protect health-promoting institutions that allow citizens to flourish.
This disease challenges the very gains made during what Inglehart terms modernisation because it exists and thrives within social groups; it can legitimately be seen as an attack on our modern way of life. This goes a long way toward explaining the bellicose language in the early days of the pandemic.
To tie punishment to violation of the rule of six may seem like a quick way to establish normative behaviour. Citizens are used to conforming to the law, and legislated behaviours tend to stabilise. But the rule of six is a radical change to how we operate; in many ways more radical than a collective effort to lockdown for a finite period in order to all protect society together.
It is legislation that gives us some freedom, but asks us to choose who to associate with. More than that, this right to choose our five other associates is in fact not evenly distributed as some people live in families of six, or larger, restricting their degrees of freedom compared with those who live alone or in smaller groups.
Quite suddenly the norm we are being asked to adhere to introduces inequality of opportunity, and that will lead to an uneven distribution of punishment and possibly the creation of specific attitudes about those who are more likely to violate the rule.
Put bluntly, the rule stands every chance of damaging our sense of collectivism.
Other dynamics
Elias and Inglehart described a direction of travel for societies, away from autocracy toward self-regulation and naturally emerging norms. It is possible to contemplate a reversal of this under harsh and austere times.
As existential threats mount – we currently face COVID-19 and the wholesale degradation of our environment through biodiversity loss and climate change leading to inevitable economic catastrophe – it is possible that our mechanisms of central governance and collectivism that brought so much freedom and tolerance might be abandoned.
Inglehart notes that existential insecurity is conducive to xenophobia, authoritarian politics and adherence to rigid cultural norms [5] and he has written about the impact of increasing wealth inequality enabling a cultural backlash from older segments of society seeking to return to more traditional norms and more authoritarian governance because they associate the progressive values of modernisation with a loss of security [8].
This is a part of his account of the rise of populism in the USA, which he sees as diametrically opposed to the collectivism discussed above. Here in the UK wealth inequality and inequality of access to opportunity across diverse groupings directly impacts upon health and longevity, reducing existential security for many.
Up until 2011, progress had been made in tackling some of these issues but then inequalities began to re-establish themselves and grow in large part due to austerity policies designed to deal with the 2008 financial crash [9].
An unequal society is one that is structurally divided or dividing into multiple subpopulations. Inglehart’s notion of populism is one where that process leads to competition or the perception of competition between those groups. This kind of situation mobilises the psychology of coalitions in a negative way, and can readily encourage paranoid responses to out groups and the structuring of complex narratives to justify a belief in out group threat [10].
Asking neighbours to report their peers for violation of an imposed norm, the rule of six, will only aid the development of paranoid ideation, in both directions; we are under threat from norm violators, we are under threat for violating a norm that is unequally applied to us.
People will either succumb to this paranoia and society will continue to suffer division, or they will ignore the rule and the hidden point about offsetting risk will be lost. I assume Inglehart has a view on those politicians who make such recommendation, and their view of governance.
Conclusion
HM Government has a difficult task and tackling COVID-19 will clearly rely upon social changes given the nature of the virus that causes it. But if my use of norm theory and the work of Elias and Inglehart is correct, then there are real dangers from imposing the wrong kind of social intervention.
Policy makers and their advisors need to be fully aware of the architecture of the population they hope to serve. Population structures not only affect viral spread, but also the ideals of the people constituting those populations.
Reading
Mackie, G., Moneti, F., Denny, E. & Shakya, H. 2014 What are Social Norms? How are they Measured?
Cialdini, R. B. 2003 Crafting Normative Messages. Curr. Dir. Psychol. Sci.12, 105–109.
Elias, N. 1978 The Civilizing Process. Urizen Books Pantheon Books.
Linklater, A. & Mennell, S. 2010 Norbert Elias, The Civilizing Process: Sociogenetic and psychogenetic investigations – An overview and assessment. Hist. Theory49, 384–411.
Inglehart, R. 2018 Modernization, existential security, and cultural change: Reshaping human motivations and society. In Handbook of Advances in Culture and Psychology (eds C. Y. Gelfand & Y.-Y. H. Chiu), pp. 1–59. Oxford University Press. (doi:10.1093/oso/9780190879228.003.0001)
Zhirkov, K. & Inglehart, R. F. 2019 Human Security And Religious Change: An Analysis Of 65 Societies Across 1981–2014. Sociology. (doi:10.2139/ssrn.3504661)
Inglehart, R. & Baker, W. E. 2000 Modernization, cultural change, and the persistence of traditional values. Am. Sociol. Rev.65, 19–51. (doi:10.2307/2657288)
Inglehart, R. & Norris, P. 2017 Trump and the Populist Authoritarian Parties: The Silent Revolution in Reverse. Perspect. Polit.15, 443–454. (doi:10.1017/S1537592717000111)
Marmot, M., Allen, J., Boyce, T., Goldblatt, P. & Morrison, J. 2020 Health Equity in England: The Marmot Review 10 Years On.
Raihani, N. J. & Bell, V. 2019 An evolutionary perspective on paranoia. Nat. Hum. Behav.3, 114–121. (doi:10.1038/s41562-018-0495-0)
Nicky Lambert, Associate Professor in the Department of Mental Health and Social Workat Middlesex, encourages focusing on our mental wellbeing and looks at the mental health of current NHS staff.
We are in the middle of #MentalHealthAwarenessWeek and this is an excellent time to think about this year’s theme: #KindnessMatters. The focus for the campaign was originally going to be sleep, but in this socially distanced world, which has shown how precarious things can be, kindness could not be more important.
This crisis has brought out the best in many of us. Communities have come together to help each other and friends and families are taking time to connect and noticing how much they miss each other. A sudden shock can make us reevaluate our choices, but the shock of this pandemic is passing.
Being anxious gets tiring, we get used to it and it gets boring. We notice that the summer we had expected is passing us by; the anticipation of sports, holidays, graduations are all gone now. We are at the stage when old habits reassert themselves, people get grumpy and complain and tempers can fray.
This is when the importance of practisingkindness kicks in – it’s not something that comes naturally to everyone, all the time. It takes intention, and it takes well, practice!
Practice good mental health wellbeing
As a mental health nurse of twenty years standing, I’d like to make a plea that you take some time out this week to consider your mental health in the same way that you monitor your physical wellbeing. Many of us have noticed that we are less physically active because of lockdown, not eating or sleeping well because of our worries and we are starting to take steps to readjust.
This is a concerning time for everyone. For the 1.4 million NHS staff, it’s not only worrying, but it’s also a confusing and sometimes frightening experience. On one hand the public are literally applauding their efforts and there is praise for staff working in challenging situations and putting the wellbeing of others before their own. However longstanding issues of poor pay and staff shortages have been compounded by dangerous working conditions due to a lack of Personal Protective Equipment (PPE) particularly in the early days of this crisis.
Not only are staff dying as a result of caring for people with COVID-19, those deaths are falling disproportionately on the BAME community who make up a significant part of London’s heath staff. Those who are unable to be with their colleagues on the front lines of practice because of their own health status or carers responsibilities can feel guilty. Those who find themselves described as ‘heroes’ and ‘angels’ sometimes struggle to process their negative feelings. It can be hard to be open about feeling despair or fear when you are expected to be superhuman. It may also lead to ‘moral injury’ (the psychological impact of bearing seeing things or having to make decisions that violate one’s everyday moral expectations).
What support is being offered?
A mental health hotline has been launched for NHS staff to receive support and advice (tellingly it’s staffed by volunteers).However staff in Mental Health and Social work and Nursing departments at Middlesex University are also rising to this challenge.
We are working with The Pan London Practice Learning Group and others to develop resources for the capital’s nursing students as they take up an extended placement to help staff our health services.
For the International Year of the Nurse and Midwife, we were to host the prestigious International Mental Health Nursing Research Conference. Obviously a conference is not possible this year but our Centre for Coproduction in Mental Health and Social Care have helped develop a solution in the shape of an innovative collaboration between @Unite_MHNA@WeMHNurses and @MHNRconf. By using a range of social media channels, the Centre will bring a range of mental health speakers to new listeners, connect up colleagues and celebrate the work of mental health staff at this challenging time.
What next
The last few years have discouraged us all from making predictions, but our staff and academics will continue to be flexible in the support of our students and to ensure they have access to the best quality online learning.
We will use our expertise to be responsive to the needs of front line services and help to build and sustain the health and social care communities that we all rely on in these challenging times.
MDX academics have collaborated with 36 scholars from all over the world to create a review of what social and behavioural sciences can do to protect and promote physical and mental health during a pandemic.
Social and behavioural sciences can support efforts to identify effective public health messages, encourage compliance with government directives, design institutional responses that are well-calibrated to human behaviour, sustain prosocial motivations in large, disconnected societies, manage anxiety and loneliness, identify cultural factors that can minimise the spread of the virus and motivate compassion for, and costly actions that benefit, vulnerable groups.
The current paper reviews insights derived from several particularly relevant areas of research in the social and behavioural sciences. For each of these areas, we highlight relevant findings, derive insights of potential use to policy makers, leaders, and the general public, and highlight areas where future research is needed.
Navigating threat
This first section discusses how people perceive and respond to threats during a pandemic and the downstream consequences for decision-making and intergroup relations.
Pandemics are often associated with rampant cases of discrimination and cases of individual assault, especially against outgroups. But pandemics may also offer opportunities to reduce distances. For example, 21 countries donated medical supplies to China in February, and China has reciprocated. Government officials can highlight events like these to improve out-group attitudes.
The media typically focus on the percentage of people who die, and less so on those who survive. Providing the opposite frame may help to educate the public and relieve some people’s feelings of panic.
To allow people to work with each other rather than against each other, the key factor is the emergence of a sense of shared identity which leads people to be concerned and care for others. It can be encouraged by addressing the public in collective terms and by urging us to act for the common good.
Social and cultural factors
This section reviews how social and cultural factors can affect response to the pandemic, and how this can be used to protect and promote healthy behavior.
People are influenced by perceptions of norms, especially when they come from people with whom they share identity. Messages that provide in-group models for norms (e.g. members of your community) may be most effective.
The spread of COVID-19 will tighten communities. A critical question is whether loose societies (UK, USA, Italy) will adapt quickly to the virus. Countries accustomed to prioritising freedom over security may have more difficulty coordinating in the face of a pandemic. We describe some of these issues in the section on social support and coping below.
Science communication
This section discusses the challenges associated with different types of misinformation during a pandemic as well as strategies for engaging in effective science communication and persuasion around public health.
People are more drawn to conspiracy theories when important psychological needs are frustrated. Conspiracy theories can have harmful consequences; belief in conspiracy theories has been linked to vaccine hesitancy, climate denial, extremist political views, and prejudice. Some evidence suggests that inoculating people with factual information prior to exposure can reduce the impact of conspiracy theories.
Fake news about COVID-19 has proliferated widely. One approach is to debunk using fact-checking and correction. However, these may not keep up with the vast amount of false information. One prebunking approach involves psychological inoculation. For example, preemptively exposing people to small doses of misinformation techniques or providing subtle prompts that emphasise accuracy.
Other approaches that increase the likelihood of the information being understood: credibility of the source, messages focusing on the benefits to the recipient, aligning message with recipient’s moral values. For health issues, there is some evidence that a focus on protecting others can be more effective (e.g. “wash your hands to protect your parents and grandparents”).
Moral decision-making
In this section, we consider how research on morality and co-operation can encourage prosocial behaviours.
Moral decision-making during a pandemic involves uncertainty. Research suggests people are more risk-averse when their decisions affect others compared to themselves, suggesting that focusing on risks to others (rather than oneself) may be more effective in convincing individuals to practice public health behaviors. Research shows also that focusing on worst-case scenarios, even if they are uncertain, can encourage people to make sacrifices for others.
Fighting a global pandemic requires large-scale co-operation. Sanctioning defectors or rewarding co-operators typically promote co-operation but are costly. Cheaper techniques can include providing cues that make the morality of an action salient or providing cues suggesting that other people are already co-operating.
Moral elevation is the feeling of being uplifted and inspired by others’ prosocial, selfless acts, and this experience prompts observers to also act with kindness and generosity themselves. Thus, exceptional role models can motivate people to put their own values into action.
Leadership
Crises create a strong demand for leadership and this demand is present in all the groups to which we belong; our family, our local community, our workplace, and our nation. What should leaders do?
The first responsibility of leaders in times of crisis is to set aside personal or partisan interests and cultivate an inclusive sense of “us”.
Solidarity within and between nations is critical during a global pandemic. The belief in national greatness can be maladaptive in a number of ways. For instance, it is likely to promote greater focus on protecting the image of the country, rather than on caring for its citizens.
Stress and coping
Distancing threatens to produce an epidemic of loneliness. There are strategies to mitigate these outcomes.
We suggest the term “social distancing” be replaced when possible with “physical distancing”, to highlight that deep social connection with a broader community is possible even when people are physically apart through the use of technology.
Major stressors alter the trajectories of our intimate relationships. Divorce rates typically surge, but also marriage and birth rates. People should calibrate expectations for the relationship to the circumstances. Continuing to expect the same level of excitement and adventure from the relationship is a recipe for disappointment.
It is important to instill adaptive mindsets, guiding individuals towards the mindsets that this illness is manageable, their bodies are capable, and that this can be an opportunity to make positive changes in the world.
Roger Kline, Research Fellow at Middlesex University, highlights the three principles NHS organisations should take forward immediately to avoidunecessary staff deaths.
Well over a hundred NHS staff have died from COVID-19 and we’re not clear why.
COVID-19 disproportionately impacts on some groups of people but we have known for a long time that it was likely to. The NHS nationally failed to ensure (or even ask whether) all employers conducted the statutory risk assessments which should have been carried out weeks ago and which might have prevented some of the tragic staff deaths and illness we have seen.
There are growing signs that the NHS nationally and individual employers are starting to do what should have been done weeks ago. I want to suggest three principles which should inform employers’ approach going forward
1. What employers do can make a substantial difference
When the deaths of 119 NHS staff were analysed by three leading clinicians they found that the proportion of nursing and support staff who died from COVID-19 was three times as high as their proportion in the NHS workforce and for doctors it was twice as high.
But their most remarkable finding seemed to largely slip under the radar.
Anaesthetists, intensive care doctors and by association nurses and physiotherapists who work in similar settings are believed to be among the highest risk groups of all healthcare workers because they care for the sickest patients with COVID-19, undertake airway management and have high risk of viral exposure and transmission.
However the analysis found there were no anaesthetists or other intensive care doctors amongst those who died. They found that of those whose speciality was identified, none were described as intensive care nurses. There were also no deaths of physiotherapists reported. The researchers conclude that
…the reason for this is not known and data on infections and serious illnesses are important to consider as well as fatalities, but this data is also currently lacking. What is likely is that these groups of healthcare staff are rigorous about use of personal protective equipment and the associated practices known to reduce risk (emphasis added).
It may be that this rigour is protecting staff better than some fear and the results can be considered cautiously reassuring. However, this finding is not a reason to slacken off on the appropriately rigorous use of PPE, but rather to wonder why others, who are likely involved in what are generally considered to be lower risk activities, are becoming infected and consider whether wider use of rigorous PPE is indicated.
What implications does this have for NHS employers? The researchers suggest a crucial one
It is not possible to know whether infection occurred at home or at work, but we have determined that the vast majority of individuals who died had both patient-facing jobs and were actively working during the pandemic. It seems likely that, unfortunately, many of the episodes of infection will have occurred during the course of work.
Had the statutory risk assessments been undertaken several weeks ago as they should have been, they would have highlighted the greater risks to some groups of staff and inevitably recommended special attention be paid to eliminating or mitigating those risks.
The risks were:
Staff from any backgrounds with long term health conditions would be especially vulnerable to a Coronavirus pandemic
BME staff being amongst those groups especially prone to such long term health conditions
BME staff being disproportionately represented amongst lower graded front line health and social care staff who might generally be at greater risk
BME staff have been found to be less likely to raise safety concerns either because they do not believe they are listened to or because they fear the consequences of doing so
BME being more likely (I’ve not seen robust data on this) to work night shifts where communication and safety measures may be more poorly managed
In addition, there has been significant anecdotal evidence that BME staff believe they are being disproportionately placed on wards with greater COVID-19 risks where staff are reorganised on a temporary basis to cope with the pandemic.
Finally, those dying do not look like those making the decisions. There is a steep ethnicity gradient across the NHS with career progression much harder for BME staff and senior positions generally well out of reach despite some recent limited progress. Diverse teams make better decisions and we don’t have nearly enough diverse senior leadership teams prepared to put themselves in other peoples’ shoes.
At a time when PPE was in serious shortage, these factors contributed to a perfect storm. The results are in the news bulletins every day. The risks were reasonably foreseeable. However, not only were many of these deaths probably avoidable but if the right measures are taken now by NHS employers, the death rate and illness rates amongst all staff but especially BME staff can be radically cut.
For that to happen two other conditions must be met.
2. Employers must take prime responsibility for staff health, safety and well-being
The statutory requirements on health and safety at work of employees, and the statutory requirements in respect of equality are primarily for employers to actively implement rather than for employees to complain when they are breached.
For example:
Section 1 (2) Health and Safety at Work etc Act 1974 states: “It shall be the duty of every employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees.”
Regulation 3 (1) of the Management of Health and Safety at Work Regulations 1999 provides that: “Every employer shall make a suitable and sufficient assessment of the risks to the health and safety of his employees to which they are exposed whilst they are at work; and the risks to the health and safety of persons not in his employment arising out of or in connection with the conduct by him of his undertaking”
The Personal Protective Equipment at Work Regulations 1992. Regulation 4 (1) provides that “every employer shall ensure that suitable personal protective equipment is provided to his employees who may be exposed to a risk to their health and safety except where and to the extent such a risk has been adequately controlled by other means which are equally or more effective.”
At the same time however, human resources practice has steadily driftedtowards a culture where policies, procedures and training are put in place which focus on enabling individuals to safely raise concerns rather than the employer being proactive and preventative. The problem is that such an approach does not work. Research on bullying, for example, concluded that
In sum, while policies and training are doubtless essential components of effective strategies for addressing bullying in the workplace, there are significant obstacles to resolution at every stage of the process that such policies typically provide. It is perhaps not surprising, then, that research has generated no evidence that, in isolation, this approach can work to reduce the overall incidence of bullying in Britain’s workplaces.
…attempts to reduce managerial bias through diversity training and diversity evaluations were the least effective methods of increasing the proportion of women in management […] programmes which targeted managerial stereotyping through education and feedback (i.e. diversity training and diversity evaluations) were not followed by increases in diversity.
There has been a similar approach in respect of staff raising concerns (whistle blowing) where it is still left far too much to individual members of staff to be brave or foolish enough to raise concerns rather than employers proactively intervening to change the organisational climate at work.
The wider industrial relations context over the last three decades has been one that has seen a move away from ‘collective bargaining’, towards one that has relied much more on a floor of employment rights that is overwhelmingly individualist in nature. Even when individuals successfully challenge inappropriate decision making using employer policies and procedures, they often have little impact on the conditions of other workers other than possibly tightening up employer policies, procedures and training, which are designed as much to defend employers as to improve outcomes – impacting on what trade unions can achieve
In respect of COVID-19, therefore, it is crucial that the emphasis is on clear expectations, monitored by both the CQC and NHSi/E, that employers will act decisively to protect all staff and especially those that evidence suggestsare most at risk.
This should be done through:
Urgent risk assessments made public and involving staff and unions
The provision of suitable and safe PPE
Enhanced staff testing
Enhanced data collection and analysis to assist proactive intervention
Enforcing social distancing and ensuring that staff who can do so work from home subject to service needs
Actively listening to staff and acting on their concerns and suggestions, and ensuring it is safe to do so
3. The narrative is crucial
All employers have a statutory duty to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all their employees. It is one aspect of the duty of care owed by all employers to their employees, contractors and visitors.
No member of staff should be exposed to risks that are reasonably foreseeable and which can be eliminated or mitigated. We know that some groups of NHS staff are at particular risk, notably those with underlying health conditions. We know that Black and Minority Ethnic staff are amongst those particularly at risk and are disproportionately working on the front line in lower graded roles, subject to more bullying, more reluctant to raise concerns, and may be more likely to work night shifts.
It is therefore especially important that when undertaking and acting on risk assessments Black and Minority Ethnic staff are accorded particular attention because they may be at greater risk, as the death and infection rates from COVID-19 for NHS staff as a whole show.
Failure to do so would be a breach of the employer’s duty of care and would risk unnecessary harm. Let us be clear. This is not an alternative to addressing the risks faced by all staff and ensuring all staff are as safe as possible, but is an integral part of such an approach which recognises that some groups, notably BME staff, are especially at risk.
The initial analysis of NHS staff deaths suggest that where the statutory requirements are fully met, risk is indeed greatly reduced. There is no time to be lost in taking the steps suggested especially as individual trusts and the NHS nationally have now accepted there is much to be done, and at speed.
