Health and wellbeing amidst a pandemic

Carolyn Ee

30/04/2020 12:52:39 PM

Dr Carolyn Ee offers some advice on keeping patients physically and emotionally well during an unprecedented time.

Hands together
‘Cultivating daily wellbeing practises alongside our comprehensive and holistic care may just be what patients need to see them through this crisis,’ Dr Ee writes.

As GPs, we are all aware of the threat of the ‘second wave’ of poor mental health due to the myriad stresses from the current pandemic and the importance of usual care for patients with chronic disease.
We are well placed to understand the socioeconomic and emotional factors that can affect our patients’ health and wellbeing.
Many of us are worried about our patients and how they will be able to cope with the multiple stresses that have been thrust upon us all, and with good reason. A large proportion of our community is suddenly unemployed, and levels of psychological distress are extremely high.
So how do we keep our patients well – physically and emotionally – during these challenging times?
Be proactive about chronic disease and mental health
Our patients need to be encouraged to keep seeing their GP for care of chronic disease such as diabetes and cardiovascular disease.
The RACGP’s new Expert Advice Matters campaign will certainly help – we can all contribute to posting on social media and sending the message out through SMS, email or other engagement platforms to our patient base.
There is a great range of mental health resources to which we can direct our patients, and mental health care plans are of course available over telehealth. These resources include, but are not limited to, the Beyond Blue Coronavirus Mental Wellbeing Support Service and Head to Health.
The General Practice Mental Health Standards Collaboration also has a collection of resources, templates and guides to assist GPs with managing mental health issues. Black Dog Institute has a comprehensive guide to e-mental health resources, and you can also join their community of practice.
Each state also has guides to mental health resources:

Other wellbeing strategies
While it is certainly true that immediate needs such as physical and financial security must be met for optimal health and wellbeing, early research by Sonya Lyubomirsky suggested that life circumstances (like the pandemic) account for a smaller proportion on our subjective wellbeing than we think.
Although this finding has since been criticised as suffering from methodological flaws, it has inspired a body of research on wellbeing, self-care and happiness practises. You might find that some of these simple evidence-based strategies may be of benefit for individual patients alongside the support you are offering with accessing mental health services and managing chronic disease.
As GPs we are also well aware of the positive impact of healthy lifestyle behaviours such as good sleep habits, minimising alcohol, keeping as active as possible and eating a healthy diet. All of these are also valuable self-care and wellbeing habits that can benefit everyone, no matter what their circumstances.
Clearly, needs such as accessing safe housing and adequate nutrition will always remain top priorities; however, it is possible that many of our patients would still find some of the following beneficial.
If there is one skill I would like all of my patients to learn, regardless of their personal circumstances, this is it.
Self-compassion is cultivating kindness to oneself, acknowledging a common humanity instead of feeling isolated, and practising mindfulness instead of over-identifying with our emotions.
Research suggests the practice of self-compassion may reduce suffering and allow people to thrive. Greater self-compassion is linked to less anxiety and depression, possibly by deactivating the sense of threat and activating a self-soothing mechanism. Self-compassion may help people to cope better with negative life events.
Some simple self-compassion practices include developing a self-compassion mantra, writing a kind letter to yourself, and changing self-talk from critical to kind.
It may seem difficult to see any good in the world during these dark times, and we would never seek to minimise the trauma our patients might be going through. Yet cultivating a sense of gratitude may actually help our patients when they emerge on the other side.
Post-traumatic growth refers to positive changes that occur as a result of experiencing trauma. Gratitude, an attitude of thankfulness and joy for benefits and blessings one has received, is correlated with post-traumatic growth.
Gratitude practices include keeping a gratitude journal or writing a gratitude letter, and savouring.
In addition to being kind to oneself, being kind to others has been demonstrated to increase happiness levels.
Giving to others translates to positive emotional benefits, and what better time to help others than during a pandemic? There are many ways that patients can give to others – they might like to draw inspiration from the Kindness Pandemic movement, for example.

Teleyoga is emerging as a popular option during the COVID-19 pandemic.
The practice of yoga may be of benefit to people with elevated anxiety levels, as well as for people experiencing depression.
Along with telehealth, teleyoga is emerging as a popular option during the COVID-19 pandemic.
Yoga therapy is preferred to a generic yoga class. These therapists have undergone at least 500 hours of extra training in delivering yoga to people with health conditions and adapting the tools of yoga to the individual.
Yoga therapists conduct an assessment of individual needs via video consultation, and can provide advice and a home practice tailored for the individual, including gentle movement, breathing practices and relaxation, depending on need and physical ability.
A guide to local yoga therapists is available online.
Can complementary therapies help prevent or treat COVID-19?
Many of your patients might be asking this question.
The simple answer is that at this stage we do not have scientifically validated evidence that complementary therapies, such as nutraceutical supplements, can help to prevent or treat COVID-19.
To put this in context, the virus has only been around for a few months – not quite enough time for rigorous and fully-powered randomised controlled trials to have been conducted and data analysed.
It’s important to be very clear about this with patients when they ask about, for example, ‘immune-boosting supplements’. Risk management is the first priority when patients ask about taking a supplement or trying a complementary therapy.
You can access information about potential interactions and adverse events at Medline Plus or the Memorial Sloan Kettering Cancer Center website, in order to assist patients with making informed decisions.
The practice of gratitude or kindness alone may not be enough for most of our patients; however, cultivating daily wellbeing practises alongside our comprehensive and holistic care may just be what patients need to see them through this crisis.  
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Dr Irandani Anandi Ranasinghe-Markus   1/05/2020 7:14:17 AM

Thank you Carolyn for all the helpful tips and great resources.