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Published 22 July 2020
COVID-19 has already had a profound impact upon the legal system in the UK; over half of the Courts and tribunals in England and Wales have been suspended whilst parties to litigation have been able to agree extensions to Court directions from 28 days to 56 days, in addition to the freezing of limitation.
For personal injury claims, there are undoubtedly added complications with rehabilitation and medical examinations. To address these, the ABI and ACSO (Association of Consumer Support Organisations) agreed a Statement of Intent in order for personal injury claims to progress in spite of the lockdown and COVID-19, including remote video rehabilitation (physiotherapy and psychotherapy) and the encouragement of remote video examinations by GPs, psychologists and psychiatrists (and other experts in appropriate cases).
DACB have taken a closer look at the impact and concerns that the current lockdown have upon those individuals who were engaging in the process of rehabilitation process, specifically those who perhaps have a psychiatric vulnerability with the assistance of David Craig, Clinical Development Director, Rehabilitation Manager, and Phil Mudge, Lead Psychotherapist, both of Rehab Direct.
The impact of the COVID-19 restrictions seems to be greater on the more vulnerable injured Claimants than on the rest of our society with some showing a marked deterioration in physical and mental health combined with a slowing down of recovery.
The whole of society is facing difficulties with employment ranging from redundancy, furlough absence, reduced hours and of course, significant changes in the work place and standard practices. We have gone through a period where almost all social activity outside the immediate household has been curtailed and treatment for all but the most serious illnesses has either been suspended or delivered over a range of new media platforms. Whilst the lifting of lockdown measures has improved the possibility of an increased level of social activity, we also know there is an unwillingness and anxiousness by some of the population to simply return to pre-COVID “normal”.
As we know, many of those who have been injured as a consequence of accidents can present with a combination of physical injury and complex psychological symptoms, including pre-existing mental health trauma, often through early adverse childhood experiences or other negative situations. This vulnerable group includes but is not limited to Claimant’s with persistent pain symptoms. This group of individuals can represent the most at risk in the current circumstances & socio-economic environment and may require additional support.
Even without the added conundrum of COVID-19, for this vulnerable group of Claimants, successful rehabilitation can require considerable attention on the consequences of the Claimant’s injuries that are not always immediately obvious. David Craig and Phil Mudge both agree that COVID-19 makes this considerably more challenging; the factors that they find Claimants present with, will typically include:
Claimants with life changing injuries often and understandably harbour fears about the direction their life will take, with many feeling that they have lost the control they once had to steer their lives in the direction they choose. COVID-19 has brought a new level of uncertainty.
A return to the labour market can often be one of the top priorities. Work provides not only an income but a purpose, independence and self-esteem. It can develop our skills and attributes and affords social opportunity. The current crisis adversely affects employment prospects with many posts lost permanently to redundancy or temporarily to furlough and there is a likelihood of a major global economic recession looming.
Individuals used to bringing income to the household can inevitability find it difficult to rely on partners and parents, should their respective employment position alter. This will inevitably place pressure on relationships and emotions of self-worth. There are instances where COVID-19 has put the entire household out of work, adding exponentially to the practical and mental health challenges of vulnerable Claimants.
Individuals with low mood, anxiety and excessive anger, find trusting different people involved in their case difficult. It takes time to develop trust but this is essential if optimum outcomes are to be achieved. The inability to meet face to face will of course make this more difficult to attain.
Many injured people find leaving their homes difficult thereby missing out on socialising and making / maintaining contact with the outside world. This can lead to withdrawal adding further to low mood and anxiety. ‘Stay at home, save lives, protect the NHS’ has become the mantra of the pandemic, but for this group of Claimants it has brought unintended consequences. The more recent call from Boris Johnson of a return to the office has not yet been answered and there remains a practical difficulty of how far this can be achieved under current social distancing guidance.
Rehabilitation aims to re-establish a ‘normal’ daily structure: getting up in the morning, getting dressed, meals at conventional times and meaningful activity. This, of course has become a challenge for a significant proportion of people in current times and with very limited options available outside their property, which has increased the challenge of re-establishing structure. Even with restrictions lifting, the availability of a pre-COVID “normal” will very much depend on the area in which you live and whether any further restrictions may be imposed, such as the recent case with Leicester.
The process of litigation is well recognised as a negative factor for recovery – ‘litigation fatigue’ can be commonplace. Difficulties are expected to arise when attempting to contact legal representatives, adding to feelings of isolation and frustration with the whole process. It is not yet known whether longer claim life cycles are now to be expected due to furloughing of Claimant’s solicitors and Court backlogs.
Rehabilitation which is bespoke and focuses on the physical rehabilitation and psychological support is preferable.
The current lockdown restrictions present difficulties with this approach. The use of video platforms to offer observation, advice and exercise progression can be limited, but some Claimants lack the desire or the technical know-how to use the media platforms or have poor internet connectivity and/or device ability and can therefore be harder to support.
David Craig considers that by adapting and progressing the self-management programmes via video links and offering explanation, re-assurance and education about ongoing symptoms, especially pain, can result in increased positivity and assist in their recovery.
At first thoughts, psychological treatments should be easier to deliver by remote means. However, Phil Mudge has come across many a situation where there can still be a reluctance to take up the offer of remote consultation.
Even when restrictions are further lifted and services become available, David and Phil both agree that there will be reluctance, or potential refusal to leave the house for fear of infection and that they will have to continue to work on confidence and overcoming fears to get Claimants back into society.
Being able to establish contact and to work with Claimants to overcome certain beliefs and behaviours, will require a number of attempts to try to restructure their fears, breaking them down into constituent parts and questioning rationale. Phil expects that he will have to teach these vulnerable individuals to rate their anxieties before and after a particular activity, and gradually build up exposure to the activity.
Anxieties that Claimants develop can on occasion not be based on rational thought at all, in which case, Phil will need to challenge them. The problem with COVID-19, of course is that it is a real threat and to many with the co-morbidities that increase the risks of infection it is completely wrong to encourage additional social contact. This of course has to be part of the balanced clinical decision making and risk analysis adopted.
Total number of UK cases is 289,603 with deaths due to COVID-19 at 44,830 (13/07/20)
Since the first confirmed cases of COVID-19 showed up in the UK procedures have been put in place to minimise risk of infection. These have included both social isolation and social distancing. We now know that anyone can catch this virus and that some individuals in society are more prone to severe disease and fatality. This has resulted in a general increased level of uncertainty.
Psychologically, this presents as a very real threat and has contributed to increased emotional distress and increased risk of psychiatric illness. Some groups are also more prone to the psychosocial effects of this pandemic e.g. those that contract the disease, older adults, those with compromised immune responses, those with certain long term conditions, those already compromised psychologically.
Anecdotal evidence suggests up to a third of individuals who develop COVID-19 will become significantly anxious and experience low mood. There is also evidence that members of the family of those that contract the virus will also experience similar levels of psychological burden.
Early indications suggest that measures such as social isolation and social distancing have a significant impact on people’s emotional wellbeing. Social distancing is leading to heightened feelings of anxiety and depression with people in low paid or insecure occupations experiencing even greater impact.
Social distancing and isolation have resulted in loss of treatment, loss of structure, loss of routine and loss of face to face social interaction. This in turn has been shown to lead to loss of self-worth, loss of motivation and loss of meaning in daily life.
Evidence suggests people experience a sense of alienation which can feel like ‘being in prison’. This can result in an overall sense of being overwhelmed and out of control adding to levels of anxiety and the sense of hopelessness.
The current lock down has altered many individuals home environments leading to difficulties managing work and families. This can lead to individuals developing a loss of motivation with completing everyday tasks including personal hygiene and exercising.
These issues are more prevalent for those living in urban, densely populated areas and is particularly relevant for those who fear losing their jobs and those reliant on parental, familial or state financial support. This is likely to exacerbate levels of general stress.
Phil Mudge considers that one of the major current issues impacting on the psychological wellbeing of individuals is the uncertainty regarding when the pandemic will end and the subsequent process of social reintegration.
There is certainly an increased risk of individuals developing a fear of future illness and increase in general hypervigilance of bodily symptoms and health anxiety. In addition, there are also many examples of an increase in maladaptive coping behaviours e.g. increased alcohol, analgesics, recreational drugs and an increase of relationship breakdown and domestic abuse.
For more information or advice, please contact one of our experts in out motor injury team.
+44 (0) 01633 657826
+44 (0)1633 657325
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