Future of Healthcare February - 2021

Future of Healthcare – February 2021

Making the most out of mixed reality

Phil Moore at Insight UK on how Alder Hey Hospital has adopted mixed reality technology to keep offering services remotely during the pandemic.

Adapting to the pandemic has driven many organisations to adopt new technology, or accelerate their existing plans, at a rapid pace. From adapting to remote working, to delivering services remotely, to minimising the risks of personal contact, we have seen a surge in innovation.

For instance, Augmented, Virtual and Mixed Reality have offered applications for remote working and collaboration for a number of years. But it has taken the pandemic for many to accelerate adoption.

Alder Hey Children’s Hospital – one of Europe’s biggest and busiest children’s hospitals – is one organisation that used Microsoft HoloLens 2 and Remote Assist to keep offering essential services. These are the lessons from that project.

Have a clear business case

Alder Hey’s aim was simple: to reduce physical contact between hospital staff, patients and visitors. HoloLens 2 would allow clinicians to:

consult medical experts without them needing to be present;
perform virtual ward rounds without needing multiple staff by the patient bedside; and
demonstrate procedures to medical trainees without being in the same room.

With the risk of not only Covid-19, but other potential infections such as MRSA, any project that could lower the risk of spreading infections was immediately attractive.

Don’t be afraid to start small

Alder Hey’s use of HoloLens 2 and Remote Assist began with just two clinicians: Mr. Rafael Guerrero, Clinical Director of Innovation and Chief of Congenital Cardiac Surgery; and Paediatric Cardiology Consultant Dr. Phuoc Duong.

Despite this small start, Mr. Guerrero and Dr. Duong could immediately see benefits. Instead of needing multiple specialists during ward rounds, a single clinician could conduct the round wearing a HoloLens 2. Other specialists could communicate with audio and video, while seeing exactly what the clinician saw.

Similarly, in the operating theatre clinicians could consult with one another without needing to meet face to face or interrupt the procedure. Mr. Guerrero did this when performing a complex repair on a heart no bigger than the size of a strawberry, transmitting a live view of the heart to other colleagues as well as reviewing the echocardiogram at the same time.

Finally, the ability to share images directly into the HoloLens 2 field of view meant Dr. Duong could share a 3D model with a colleague so they could ensure a tiny stent was precisely placed within the blood vessel of a small child. Mr. Gurrero and Dr. Duong showed that a project doesn’t need to be large-scale to produce results. A limited proof of concept can still have a significant effect, and demonstrate the validity of a larger implementation.

Make sure the organisation can support the project

Introducing new technology, such as Mixed Reality, places new demands on organisations. For instance, Alder Hey’s use cases demanded a reliable, high-speed network connection so that users could share and receive high-quality images and video in real time.

At the same time, any new mixed reality implementation will generate and record new data; from images and video, to messages. As with any other sensitive data, this needs to be protected; whether by ensuring it is secure, or deleting immediately after it’s collected.

As an established children’s hospital Alder Hey had the network, and the security and data protection policies, in place to ensure it could begin using HoloLens 2 and Remote Assist effectively without putting patient privacy or data at risk. However, other organisations might need to review their capabilities and policies to ensure they’re up to the task.

Get technology in end users’ hands

Ultimately, Mixed Reality is most valuable when it’s in the hands of the teacher, engineer or doctor who will benefit from sharing their view or receiving information straight into their line of sight. This means ensuring a streamlined process where end users can begin using technology as soon as possible.

At Alder Hey, Insight worked directly with the hospital’s IT team to guide Mr. Guerrero and Dr. Duong through the features and functionality of HoloLens 2 and Remote Assist. They were taken through setting up user accounts and assigning roles, connecting securely to the network, and their first few Remote Assist calls with the devices. A short while after unboxing, the technology was in use on the wards and operating theatres where it could start showing its value.

Don’t stop innovating

While more clinicians using more HoloLens 2 devices is a natural progression for Alder Hey, it is also looking beyond the hospital itself. For instance, Alder Hey is a centre of expertise for congenital heart treatment responsible for more than 8.5 million people across Wales, North-West England and the Isle of Man.

The hospital is investigating using HoloLens 2 and Remote Assist to support clinicians and patients both in other hospitals and in the community, without the need for travel in either direction. This helps the NHS treat patients and share expertise more efficiently to improve patient care.

Similar to other hospitals and organisations worldwide, the pandemic meant Alder Hey had to carefully consider how to deliver its services while minimising risks. Mixed Reality has been an essential part of that. Whether teaching remote classes, performing quality control on manufacturing lines on other continents, or maintaining critical infrastructure, there are multiple use cases that will benefit organisations across many different sectors.

Phil Moore is Public Sector Digital Innovation Lead at Insight UK

Hospitals are near their limits – computer models can help keep their doors open

Robert Van Der Meer, University of Strathclyde and Gillian Hopkins Anderson, University of Strathclyde

Coronavirus is causing a strain on health services around the world. Just last week, over 80% of critical care beds in England were full, with warnings of hospitals hitting their limits in the coming days.

Because of the fast moving and uncertain nature of the pandemic, it is difficult to predict with any certainty how many beds will be required, even over a relatively short timescale. One option would be to reduce admissions of non-COVID patients, but that is normally a last resort.

Faced with an unexpected rise in admissions, senior managers responsible for hospital bed planning have relatively few levers at their disposal. Unfortunately, unforeseen events such as the rapid spread of novel variants make it easy to get such decisions wrong.

This is where academic modelling teams like ours can provide practical guidance and advice at both national and local hospital levels.

Working in an emergency

Our team works with NHS Lanarkshire (NHSL), which is the third largest integrated Health Board in NHS Scotland, serving a population of about 660,000 people. NHSL manages three large general hospitals, together comprising more than 1,400 inpatient beds, plus several small community hospitals.

We have been providing NHSL with detailed local COVID-19 modelling support since early March 2020, to complement the national advice and guidance.

March 2020

In the middle of March 2020, new confirmed COVID-19 cases in the UK were rising very rapidly. London seemed to be the worst hit but the situation appeared to becoming critical in Scotland, too.

Health Boards, including NHS Lanarkshire, were getting strong advice from the Scottish Government to substantially reduce hospital admissions of non-COVID patients. Operating theatres were cleared of their normal equipment and filled with COVID-19 beds. Patients who were in hospital for other reasons, many of them elderly, were discharged as soon as practicable or transferred into care homes.

However, by the end of March 2020, we were already able to predict the peak of COVID-19 cases would be reached in the first two weeks of April. In consequence, plans for further reductions in non-COVID healthcare could be shelved at an earlier stage than would have been possible otherwise, and hospital managers could contemplate the future with greater confidence.

How the models work

Computer models estimating the requirement for hospital beds, whether in intensive care units (ICU), high dependency units (HDUs) or general wards, need to take into account a few key factors.

These include the number of new infections, the estimated proportion of infected people requiring hospital admission, the probability of the length of stay and the number of beds already occupied, whether by COVID-19 patients or people admitted for unrelated conditions.

As the full force of the COVID-19 pandemic started to become nationally apparent, a key question was how many intensive care beds would be needed locally for the impending surge in COVID-19 patients.

Our modelling team, which initially also included Dr Nicola Irvine a consultant in acute medicine, collaborated closely with the public health department. Along with Chandrava Sinha, we built a model showing the impact of expected new COVID-19 cases, with a detailed age profile, on the use of ICU, HDU and general ward beds over a six- to eight-week planning horizon.

The resulting model provided NHSL executives with a tool to predict critical needs during the COVID-19 pandemic. But an important strength was our ability to incorporate detailed local data – for example on age profiles, length of stay distributions, local clusters of cases - into the national picture.

The situation today

Essentially, the same scenario we faced in March 2020 is playing out now. COVID-19 cases rose very rapidly across the Christmas and New Year period, as the novel coronavirus variant was taking hold.

As before, urgent questions have arisen about how much non-COVID healthcare activity should be curtailed. Again, we are inserting the latest case data and age profiles into our computer model to support senior managers in making these difficult decisions.

It is already becoming clear the current national lockdown measures are having a significant dampening effect on the growth in new cases in Lanarkshire and elsewhere. This new downward trend in cases is reflected in our latest forecasts, presented last week, for bed occupancy over the next six weeks. They show a substantial reduction compared with forecasts we produced only a fortnight ago.

Computer modelling can offer a vital tool during situations when planning resources in scenarios hospitals have never encountered before. To be effective, modelling support must be timely and realistic, while properly reflecting the high degree of uncertainty involved.

Robert Van Der Meer, Professor of Management Science, University of Strathclyde and Gillian Hopkins Anderson, Research Associate, Management Science, Strathclyde Business School, University of Strathclyde, University of Strathclyde

This article is republished from The Conversation under a Creative Commons license. Read the original article.

‘You may be hacked’ and other things doctors should tell you

Maximilian Kiener, University of Oxford

On September 9 2020, a woman died during a cyber-attack on a hospital in Düsseldorf, Germany. The woman was in a critical condition and about to be treated when hackers disabled the computer systems of the hospital. Unable to avert the attack, medical staff had to transfer the woman to another hospital, but the help came too late and the woman died.

This incident was the first reported case of death after a cyber-attack and shows that such attacks are not just a threat to our data anymore, but also to our lives. In fact, the situation is urgent. We know that cyber-attacks on medical devices and hospital networks are a growing threat. During the current pandemic, some types of cyber-attacks have increased by 600%.

And it’s not just old computer systems that are vulnerable. Even the very best artificial intelligence (AI) in medicine can be compromised. Academic research continually reveals new ways in which state-of-the-art AI can be attacked. Such attacks can block life-saving interventions, undermine diagnostic accuracy, administer lethal drug doses, or sabotage critical moves in an operation.

Inherent risks

Doctors need to do everything they can to keep patients safe, but as a matter of general medical disclosure, should they have to tell patients about the risk of a cyber-attack, at least when their healthcare critically relies on computers? After all, patients have to give their informed consent to medical procedures and doctors are required to warn patients about potentially harmful consequences.

In some US legal cases, judges have argued that doctors need to disclose a risk only if it is “inherent” in a medical procedure, that is, a risk that “exists in and is inseparable from the procedure itself”. Relying on such a view, one may argue that the risk of cyber-attacks is not an “inherent” risk and so does not require disclosure. Many equate “inherent” risks with “medical” risks and thereby rule out the “criminal” risk of a cyber-attack.

This view against disclosure raises an important point. There is indeed a connection between the requirement of disclosure and the expertise of a doctor as a medical professional. Doctors need to disclose inherent medical risks because they are, unlike laypeople, especially well placed to know about them. But doctors cannot be expected to predict whether certain people will target their patients through cyber-attacks. After all, doctors are not criminologists. So they are not really able, let alone obliged, to disclose those risks.

On the other hand, this view against disclosure underestimates several important aspects. To begin with, the growing digitalisation and use of computer systems in medicine will render the risk of cyber-attacks ubiquitous in healthcare. Even though it may not be an “inherent” risk, it will certainly be an inevitable part of future clinical reality, and if we want patients to make well-informed decisions, they should know about such a risk.

Also, even though doctors don’t need to disclose general criminal risks, they are required to disclose the risks that their medical equipment poses to patients. After all, being subject to medical procedures leaves people vulnerable in important ways, and if certain computer-based procedures introduce new vulnerabilities, an informed patient will need to know about them.

Finally, unlike traditional cyber-attacks, the risk of some new cyber-attacks may become “inherent”, as defined above. Consider the case of medical AI. In so-called “input attacks” on medical AI, an attacker can change the pixel value of an MRI scan so that the AI system will categorise tissue as falsely malignant with a confidence rate of over 99% when it would correctly categorise it as benign with the same confidence rate in absence of the attack. The human eye is unable to detect such changes. The attacker would only have to scatter some well-placed digital dust over the image.

The only way to detect an attack is to detect the intrusion in another computer system where the medical images have been stored. But even here, we may not know whether, in addition to the intrusion into the database and the potential theft of medical data, attackers made any changes to medical images at all, what their motives might have been, and what consequences could await patients as a result.

So, unlike other cyber-attacks, input attacks no longer compromise their target system. The AI system itself, its algorithm, and how it works can be left completely untouched. In other words, the AI system would still work normally, not be affected by any bug or interference, and the doctor performing or supervising the procedure would act as professionally as possible.

Therefore, no such AI-based procedures can avoid the vulnerability to input attacks. But if this is so, then the risk of input attacks does become “inherent” to certain medical procedures, as defined earlier.

Be prepared

There are sound reasons to require the disclosure of cyber-risks to patients, at least in certain high-stakes medical procedures. However, cyber-risks are only one new type of risk that patients may face in the future. When algorithms play an increasingly large role, we also need to think about whether doctors should disclose the risk that these algorithms are systematically biased or the risk that, because of the opacity of certain AI systems, doctors may no longer be able to understand and double-check the AI’s decisions.

In any case, the growing reliance on computer-systems and AI demands that we think afresh about medical disclosure and which risks to disclose to patients. Otherwise, our clinical practice will be unprepared for the major transformations that await it.

Maximilian Kiener, Extraordinary Junior Research Fellow in Philosophy, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Join us to preserve water, our shared source of life!

Water is one of our most precious natural resources, and most fragile ecosystems. That’s why Swiss IoT startup Droople is calling on everyone to get involved in protecting it

The United Nations predicts a 40 per cent shortfall of global water supply within the next decade, as well as an increasing concern over water quality. We have to take actions now, in order to preserve water, our shared source of life.

Most people don’t give any thought to what happens to water after it’s gone through the main water meter in a residential, commercial or industrial building. Droople aims to provide people and businesses worldwide with the necessary insights and tools to improve the way they use water, helping ensure a sustainable future for humanity. More than 36 billion off-radar water assets today are waiting to be digitised, including sanitary ware, water treatment systems and appliances. Once we are able to monitor them, we can predict their maintenance requirements and reduce water and energy waste.

Droople can support you and your organisation to make an impact in many areas of water conservation. Let’s make the Sustainable Development Goals (SDGs) happen together!

SDG 6 – Clean water and sanitation

We can help you pollute less and conserve water for future generations.

SDG 9 – Industry, innovation and infrastructure

We support you in bringing transparency-driven business models to your customers.

SDG 11 – Sustainable cities and communities

We help you optimise your service cost while making a sustainable impact.

SDG 17 – Partnerships for the goals

We partner with you to educate people in and create awareness of water and hand hygiene.

Droople paves the way with concrete solutions to help you realise those goals, offering end-to-end solutions such as smart filtration (predictive maintenance of water treatment systems), smart sanitation (affluence-based restroom cleaning) and smart water monitoring for individual applications.

Smart filtration: ensuring consistent water quality with new business models

Water treatment systems are widely used worldwide to provide high-quality drinking water for households, food and beverage businesses and industrial and chemical processes. Most of the time these assets are not monitored, leaving the operators and end-users blind to their efficiency, maintenance needs and cost-effectiveness.

Droople provides you with a telemetry solution based on retrofit, battery-operated, flow, pressure, and other sensors to efficiently manage and monitor your water treatment systems (such as RO systems, filters, softeners) and dispensing systems (water coolers, taps, and water fountains). Droople can help you monitor their performance easily, enable on-time maintenance and predict when you need to replace consumables such as filters, cartridges and UV lamps.

Smart sanitation: jump into the future with a cutting-edge Swiss IoT sanitation management system

Restrooms, with their toilets, faucet taps and urinals, are used every day, and require regular cleaning. It’s difficult to gauge how many times and when these objects are used, which means their cleaning schedules are not always optimal or cost-efficient. Airports, shopping centres, schools and corporate offices have highly varying flows of people, and cleaning processes must be continuously adapted to maintain an adequate level of hygiene and quality of service.

Droople provides you with an IoT solution based on retrofit, battery-operated flow sensors to monitor restroom usage and cleanliness anonymously. With the help of real-time toilet and tap usage data, you can optimise the cleaning frequency, monitor hand hygiene and accurately predict when to replace consumables, such as sanitary bin liners and paper towels, saving both human and material resources.

The role of education

Droople is playing its part in raising awareness in schools about the role of water and hand hygiene, something that’s even more important given the pandemic of the past year.

Ecole Vivalys Ecublens in Switzerland is the first school in the world to automatically measure the level of hand hygiene of its students through connected water sensors. Developed by Droople, this first-of-its-kind solution will contribute to thefight against the spread of Covid-19.

Since implementing this innovative system, the school has observed a reduction in pupil absence as a result of illnesses such as gastroenteritis, flu or colds. Mobilised for the safety of schoolchildren during the pandemic, this innovative solution has already proven its usefulness.

Olivier Delamadeleine, MD of Vivalys, a private school affiliated to the Educalis Group, said: “The data collected by Droople's sensors are displayed in real time on a screen and on our website. Analysed daily by our staff in the form of graphs and statistics, this information represents an additional source of learning, which systematically links the teaching of fundamental knowledge to concrete experience.”

Would you like to know more? Join us to preserve water, our shared source of life!

contact@droople.com | www.droople.com

Women’s health is better when women have more control in their society

Siobhán Mattison, University of New Mexico; Adam Z. Reynolds, University of New Mexico, and Katherine Wander, Binghamton University, State University of New York

Gender disparities in health are not a phenomenon unique to the pandemic. Long before COVID-19, women made less money than men, had more child care responsibilities and were at increased risk of gender-based violence. But now, the pandemic has made them, and their children, even more vulnerable.

Women typically live longer than men but experience generally worse health, including higher risk for many chronic diseases, a phenomenon often referred to as the health-survival paradox. Many see this as due to biological differences between women and men. Female reproductive hormones affect many tissues in the body; pregnancy and childbirth come with additional risks to health.

But a large body of research suggests human health is strongly influenced by social circumstances. Living in societies that are more unequal is associated with negative health outcomes. Preferences for sons can cause neglect of daughters, which can lead to poor health and even death. What role, then, do gender norms play in subtler gender health disparities?

Two of us are anthropologists, the other an epidemiologist. Together our team developed a study to investigate how male-biased versus female-biased gender norms impact health.

A unique comparison

That study, published in Proceedings of the National Academy of Sciences, was conducted in two farming communities in southwestern China. Both communities, part of the Mosuo ethnic minority, share a common language, religion and rites of passage. They differ, however, in one key way that made this unique study possible: kinship.

Some Mosuo pass land and other resources from mothers to daughters. Anthropologists call this system “matriliny.” The role of men in Mosuo families is de-emphasized, although some take active roles as fathers and husbands. About 30% are in “walking marriages”: men and women are together at night, but do not formally marry. Instead, the men remain part of their mother’s or sister’s household. The men in matrilineal communities often provide financial support to women, and the walking marriages, though easy to dissolve, are often monogamous.

Compare this with a smaller, less well-known population of “patrilineal” Mosuo, who typically marry monogamously and pass inheritances from fathers to sons. They are more similar to many Euro-American families, where gender norms typically empower men.

With that as background, we began to wonder if the Mosuo would show evidence of improved health for women in matrilineal communities, where women have greater autonomy and access to resources. This has proved very difficult to test, because communities differing in kinship and degree of women’s autonomy also differ in other ways.

Our team traveled to hundreds of households in both the patrilineal and matrilineal communities of Mosuo. We asked participants about their social, economic and household circumstances. We measured their blood pressure and collected small specimens of blood for other health assessments. From that, we could compare matrilineal and patrilineal communities, and found this: Gender disparities in health were completely reversed in matrilineal communities.

For women with greater autonomy, better health

Briefly, women’s health was poorer than men’s in patrilineal settings. But it was better than men’s in the matrilineal communities. There, women’s rates of chronic inflammation were roughly half of men’s, with rates of hypertension roughly 12% lower.

Both chronic inflammation and hypertension are early indicators of long-term chronic disease. Both put people at higher risk for cardiovascular disease, diabetes, neurodegenerative disorders and death. The poorer health that women experienced in the patrilineal Mosuo communities likely occurred due to differences in daily experiences, including stress that accumulated both in the short and long term.

Our findings challenge simplistic notions that biology is the only or primary determinant of gendered health differences. This is not a new revelation, but the study suggests an even stronger role for culture than previously evidenced.

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This does not mean biology plays no role in the health differences between men and women. Virtually all diseases are biological at the cellular level. But emphasizing only biological differences assumes everything else between men and women is equal. This is rarely, if ever, the case.

Child care and household duties are easier when women have help and autonomy. Mosuo women in both matrilineal and patrilineal communities take on substantial responsibility for both. But those in matrilineal communities do so with greater autonomy and more support from relatives and childhood friends. Those in patrilineal communities are more isolated from their sisters and often take on household chores with less help.

These findings are relevant to women’s health, not just in Mosuo communities, but elsewhere. Everyone’s health is affected by their autonomy and access to support, even nonhumans. Now, with a better understanding of how kinship and gender norms can impact women’s health, we can work to lessen health disparities and decrease the ever-growing burden of chronic disease.

Siobhán Mattison, Associate Professor of Evolutionary Anthropology, University of New Mexico; Adam Z. Reynolds, Doctoral candidate, University of New Mexico, and Katherine Wander, Assistant Professor, Binghamton University, State University of New York

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Social prescribing: an old art in a new world

Professor Andrew Corbett-Nolan, Chief Executive, Good Governance Institute; Harry Brunjes, Chair, English National Opera; Jenny Miller, Artistic Director, Barefoot Opera; Dr Jonathan Lubin, Principal GP, Derwent Medical Centre

For more than 10 years the Good Governance Institute has supported the boards of public, private and third sector organisations to help create a fairer, better world with improved outcomes for citizens. A significant proportion of this work has been with the NHS, and during the pandemic GGI has provided a free advisory service as well as collating and sharing the best knowledge and insight through our Covid-100 bulletins.

In our work with the NHS, the voluntary sector, community groups and local government, we have seen the rising importance and role of social prescribing. With the societal challenges posed by the impact of Covid-19 and the future of healthcare in integrated systems, social prescribing will play a significant role in the months and years to come.

What is social prescribing?

Social prescribing is the practice of helping patients improve their health and wellbeing by connecting them with non-clinical services to help address their social, emotional or practical needs.

Also known as community referral, social prescribing derives from the recognition that people’s health and wellbeing are shaped by a range of social, economic and environmental factors.

Social prescribing is usually carried out by primary care professionals such as GPs or practice nurses and supports people to take greater control of their health. Examples of social prescribing include referrals to healthy eating groups, volunteering, arts activities, sports or gardening.

There are various models for social prescribing in use across the UK, but most involve the patient working with a link worker (sometimes known as community connectors or health workers) to find the local support best suited to them.

Why is it important?

Social prescribing provides the greatest benefit to people with mild or long-term mental health problems, those who are socially isolated, or those who have multiple long-term conditions and frequently need primary or secondary healthcare support.

In the context of increased isolation and more sedentary working routines many of us have faced as a result of Covid-19, social prescribing could be more valuable than ever.

Social prescribing continues to grow in popularity, scope and scale across the UK. Its role and importance is being more formally recognised too: it was listed as one of the ten high-impact actions in the General Practice Forward View and is part of the NHS Long Term Plan’s commitment to make personalised care a more fundamental part of our health and care system.

As well as empowering people to develop and maintain their health, social prescribing also has the potential to help people recover to good health, particularly after serious illness such as Covid-19. It is in this area that social prescribing is being used in interesting and innovative ways with great effect.

Prescribing opera

In August, the government allocated £5 million to the National Academy for Social Prescribing (NASP), some of which went to a programme called ENO Breathe, devised by Imperial College Healthcare NHS Trust and the English National Opera.

The ENO Breathe programme of singing, breathing and wellbeing was aimed at supporting and enhancing the recovery of Covid-19 survivors. Led by ENO Baylis, the ENO’s learning and participation programme, this six-week online programme brought together medical and musical expertise to provide tools for self-management, particularly with regard to posture, breathing and anxiety. Just one example of an innovative and effective use of social prescribing.

GGI is itself a proud supporter of both ENO and Barefoot Opera, a rather smaller but no less enterprising opera company that keeps opera alive and vibrant at a grassroots level on the south coast. Both companies understand the therapeutic power of music and communal creative activity – and both are shining examples of how to remain relevant and viable in difficult times by thinking outside the box and embracing the new.

What does the future hold?

Despite its growing popularity, and its increasingly important role in light of the pandemic, the future of social prescribing faces considerable challenge.

Social prescribing is fundamentally reliant on partnership work between the NHS, voluntary and community groups and local authorities. The community and voluntary sector has been devastated by Covid-19, both operationally and financially. Research suggests that Covid-19 will negatively impact the ability of eight out of 10 charities to deliver on planned objectives in the coming year and force 10 per cent of them to close. At the same time local government, also crucial to social prescribing, is suffering a similarly significant financial challenge. Policy support for social prescribing must therefore marry up with financial support for these organisations.

Social prescribing is an example of the efficacy and value of a partnership approach to health. With the future of healthcare in the UK very much centred on integrated care systems, examples of the success of social prescribing are encouraging for the future of healthcare provision.

Social prescribing can help us to have a healthier society and keep our NHS sustainable, through accessible forms of art. For more information, visit www.good-governance.org.uk , www.eno.org and www.barefootopera.com.

Six evidenced-based ways to look after your mental health during another lockdown

Christian van Nieuwerburgh, University of East London

Already experiencing pandemic fatigue, many of us feel ill-prepared for another lockdown. Yet this is what we must do, and maybe not for the last time.

The problem is, the pervasive effects of the pandemic and the restrictions imposed as a way of containing it seem designed to harm our mental health, cutting us off from the things that give our lives meaning and bring us pleasure. With no clear end in sight, coronavirus is having a significant negative effect on mental health with many of us experiencing stress, anxiety and insomnia.

So what can we do in the face of another lockdown? We need to take proactive steps to protect our psychological wellbeing. Here’s what can help.

Psychological wellbeing

Our most comprehensive understanding of mental wellbeing comes from American psychologist and resilience expert Carol Ryff. According to Ryff’s model, in order to experience psychological wellbeing:

You need to believe that your life has purpose and meaning
You should feel that you have autonomy
You should be experiencing personal growth
You should feel that you are managing your life well
You should have positive relationships
You should know yourself well

In normal circumstances, everyday occurrences can often allow us to maintain your psychological wellbeing without much intentional effort: chance encounters with colleagues; the boost of energy from meeting new people; the sense of awe when visiting a beautiful place; the excitement of a night out with friends; the warm feeling of going to the cinema with a loved one; the anticipation of a holiday abroad.

Lockdowns prevent us from experiencing many of these things. When our activities are restricted, our lives are diminished. That is why we must be more intentional about protecting our psychological wellbeing.

One way of doing this is to create a wellbeing plan that addresses your psychological needs. Below are some ideas that may be useful as you develop your own plan, based on your needs and circumstances.

1. Explore purpose and meaning

Dedicate time to think about what gives our life meaning. What is most important for you? If you are religious, how can you leverage your faith to get you through these challenging times? Otherwise, what opportunities are there for you to reflect on or discuss what is meaningful about life? Just finding time to talk this through with someone else can make a big difference.

2. Retain your autonomy

Find ways to retain a sense of autonomy in spite of lockdown restrictions. How can you continue to live according to your principles? What aspects of your life do you have control over? For example, you have control of how much time you spend watching the news, how tidy you are going to be and what to eat. Avoid the inclination to just wait it out. Take charge of how you will spend your time by writing our weekly plans and daily schedules: when you will wake up; how you will spend your days off; amount of time you’ll for exercise; when to stop working.

3. Experience personal growth

No, you don’t have to master a whole new language in lockdown, but do make sure that you allow time for learning and personal growth. Include opportunities to learn something new or to achieve health goals. When setting your learning or fitness goals, set achievable targets so that you can monitor progress and celebrate successes. Rather than having just one long-term goal, set yourself sub-goals and weekly targets.

4. Manage your life well

Make sure there is variety in your activities and avoid the temptation to get complacent. It’s a good idea to wake up at a consistent time and get dressed, even if you’re not going to be leaving your home. If you are no longer able to maintain your usual routine, think about creating a new schedule that has a good balance of leisure, work, learning and physical activities.

5. Invest in positive relationships

In spite of restrictions that prevent you from meeting other people in person, invest in personal relationships through email, social media, telephone or video chat applications. Yes, we are all sick of Zoom, but don’t use that as an excuse to avoid connecting with loved ones. Take an active interest in the welfare of others, especially those who are vulnerable within your community. If there is a safe way to volunteer to help those in need, consider signing up with a local charity.

6. Learn about yourself

Take advantage of lockdown by getting to know yourself better. Identify your own strengths and take time to appreciate them. One way of doing this is to complete a reputable online survey that helps you work out what your strong points are. Rely on your strengths to get through the lockdown and think of ways of using them more broadly when this pandemic is over.

Adopting a proactive approach to protecting your mental health by creating a wellbeing plan will have immediate benefits. It will also reduce the likelihood of experiencing mental ill-health as we continue to grapple with the far-reaching consequences and implications of COVID-19.

Most importantly, we must acknowledge that these are challenging times for us globally – whether we or our loved ones are directly affected by the virus or indirectly impacted by the implications of the pandemic. Everyone, in their own way, is doing their best to cope with the enormous challenge of COVID-19. The most positive and human way that we can respond is with compassion and kindness to ourselves and others.

Christian van Nieuwerburgh, Professor of Coaching and Positive Psychology, University of East London

This article is republished from The Conversation under a Creative Commons license. Read the original article.