“Quarantine period is depriving people of the things that they need to stay well, from peer support groups to the routine of work and social engagements.” – Danielle Hamm
According to the Lancet Commission on global mental health and sustainable development, mental health problems exist along a continuum: from mild, time-limited distress to severe mental health conditions. The COVID-19 pandemic is influencing where people are situated on this continuum.
Many people who were previously coping well are now less able to cope because of multiple stressors generated by the pandemic. Those who previously had few experiences of anxiety and distress may face an increase in the number of such experiences, with increased intensity; this may lead to a mental health condition for some. And those who previously had a mental health condition may experience a worsening of their condition and reduced functioning.
The Lancet also published a review of 24 studies highlighting the psychological impact of the quarantine period. The data findings portray a picture of the poor mental health conditions in millions of households globally. As per the review, the quarantine period can lead to negative psychological effects, including post-traumatic stress symptoms, confusion and anger.
Also, the duration of the quarantine period of more than 10 days, fear of getting infected, feeling frustrated, experiencing boredom, facing inadequate supply of basic necessities including food, water, clothes and shelter, inadequate relevant information, finances and stigma have been listed as ‘stressors’ of the quarantine period.
According to the United Nation’s policy brief, during the COVID-19 emergency, people are afraid of getting infected, dying, and losing family members. At the same time, a vast number of people have lost or are at risk of losing their livelihoods, been socially isolated and separated from loved ones, and, in some countries, experienced stay-at-home orders implemented in drastic ways. Women and children have also experienced increased domestic violence and abuse.
Widespread misinformation about the virus, its preventive measures, and deep uncertainty about the future are additional sources of distress. Repeated media images of severely ill people, dead bodies and coffins add to the fear. The knowledge that people may not have the opportunity to say goodbye to their dying loved ones or be able to hold funerals for them further contributes to the distress.
In order to deal with these stressors, people may resort to different negative ways of coping, including use of alcohol, drugs, tobacco or spending more time on potentially addictive behaviours such as online gaming.
The long-term impact of the crisis on people’s mental health, and in turn, on society should not be overlooked. It is anticipated that as the economic burden of COVID-19 rises, there will be a decline in mental well-being, impacting individuals, families and the human race at large.
The effects of COVID-19 on the brain are of great concern. Neurological manifestations have been noted in numerous countries with people who have COVID-19. Moreover, the social consequences of the pandemic may affect brain health development in young children and adolescents, and cognitive decline in the older population. Urgent action is needed to prevent a long-term impact on the brains of both the youngest and eldest members of our society.
COVID-19 can cause neurological manifestations, including headache, impaired sense of smell and taste, agitation, delirium, stroke and meningo-encephalitis. Underlying neurological conditions increase the risk of hospitalisation for COVID-19, especially in case of older adults.
Stress, social isolation and violence in the family are likely to affect brain health and development in young children and adolescents. Social isolation, reduced physical activity, and reduced intellectual stimulation also increases the risk of cognitive decline and dementia in older adults.
Affordable mental health services were already very limited in many communities around the world, and due to the pandemic, these services have diminished due to barriers on meeting people face-to-face and converting mental health facilities into care facilities for COVID-19 patients.
Due to the fear of infection, demand for face-to-face mental health services has significantly decreased, particularly in the older population.
At the community and grassroots level, mental health and psychological support are critically impacted.
Group associations and community-based initiatives that urged people to physically come together before the pandemic like senior citizens associations/clubs, youth clubs and communities, mutual-help groups — offering social support and a sense of belonging — have not been functional for the past few months.
With restricted movement and fear of getting infected from the contagious disease, organisations are unable to continue their services. In the same way, school-based mental health services have been seriously affected and many of these services are not able to provide adequate care using remote methods. In low middle-income countries (LMICs) like India, millions of children who were already living on streets and out of schools and have faced severe violations of their rights, are more vulnerable to these additional stressors.
Sustaining and strengthening mental health services and programmes must be a priority to address current and future mental health needs and help prevent a rise in mental disorders in the future. The response to the pandemic is an opportunity to improve the scale and cost-effectiveness of various mental health interventions.
As a mandatory public health measure of social isolation and quarantine, people’s mental well-being is being supported through creation of online social support groups, communities and campaigns.
One such online campaign is ‘Ujjai’. It is a positive initiative that aims to combat loneliness and boredom, and reinforce social connectedness in order to disseminate positive messages of hope and unity, and mobilise community volunteers to assist those who need help. The campaign encourages its community members to relieve their stress and tension by involving them in activities like art, singing, dancing, yoga, cooking, playing with children and pets, photography and poetry. It was launched on social media on 9th May, 2020, and is a hit with its members.
Mental health and life skills education need to be included in the mainstream in India’s education system. Mental health requires a much larger overall investment. An ongoing, long-standing issue is that mental health — across health, social, education and other sectors — has been heavily underfunded.
The capacity of staff needs to be built across health, social and educational sectors to address mental health, especially in low and middle-income countries. Moreover, mental health care must be included in healthcare benefits packages and insurance schemes to ensure essential mental health needs are covered.
Research needs to become part of recovery efforts. Programmes to reduce or address mental health problems created by the pandemic need to be monitored and evaluated.
Educate people about the expected psychological impact and reaction to trauma if they are interested in receiving it. Make sure people understand that a psychological reaction is normal.
“The Earth is rejuvenating, and so can we.”