Currently, the world is battling the crisis of COVID-19 mainly in terms of physical losses of life and financial crisis. The health care system is burdened heavily because of lack of resources both with regard to manpower and, infrastructure and equipment. However, we need to visualize and take proactive steps to prevent the fallout of the corona crisis on the mental health aspects of our population.
The psychological symptoms arising out of this corona crisis may not be that evident at present, but these may manifest over a period of time. Given the uncertainty arising from the pandemic, the prospects of loss of job, financial insecurity, social isolation, there is going to be a rise in the mental health problems in the near future. The disruptions in the routine life coupled with fear and anxiety arising out of inability to control the situation may affect our day-to-day functioning and lead to adjustment problems. Like the asymptomatic people who may be the carriers of coronavirus are not aware of the virus in their body, similarly many of us may not be aware that we may fall prey to the mental health problems and disorders. Many of us will have great resilience to overcome the mental health fallouts of the crisis, but at the same time many of us may also succumb to this stressful situation which has changed their lives in very drastic ways.
Hence it is better that we take proactive steps to pre-empt any kind of challenges that people may face with regard to mental health or at least reduce the impact of the crisis on the individual well-being.
Hence, a systematic mechanism needs to be worked out to take care of the mental health of people.
The Risks
COVID-19 has forced people to live socially isolated and with almost no social interaction. We all have now become more involved in the digital world. Everything is happening online. However, since not all have the online resource, and even if they have, connectivity issues of the internet pose a challenging situation for them to carry out their work – be it online classes for students, doing various online courses, working from home, online video calls to stay connected with family and friends, engaging in online entertainment and so on. This creates further irritation and stress in people. It may lead to feelings of helplessness and further isolation.
The crisis has brought a sea change in the way we used to carry out our day-to-day activities. Social distancing and digitalization have become the new norms. However, not everybody is comfortable with this change and are able to adapt to this new normal in our life. The crisis requires us to change our mindset- a life where we have taken everything for granted has now changed to functioning in a different way. And we all – children, adults as well as elderly – are required to get net savvy and function through the digital world. Mindset to accept this new normal – adapting to new ways of doing things, new ways of living and connecting, and carrying out business and work, new ways of learning things, new ways of studying, and also learning the mechanisms how to function in the virtual world – are crucial to keep our pace and effectively function in daily life.
People may experience psychological symptoms of irritability, anger, upset, sadness, feeling of lack of control, hopelessness, fear of uncertainties, not knowing what to do, feeling disoriented, stressed, adjustment problems, crying spells, feeling panic etc. All these if continued for long may lead to mental health problems and various psychological disorders such as depression, anxiety disorder, stress disorder, substance abuse, rise in domestic violence and abuse, suicide ideation, posttraumatic stress disorder etc.
Who are at more risk
Everybody is at risk of developing mental health problems unless we understand the impact of COVID-19 on our well-being and take appropriate steps to ensure our mental health and well-being. It requires to have a proper perspective on this crisis so that we are able to differentiate between our thoughts/views that may not be based on reality and the facts that are reality, and focus on the positive aspects and opportunities during this crisis situation.
However, our health care workers who are working in the field are more at risk of facing mental health issues. They may experience health anxiety and fear as their own safety as well as family safety is at risk. Being constantly engaged in providing health care to people, they will have neglected self-care and increased stress.
Further, they may have moral distress arising out of ethically challenging decisions where they have to take a call on allocating resources such as providing ventilators and other essential services to people in case of shortage scenario.
Children and youth who are ever energetic may feel constrained and limited to be isolated from others and restrictions on going out. Their studies and career have suddenly changed from a predictable way of happening to uncertainties about their studies, exams and assessments. There are also the insecurities with regard to job and career progress.
The elderly are also at risk of developing mental health problems as they cannot go out and socialize now. They may also have existing health conditions and the isolation from the lockdown will add to their worry and anxiety. If they are living alone away from other family members, it may create a more stressful situation for them managing everything on their own.
Further, the present crisis and social isolation may worsen the situation for people living with domestic abuse and violence. The prospect of living with the abuser days and nights for together in the same house may be very stressful and create a panic situation for the person.
Those who are already suffering from mental disorders are more at risk for the relapse of their conditions. There may be a feeling of helplessness and feeling of isolation and lack of support. A lack of routine ways of earlier times and adapting to the new normal ways of doing things may be traumatic for them and increase their symptoms.
Moreover, those with special needs may also face a challenging situation in case of lack of support services for them. This may further create the burden on the family members and caregivers of such people.
Ways to prevent a mental health breakdown in the COVID-19 lockdown
Various measures can be taken to prevent a mental health crisis and ensure wellbeing in people:
1. Psychological First Aid:
Psychological First Aid (PFA) refers to providing support to people in the event of a crisis. It is not professional counseling. Like we have first aid in case of a physical injury before going to a medical doctor, similarly PFA is providing first line of support in terms of taking care of the person’s emotional, social and practical aspects so that the person is able to maintain balance and cope with the situation. The help of professional counselor and other mental health professionals such as clinical psychologist or psychiatrist is taken later on if clinical assistance/service is required. The objective of PFA is to reduce the initial distress and prevent it from spiraling up to a major mental health issue. It promotes effective ways of coping and adapting to the situation so as to foster good emotional and social health in the individual.
In the event of COVID-19 and it’s likely long-term impact on almost all the aspects, mainly the education, economic and social interaction, it is very important to learn adaptive functioning and coping. We now need to operate with new behaviours, new ways of thinking, relating and conducting business. In any crisis we have physical, emotional and psycho-social reactions. PFA not only helps us restructure our thoughts and provide emotional care, but also provides social support and practical support to deal with the crisis.
Thus PFA is the first line of support and helps prevent escalation of psychological symptoms to serious mental health issues. Psychological first aid (PFA) begins with a calm, compassionate and supportive presence of the helper. It involves assessing the basic needs of people in the crisis situation, providing comfort, making them feel calm, and provide information about various services and support. It includes three steps:
(a) stabilize (prevent the stress from worsening),
(b) mitigate (de-escalate and dampen) acute distress, and
(c) facilitate access to continued supportive care, if necessary
Everly & Lating, (2017). McGladrey (2017) has proposed five components of psychological first aid:
- creating a sense of safety,
- a sense of calmness,
- generating hope,
- building connection and
- fostering self-efficacy.
These are five tools that can help reduce further harm to the person in crisis.
2. Building Resilience:
Resilience refers to the ability to ‘bounce back’ in the face of a crisis. That means, you are not letting the crisis affect you negatively.
You are learning from the crisis and emerging out of it with a new perspective. How does one build up resilience? It has several components such as acceptance, hope, being optimistic, having a positive attitude, confidence, courage, managing one’s emotions and accurate self assessment.
Accepting the presence of the crisis is the first step which then will direct our thought and energy towards finding ways of coping and managing the crisis situation, and finding the solutions to it. Accurately assessing the situation and resources one has will help to be realistic about the measures to be taken to deal with the crisis. Further, recognizing one’s emotions in this crisis situation will enable one to manage them successfully.
3. Mindfulness:
COVID-19 has created a disturbed scenario and changed the way we have been functioning. Whatever we have taken for granted has been shaken and we are required to adapt to new ways of functioning and behaving. All these require us to be mindful of the impact of the crisis on our behavior, work and relationships. Further, the present crisis has also raised the insecurities, anxieties and fear among people. They feel a lack of control about their present and future, adding up to their stressful state. Mindfulness will help them to focus on the present instead of getting worried about the past or the future. Mindfulness refers to being aware of the present moment without any judgment or any conclusions. We need to take care of ourselves in the present moment so our future can be taken care of. What are my thoughts, feelings and action tendencies now? Focusing on this and taking care of these aspects accordingly will help us to accept the situation. It will reduce the stress experienced by us.
4. Support group:
Forming support-groups gives us the message that we are not alone in this fight against COVID-19. Support groups are a great source of acceptance, confidence and courage to face the situation. They offer a sense of togetherness and solidarity to handle the crisis. The act of listening to the person in the first place in the support groups plays a crucial role in accepting the crisis and releasing the pent up emotions and stress inside.
Online courses can be provided to guide people, especially the health care workers who are more exposed to this stressful crisis, regarding how to deal with common psychological problems, providing them psychological assistance and psychological interventions. Mental health help-lines and crisis hotlines can also extend the support to people suffering from distress in this corona crisis.
COVID-19 crisis has created a new set of circumstances, a new culture of working and functioning in daily life. We need to change our mindset in this new circumstance – doing almost everything from the confines of our home – getting education, doing office work, carrying out businesses, providing medical services, shopping, engaging in hobbies through online classes and groups and so on. But change is not always easy to adopt. Hence in this crucial juncture where we have to adapt to this new normal way of functioning and relating with others, we need to focus on the mental health and well-being of people so as to enable them to deal with the crisis and help them in effective adaptation and transition.
Dr. Swati Patra is the author of the above article. She is a Professor of Psychology at IGNOU, New Delhi.
References:
- Everly, G.S., & Lating, J.M. (2017). John Hopkins guide to psychological first aid.
- Baltimore: John Hopkins Press.
- McGladrey, Laura (2017). The 5 components of psychological first aid. blog.nols.edu
