The Clinical Challenges of Fatigue: Living in a Post-Covid World.
28th April 2023
Written By Olivia Fretwell, Assistant Psychologist.
Back in 2020, following the immediate impact of Covid-19, I spoke with Fran Hill, Founder and Director of South Coast Fatigue (SCF) where there was much uncertainty, specifically surrounding long covid and fatigue (https://psychologychartered.co.uk/blog/the-clinical-challenges-of-fatigue/). More recently I had the opportunity to speak with Liz Toy, SCF’s Business Manager and Specialist Occupational Therapist to review how they have been meeting these challenges.
South Coast Fatigue are specialists in fatigue and energy management, who help people with low energy, burnout, fatigue, or poor sleep, to return to work; remain well at work and improve their health and wellbeing. SCF work within both the NHS and private sector.
The service offers a number of different programmes, all of which are tailored to meet the needs of the individual client. As Occupational Therapists a recovery focussed approach is adopted with all clients. For some conditions there may not be a cure, but with good fatigue and energy management strategies, function can be improved. Each programme starts with an assessment that serves as the starting point for what’s important and identifies the goals of the intervention. The service primarily uses a behavioural approach that enables clients to manage their condition, with a positive focus on making changes to maximise existing functions and limiting energy wastage. A ‘step by step’ approach allows consolidation of energy levels and greater stability longer term, whilst also supporting clients to build tolerance to activities which are important to them, such as work.
A common thread of our conversation was the importance of understanding the client’s needs, specifically when planning a return to work. This is important for many reasons in the context of rehabilitation and treatment – engagement, motivation, recovery, and sustainability. To plan a successful return to work, a number of factors need to be considered and acknowledged, including but not limited to; the condition, the individual, the job role, expectations of colleagues and managers, work base and how long they have been off sick.
Prioritising is also very important to maximise function and rehabilitation gains but must also consider the client’s energy supply, lifestyle and support network to minimise risk of burnout. It’s important that return to work programmes consider the other elements of a client’s life – it’s not just about getting them back to work. If they don’t have the energy to shower and get dressed, these issues would need to be addressed first.
Prior to SCF involvement, the client may have a history of failed attempts to return to work. This can lead to clients feeling overwhelmed or worried that the same thing might happen again. Energy needs to be carefully managed and the return to work planned carefully with all key stakeholders. Initially, everyone needs to be aware what the impact of each stage and the tasks involved may have on the client’s energy and levels of fatigue. A framework is carefully built by all involved to fully support the client and the organisation they work for.
Empowering the client is key in terms of sustained progress and confidence and SCF find that providing education about why energy levels fluctuate offers an understanding of how their body works. Educating all key stakeholders in these matters will also be important in achieving a sustainable return to work.
One of the hardest elements for clients, is the chaotic, unpredictable nature of life and being on demand and available all the time. Particularly with work cultures, this can lead to an expectation that emails are dealt with out of hours, or that people exceed their contracted hours. Work culture can be gradually changed within an organisation as clients are supported to prioritise their own needs. SCF have seen whole teams start to take ‘micro breaks’, or step outside for some light and fresh air; start taking a walk at lunch or eating their food away from their desks.
Our discussion then shifted to thinking about the effects of long covid fatigue. What is particularly difficult for this particular group is that, in a relatively short space of time, someone has gone from being healthy and well, to experiencing what can be debilitating fatigue, restricting them in many, if not all, aspects of their daily life. SCF began supporting clients with long covid fatigue in October 2020, alongside the NHS long covid clinics and employers following NICE recommended fatigue management strategies. They have seen excellent outcomes in this cohort of clients. Many individuals are of working age and staff at SCF have used their CDMP (certified disability management professional) training in vocational rehabilitation to support clients remain in work / return to work in a sustainable way.
In terms of progression since my previous chat with Fran in 2020, the fatigue management programmes have continued to evolve and change to meet the needs of the clients being referred and the organisations they work for. Outcomes and engagement rates remain high and there has been no change since moving to a fully remote model.
If you are working with clients experiencing significant fatigue, we hope this update on SCF is helpful and informative. Equally, if you are new to this area, the rehabilitation and treatment delivered by this service on the south coast could help educate as to the types of services available to these patient groups. A huge thanks to SCF and Liz Toy in particular for offering her time and providing us with such an enriched and informative conversation about their important and impressive work.
South Coast Fatigue website: https://www.southcoastfatigue.co.uk