Presentation for the 12th July Local Government Association Webinar Grief Not Grievance on Trauma, Psychology and Covi

1. Grief not Grievance: Loving our Communities
to resilience and recovery
From social science insight to practical tasks
Jim McManus, CPsychol, FBPsS, Csci, Chartered FCIPD, FRSB
Director of Public Health
Hertfordshire County Council
Vice-President, UK Association of Directors of Public Health
Jim.mcmanus@hertfordshire.gov.uk
LGA/ ADPH/ Centre for Mental Health Webinar
12th July 2021
*Also known as: incorrigible optimism from a DPH

2. From the last Pandemic: What worked then
www.adph.org.uk
1219379.pdf (publishing.service.gov.uk) (PDF) faith communities, emergency planning and civil
resilience | Professor Jim McManus - Academia.edu
2009 2008

3. Public Engagement during Crises:
use of psychology in mass casualty response
show respect for the public's needs (which means listening for information on needs, as well as
using knowledge obtained in the preparedness phase); (2) be open and honest;
provide health-focused information (why is the procedure necessary?);
provide sufficient practical information
Carter H, Amlôt R. Mass casualty decontamination guidance and psychosocial aspects of CBRN
incident management: a review and synthesis. PLoS Curr. (2016) 27
https://doi.org/10.1108/IJES-06-2012-0026

4. Evidence 1: Coronavirus is not a Pandemic it is a Syndemic
• Singer, 2009
• 1st Wave: Immediate mortality and
morbidity of COVID-19.
• 1st Wave Tail: Post-ICU and admission
recovery for many patients.
• 2nd Wave: Impact of resource
restrictions on non-COVID conditions –
all the usual urgent things that people
need immediate treatment for –
acute.
• 3rd Wave: The impact of interrupted
care of chronic conditions (people
stayed home).
• 4th Wave: Psychic trauma, mental
illness, PTSD, economic injury,
burnout, and more.
• LONG COVID

5. Evidence 2: Population approaches and
priorities:
we cannot treat our way to good population
mental health
Population and Life Course Perspectives, Understanding, Evidence, Outcomes
Syndemic not Pandemic Impacts
Preventive And Recovery Approaches – From Flourishing to Resilience to Recovery
Building vulnerability and protective factor interventions into responses (eg Bullying)
Building Positive Prosocial Settings and Communities
Build Networks which understand and promote this

6. Evidence 3:
Collective
trauma, Grief
and grievance
the psychological upheaval that is
shared by a group of people who
all experience an event.
This type of trauma can affect
groups of people of any size,
including entire nations or
societies.
https://www.ncbi.nlm.nih.gov/pmc
/articles/PMC6095989/
HIV, Hospice Trusteeship, London Bombings, Hate Crime, Swine ‘Flu
When grief may turn
to grievance

7. What do we know about Mental Health and
Covid-19? (For reference not use in session)
1. It has multiple impacts from mild to severe affecting all populations
2. Some MH need which existed before covid has not been dealt with and has
worsened (Pre-Covid Baseline)
3. Some MH need has been caused by Impact of Covid
4. Long Covid (est 40,000 people in Herts) has neurological and psychological impacts
5. Post Traumatic Stress in staff and responders
6. Anxiety returning to work
7. A recent HPFT exercise agreed we need a “public health” approach but there will be
demand for MH services too
8. Centre for Mental Health Models have projected needs and this was used in ICP work
Suggests 202,676 people with moderate to severe forms of the seven common
mental health disorders post Covid

8. Waves of population psychosocial change
1. Grief – complex and unresolved
2. Additional mental health need which clinical services won’t cope with
3. Neuropsychological and psychological sequelae of Long Covid
4. Compassion fatigue, burnout, complex stress, post-traumatic stress
5. Lack of control of the narrative, tipping people into resentment, isolation and
seeking alternative narratives
6. Grievance
7. The role of “selfish entitlement” and the role of “exclusion” – no one size fits all
8. Rise in anger and expressions of this. Rise in Hate Crimes
9. “Othering” as an attempt to bolster my own identify
10. Conspiracy Theory and Anti-Vaxx
11. American polarisation

9. Some further background
• The UK History of policy level interventions for social cohesion is very
mixed. Some population level interventions (legislation/policy) with
an unfortunate tendency to look to “personal responsibility”
• The significant legacy of civic society from community groups to faith
groups and identity groups
• An inability to disagree respectfully
• Collective Trauma – collective and individual existential threat

10. Starting point: we cannot treat our way to
good population mental health. We must
not look to NHS funding more mental health
services as anything more than one part of
the solution. We are not good at whole
system solutions in England when the word
“health” gets mentioned. This is a pervasive
persistent population wide trauma not a
clinical crisis

11. How do we get out of this?
Others have been here before: War, Conflict
1. A population approach, with ability to understand diverse impacts on
diverse sub-populations
2. Orchestration – harness the whole range of resources
3. Social Norms and their reinforcement in civil society “You may think what
you want but we won’t tolerate its expression or incitement”
4. Use lessons of trauma , war and conflict psychology
5. Use lessons of Social psychology – social identity work
6. A public mental health approach
7. Has to work through both Grief and Mental Health and Social Cohesion

12. Why Social Identity?
• Basically it has worked in a range of situations alongside other sensible
interventions.
• Councils, Councillors and community groups have got innate skills in this
• It sits well with population and sub-population approaches
• After trauma many people will go on to build positive lives. Some not. Why is
this? Multiple psychological explanations
• Social factors important in responding to trauma – we are social beings
• Social Identity – level of commitment to a particular group or category
• Social Cure, Jetten Haslam and Haslam 2012
• Social Identity theory successfully applied to trauma especially in recent war zones
• Build positive social identities within and across populations

13. So how do we do this? Triple Track of
Priorities and some guides
1. Public Mental Health Priorities
• Disaster Psychology. Public MH. Centre for MH. Grieving
2. Social Identity “Social Recovery” Priorities
• Social Identity
3. Economic and Social Justice : Build Back Fairer Priorities
• ADPH and Marmot would be my go to guides

14. Track 1: Public Mental Health Priorities
Ensure people with clinical levels of need get service provision respond to clinical need
with a recovery focus
Recover some fundamental things we need and have lost. Good end of life prep for
relatives. Good Bereavement support. Normalise grieving as work and make it easier
Psychological resilience and wellbeing in Organisations (workforce) – traumatised
workforce, collapsed economy
Resilience, recovery, grieving and pro-social culture among population at large – get
upstream, pre-clinical with grieving
Address specific issues for each lifecourse stage in a preventive way – intervene using
existing settings and systems to reinforce positive identity and coping

15. Track 2: Community
Recovery and
Cohesion
remember what
Andy Said about
protective factors
and Cllr Craig said
about engaging
with communities
1. Build on every bit of what civil
society has done. Saturate people
with social norms of co-operation
2. Visible, Authentic, Compassionate
Leadership
3. Social support intimately links
with social identity – reinforce
and work with it. Understand and
work with group norms not again
4. Evidence based and pre tested
communications strategies. And
Listen don’t just transmit
5. Identify and use trusted leaders
6. Build shared identities
7. Build narratives of possibility “We
can”
8. Accommodate the Public Urge to
Help
9. Keep Listening
10. Be careful on lessons from
radicalisation. These can backfire
• Multiple lessons – twelve lessons
from Drury et al which should be
read carefully (some of them on
list on left)
• Frontiers | Facilitating
Collective Psychosocial
Resilience in the Public in
Emergencies: Twelve
Recommendations Based
on the Social Identity
Approach | Public Health
(frontiersin.org)
• Lessons from Leadership
Psychology
• Authenticity
• Compasision
• Discernment
• Agility

16. Track 2a: Communications Principles
• Invoke shared identities
• Invoke “our group” values
• What we do do not just should do
• Inclusion not sitgmatizing or blaming
• Self-relevance of information
• Don’t equate measures with restrictions or
freedom
• Support is better than coercion and threats
EXAMPLE
• Hertfordshire Self-Isolation Comms
• “Play Your Part”
• Elected Members. Information Champions Evidence-based guidance on COVID communications :
Public adherence : Groups and COVID : University of
Sussex
How do we communicate for better in a fractious
world full of misinformation?

17. Examples
Play Your Part campaign | Hertfordshire County Council

18. Track 3: Build
Back Fairer
Phase it: Respond,
Recover, Rethink.
Who has born the worst
burden? Systematic analysis
of what can help recover using
syndemic lens
Leadership attitude and
approach – “we”
“inclusion”
Harness the wisdom and
capabilities of community
groups for their communities

19. Build back fairer
1. ADPH recently published it’s “Living in a covid Endemic
environment guidance” Living with Covid
2. This morning Centre for MH Published a key report on MH
Need
3. Key PH Issues – stigma, knowledge, access – a PH approach –
feels like some areas still focusing on how many more RMNs
will we need
4. Collective trauma, covid displaced and covid generated need (
the need generated by long covid and worklessness are just
two examples) – multiple whammies
5. Work together on a population approach – multifactorial
approach to stigma, resilience, coping, early intervention, and
stratify people
6. Until every workplace, school , community and setting is a
mental health promoting setting we will not win. So LAs and
Place come to the fore

20. The role of Faith Communities:
REPORTS | BCBN
Home - GoHealth FaithAction - Faith—too significant to ignore!

21. Some Local Herts Track 3
Interventions

22. Putting it together: A Public Health
Matrix for Recovery
Different
Populations,
Different Issues
Lifecourse
Perspective
Resilience
Self Care
Early
Identification
and Response
Recovery
Normalise, DO NOT MEDICALISE
Meaning, Hope, Questions of Ultimate Concern, Spirituality, Faith