This chapter introduces readers to important concepts and practicalities in facilitating, managing, and delivering the wellbeing and psychosocial agendas. It describes the research undertaken by the Social Influences on Recovery Enquiry (SIRE) undertaken in the wake of the Manchester Arena bombing in 2017, and its importance in framing the practical implications for planning and delivering services.

It is usual for humans to experience distress in the aftermath of emergencies, incidents, disasters, and disease outbreaks (EIDD). The manifestation, severity, and duration of the experiences that constitute distress depend on many intrinsic and extrinsic factors. Recent research has demonstrated that distress may be more ubiquitous than was previously thought, and that some interventions, even if well meaning, may not be helpful. Amelioration for most people comes with timely, proportionate, and targeted support and the passage of time. Validation of people’s experiences and minimising the medicalisation of distress are important in helping people to return to ordinary social functioning. This chapter looks at distress related to major events, including the scientific principles, impacts, and implications for intervention. The case study draws on the experience of three members of a pre-hospital team and how a challenging case affected them all.

There is increasing awareness that working within the field of pre-hospital care can have psychosocial effects on clinicians. This chapter describes a systematic review of current knowledge of the psychosocial consequences of working in pre-hospital care. A considerable amount of research has been conducted, examining in particular whether practitioners develop burnout and psychiatric disorders, especially symptoms of post-traumatic stress and post-traumatic stress disorder (PTSD), as a result of their work. However, most studies did not fully assess whether practitioners developed clinically significant symptoms.. Instead, cross-sectional surveys and self-report questionnaires were used, which considerably overestimate the incidence of these problems. Perhaps the high scores on these questionnaires indicate that practitioners who work in pre-hospital care often suffer considerable stress and distress that can be the result of daily organisational and operational hassles, a high volume of work, lack of resources, and, less than has often been thought, attending unusual and high-profile incidents.

This chapter draws together key principles that underpin how the responsible authorities should respond to the psychosocial and mental health needs of the public who are affected. It presents an approach that blends psychosocial care with mental healthcare into a comprehensive and inclusive combined cross-agency approach that combines the prominent biomedical and psychosocial conceptual approaches.

Chapter 4 examines Galen’s credentials as an ethical philosopher in the light of his recently discovered essay Avoiding Distress. It argues that his moral agenda which is expanded upon here makes him an active participant in the practical ethics of the High Roman Empire, with a more profound attentiveness to popular philosophy than is usually admitted. Galen’s dialogue with what has been termed ‘Stoic psychotherapy’ and the Platonic-Aristotelian educational model helps build up his ethical influence through an engagement with the past. On the other hand, his individual characteristics, such as the autobiographical perspective of his narrative and the intimacy established between author and addressee, render Avoiding Distress exceptional among essays (whether Greek or Latin) treating anxiety, especially when compared to the tracts on mental tranquillity written by Seneca and Plutarch. Another distinctive element of the treatise is that Galen’s self-projection as a therapist of the emotions corresponds to his role as a practising physician as regards the construction of authority and the importance of personal experience.

Digital processes need to have wellbeing at their core. Rather than focusing on burnout and distress, digital can be considered as an enabler of wellness. Using key concepts such as user-centred design, reimagining processes and education, digital can enhance the lives of staff and patients. Many solutions to digital distress involve taking a break from technology. These solutions are temporary and do not address the root cause of the issue. As technology embeds itself into every facet of our lives, we have an opportunity to take control of how we engage with digital. Instead of translating paper processes into digital equivalents there is an opportunity to leverage the power digital brings to reduce the burden rather than add to it. Clinician and patient engagement are key to digital wellbeing and the success of digital in our healthcare systems. Increasing autonomy and providing flexible support can reduce burnout with digital systems. Involvement must be meaningful and not acceptability testing at the end of system design. Critically, we must remember that people are the most important determinant of the success of any digital project.

This chapter explores Evagrius of Pontus’ contribution to a uniquely Christian construction of the human being as knowing subject and known object. Evagrius includes distress (λύπη) among the ‘Eight Evil Thoughts’. Evagrius, following Paul, distinguishes between ‘worldly’ or ‘demonic’ λύπη and godly λύπη. This chapter probes this distinction in context of ancient passion-lists, which create affective lexica and cultural scripts for the articulation and management of emotions. In them λύπη is a deleterious emotion and an impediment to proper cognition. Evagrius emulates these lists but modifies their logic: he replaces classical with biblical exemplars, and he inserts the Pauline distinction between godly and worldly λύπη. Evagrius thus differentiates between positive and negative emotion on the basis of cause or intentional object. This results in λύπη becoming a valid dimension of human knowing, while creating a new need for a hermeneutic of λύπη and organisation of human emotion and knowledge.

The moral foundations of crisis response seem simple: responders save lives, reduce human suffering, and pursue a lofty societal goal. Yet, crises often produce morally complicated situations as well. Crisis organizations have adopted norms, which help responders to work in complex moral contexts, but these norms cause moral distress when responders do not fully agree with them. Responders can choose to deviate from the norms and follow their inner moral convictions instead. This will not remove the moral complexities of their work though. Rather, it means that crisis professionals have to resolve moral dilemmas on their own and bear the full weight of moral responsibility. The moral dilemma for responders concerns this tension between following organizational norms and their own convictions. In response, crisis organizations could pursue an ethical culture by promoting organizational deliberation on moral questions in crisis operations. Creating an ethical culture allows for an open, flexible attitude by enabling active dialogue and collective reflection on moral dilemmas in crises. It facilitates a confrontation with the inevitable moral discomforts of crisis response.

Internal waters, the territorial sea, international straits and archipelagic waters are marine spaces under the territorial sovereignty of the coastal State. However, the use of the marine environment for sea communication necessitates the freedom of navigation through those spaces. Consequently, marine spaces under territorial sovereignty are part of the territory of the coastal State and the highway for sea communication at the same time. The dual nature of marine spaces gives rise to the fundamental question of how it is possible to reconcile the territorial sovereignty of the coastal State and the freedom of navigation. With that question as a backdrop, this chapter will examine the following issues in particular: (1) the coastal States jurisdiction over foreign vessels in internal waters, (2) refuge for ships in distress, (3) the right of innocent passage through the territorial sea, (4) the legal regime of international straits, (5) the legal regime of archipelagic waters, and (6) the differences between the right of innocent passage, the right of transit passage and the right of archipelagic sea lane passage.