COVID 19: Notes from the United Kingdom

Abstract

In May’s edition of the British Journal of Music Therapy (BJMT), Tessa Watson (2020) commented on Music Therapists pausing and watching as the events of COVID-19 began to unfold. Those events are ones that will impact people’s lives for many years to come. At the time of writing, 654,000 people in the United Kingdom have tested positive for COVID-19 and sadly 57,000 people have lost their lives (Public Health England (PHE), 2020). This comes 7 months after the Government imposed lockdown measures across the United Kingdom, closing schools (except for children of key workers or those with an Education and Health Care Plan (EHCP)) and shops while limiting travel and physical contact with those outside their immediate home (Cabinet Office, 2020). These measures have had a significant impact on the music therapy community. Some Music Therapists working in hospital settings were able to continue working while wearing personal protective equipment (PPE). For many Music Therapists, though, these measures saw work paused as places of work closed their doors to all but core staff.

Music Therapists paused and watched; they then reflected, improvised and unified in order to develop ways of continuing to connect with and meet the needs of clients. When adversity struck, it would have been understandable for organisations and charities to look after their own interests above that of the wider profession. However, this was not the response. The profession and professionals within reflected upon their practice and their experiences. They used their creativity to quickly develop music therapy practice in response to this situation. To see this in action made me feel proud to be a Music Therapist. The profession had ‘the courage to show up when they could not control the [greater] outcome’ (Brown, 2018: xviii).

The role of British Association for Music Therapy (BAMT 2020a) has been to support, co-ordinate and communicate. The core team led by Andrew Langford (CEO, BAMT) collated a resource bank of useful information that was made available for all to access regardless of their membership (BAMT, 2020c). This comprised over 100 documents covering all areas from funding and government guidance, to social stories and bereavement support (BAMT, 2020c). The member-created library served as a reference point for therapists and practitioners early on in the pandemic when information was lacking or was widely spread across many sources.

On a strategic level, BAMT was able to represent and advocate for the profession at numerous meetings with Health Education England and the Allied Health Professional Federation (AHPF). This included advocating for final year students with the appropriate clinical experience levels to be able to join the temporary Health Care & Professions Council (HCPC, 2020) register to strengthen the Allied Health Professional (AHP) workforce and for adequate levels of testing and PPE for AHPs (AHPF, 2020). This is ongoing work, and we continue to advocate for the inclusion of music therapy within COVID-19 rehabilitation and to further educate those outside the profession about the value of music therapy.

There has been much creative working in UK music therapy throughout the pandemic. Music Therapists have come together, developed guidance and supported each other and other healthcare professionals through the pandemic.

BAMT publications

As the immediate implications of the COVID-19 restrictions became clear to Music Therapists, for most it meant that face-to-face sessions would not be possible for the foreseeable future. For others, it meant that they found themselves facilitating sessions while wearing high levels of PPE or being redeployed elsewhere within a hospital or clinical setting. For those not able to meet face-to-face, online sessions quickly became a viable option for work with some people. Within all of these different situations, it was important for Music Therapists to have a framework to aid the development of clinical work.

To meet this need, the BAMT drew together and published four documents. First is the BAMT Guidance for Music Therapists working during COVID-19 (Rizkallah, 2020b) and secondly BAMT Guidance for Music Therapists working alongside COVID-19 (Rizkallah, 2020a). The first collated advice from organisations and therapists around the United Kingdom, which formed best practice documents and helpful advice for clinicians working online. The latter document focused on issues surrounding return to work. These were updated as fresh Government advice and research were released. A third document titled BAMT Guidance – COVID-19 and the HCPC Standards of Conduct, Performance and Ethics (Cousins-Booth, 2020) sought to offer guidance to therapists working face-to-face, online or who were redeployed to other clinical areas. Based on the HCPC Standards of Conduct, Performance and Ethics (HCPC, 2016), this BAMT publication offered guidance on how to maintain these standards in different situations despite the COVID-19 pandemic. The final publication was a submission to the Government’s Health and Social Care Select Committee (BAMT, 2020b), detailing the evidence base for music therapy and its suitability both for use within COVID-19 rehabilitation and to meet the extra demand on mental health services. Not only was this document useful to submit to the Health and Social Care Select Committee as part of a wider body of AHP evidence, it also served as a reference document for potential new service commissioning.

As the significant mental health impact of COVID-19 continued, other music therapy organisations also provided resources for families (Chroma, 2020; Suffolk Music Therapy Services, 2020) in order to support mental health, well-being and ‘provide an extensive base to help keep family connections strong during this time of uncertainty’ (Chroma, 2020). Specialist continuing professional development was also developed to help clinicians understand how trauma could present during COVID-19 (North London Music Therapy (NLMT), 2020).

Three specific initiatives are now described to give more detail about how Music Therapists have been working in the United Kingdom. While only three initiatives are described here, there have been many pioneering and creative initiatives across the United Kingdom from Music Therapists working in a wide range of settings that we have been proud to hear about and share with members and the broader music therapy community.

Phone Support Service

Music Therapists have many transferable skills, including the potential to offer broader therapeutic support as well as their specialist music therapy interventions. Early in lockdown, North London Music Therapy (NLMT) became aware of reports of National Health Service (NHS) staff in the United Kingdom experiencing significant symptoms of stress and anxiety as a result of the added pressures of treating COVID-19 patients.

Staff at NLMT took inspiration from existing and developing service providers to design and implement a free Phone Support Service for NHS workers and other key workers. NLMT therapists undertook Psychological First Aid training to carry out the service and offered acute support rather than therapy as existing research pointed to this type of support being more appropriate than therapy at times of acute trauma (Everly, 2020). NLMT received referrals from London, Manchester and the Midlands, and an evaluation of the service has been written about elsewhere (Rizkallah, In Press).

Online training

Chiltern Music Therapy provided a low-cost training in the early days of lockdown that gave Music Therapists a basic grounding in online work. This was attended online by 350 Music Therapists, community musicians and arts in health practitioners from across the world, who were then able to take this knowledge into clinical and training settings. The 2-hour ‘Making Therapy Digital’ workshops covered safe platforms, setting up and running digital sessions, gaining confidence when developing and sharing pre-recorded content, advice about equipment and how to keep service users safe through digital delivery. These sessions offered much-needed information and skills to Music Therapists and others who were moving their clinical and educational practice online (Chiltern Music Therapy, 2020). The impact of the workshops continued with Chiltern sending information documents to delegates and with supportive contact continuing between delegates, providing a community of support.

Music therapy providers meetings

At the beginning of lockdown, Dan Thomas (Chroma) and Sandra Schembri (Nordoff Robbins) invited several music therapy service providers to form a support group. All were responding to the increasing restrictions put in place by the Government and the drastically changed landscape in terms of access and provision of music therapy services. The group began meeting weekly via Zoom on Monday mornings, recently moving to fortnightly meetings. The group includes representatives from service providers of varying sizes and clinical backgrounds across the United Kingdom, including services in the NHS, private and third sectors. Meetings are chaired by Andrew Langford.

The group has proved invaluable in sharing and learning best practice across the sector. The group contributed to the best practice documents developed by BAMT, and group members have been able to provide instant advice to each other’s queries or provide help when needed.

On another level, the group has also been an unexpected emotional support. Especially during the tightest restrictions experienced across the country, this group, and others like it, became a place for participants to express and share vulnerability and fear of the unknown future weeks and months, both for their services and for their staff teams. The group continues to run, providing a supportive forum.

Final thoughts

Music Therapists may not be able to work with all service users at the current time, as social distancing remains in place and high levels of cleaning means that there are still limitations on the types of instruments that are currently in use. What has remained evident throughout the pandemic is the Music Therapist’s ability to connect: via an online session, playing an instrument through the window of a care home or in a phone call asking how someone is. Our connections may start within music but they reach more deeply. The examples given here offer a glimpse of the way in which some Music Therapists have creatively adapted to the needs of service users. BAMT has been proud to support the work of UK Music Therapists during this time.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author biographies

Jonathan Cousins-Booth is the chair (Acting) of the British Association for Music Therapy. He is also a music therapist for Southern Health NHS Foundation Trust and Fair Ways Care.

Marianne Rizkallah is the vice chair of the British Association for Music Therapy, director and head music therapist of North London Music Therapy, and Music Therapy Outreach and Enterprise for the Guildhall School of Music and Drama.

References

Allied Health Professions Federation (AHPF) (2020) COVID-19 implications. Available at: http://www.ahpf.org.uk/Covid_19_Implications.htm (accessed 14 October 2020).

British Association for Music Therapy (BAMT) (2020a) BAMT homepage. Available at: https://www.bamt.org/ (accessed 14 October 2020).

British Association for Music Therapy (BAMT) (2020b) BAMT submission to HSC Committee COVID-19. Available at: https://www.bamt.org/about-british-association-for-music-therapy/covid-19-useful-information.html (accessed 14 October 2020).

British Association for Music Therapy (BAMT) (2020c) COVID-19 useful information. Available at: https://www.bamt.org/about-british-association-for-music-therapy/covid-19-useful-information.html (accessed 14 October 2020).

Brown

(2018) Dare to Lead: Brave Work – Tough Conversations: Whole Hearts. London: Ebury Publishing.

Cabinet Office (2020) Staying at home and away from others (social distancing). Available at: https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others (accessed 18 October 2020).

Chiltern Music Therapy (2020) Training. Available at: https://www.chilternmusictherapy.co.uk/training/therapists (accessed 18 October 2020).

Chroma (2020) Chroma offers virtual therapy to support parents and therapists during the COVID-19 pandemic. Available at: https://wearechroma.com/chroma-offers-virtual-therapy-support-parents-therapists-covid-19-pandemic/ (accessed 18 October 2020).

Cousins-Booth

(2020) BAMT guidance: COVID-19 & the HCPC of conduct, performance and ethics. Available at: https://www.bamt.org/about-british-association-for-music-therapy/covid-19-useful-information/bamt-guidance.html (accessed 14 October 2020).

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(2020a) BAMT guidance for music therapists working alongside COVID-19. Available at: https://www.bamt.org/about-british-association-for-music-therapy/covid-19-useful-information/bamt-guidance.html (accessed 14 October 2020).

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Rizkallah

(2020b) BAMT guidance for music therapists working during COVID-19. Available at: https://www.bamt.org/about-british-association-for-music-therapy/covid-19-useful-information/bamt-guidance.html (accessed 14 October 2020).

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Rizkallah

(In Press) The North London Music Therapy Phone Support Service for NHS staff during the COVID-19 pandemic: Service report and its relevance for the music therapy profession. Approaches.

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Watson

(2020) Editorial. British Journal of Music Therapy 33(1): 3–4.