By Dr Tariq Jagnarine, MD, MMed Family Medicine, CCFP
During a Pandemic as COVID-19, there are always increased levels of anxiety and worry among the population. It is also well-recognised that there are increased rates of diagnosable mental illnesses. This is due to the fear of personal or family infection or illness, as well as the wider consequences on the community, for example, the restriction of activities and movements on the street and public places, or closure of schools and workplaces, or concerns about accessing basic needs such as food or water.
At the population level, at its most extreme, panic can lead to negative behaviours that can themselves impede public health efforts to contain the spread of infection or establish effective interventions for treatment for those in need. For example, people not complying properly with isolation or quarantine measures. Of course, anxiety, fear, and even distress are an appropriate reaction to extreme circumstances, uncertainty, or threat.
The experience of past outbreaks has shown that the great majority of people are very resilient and able to cope very well in such circumstances, and in fact show great resourcefulness, supporting others in their communities and recovering well after the crisis is over. With respect to COVID-19, there is no evidence of direct effects on the brain of this condition. Nevertheless, it is worth remembering that any infection can affect thinking and behaviour if sufficiently severe.
Mental burden on families and communities with Covid-19?
There are a number of effects that living in a community at risk from the spread of Covid-19 can have on the emotional well-being, mental health, and behaviour of individuals. This can worsen, as a sense of the infection being close-by gets worse. All people are likely to have increased anxiety around contracting the condition, and by extension, concern for their families and community members. This is likely made worse by uncertainty about risk from infection itself, and the impact on the lives of families and communities. At the collective level, these understandable concerns can lead to a more damaging sense of fear if not managed well, which limit outbreak control measures. Mass media like TV, radio, newspapers or social media, and other forms of communication and information exchanged can amplify fear if not managed well.
Quarantine, does it affect mental health?
The effects on people’s lives of infection control measures such as extended quarantine can be really distressing. The separation from loved ones and opportunity to carry out normal social activities, travel, or work responsibilities can slowly take a toll on the mind. With extensive quarantine in place, as in some sites with the coronavirus response, it can be difficult for people to access basic needs. Some factors that tended to make outcomes worse includes longer quarantine duration, uncertainty and fear of infection, frustration or boredom, inadequate information, and difficulty in accessing supplies. And in the longer term, financial loss and stigma all contributing to worse outcomes. This is particularly the case for those who are relatively isolated or made vulnerable due to illness, disability, or difficulties in self-care.
What can we do to address the mental health impacts of outbreaks of COVID-19 in Guyana?
Mental health and psychosocial support should form a part of emergency planning and response measures. As early as possible, a rapid assessment of the context of mental health and psychosocial support needs and resources should be carried out, and a strategy put in place.
Some practical solutions to reduce the mental burden includes:
- Promote easy communication between families and people who can offer support in communities by proving access to telephones, internet and Media.
- Facilitate access to basic needs like food and water, heat and electricity, as consistently and reliably as possible.
- Identify people at high risk. Make sure their particular needs are met. Which includes young people, older persons, disabled persons, persons with language barriers, psychiatric conditions, and pregnant moms.
- Provide hotline to help persons with Covid-19 and their families to access psychological support especially since, anxiety is made worse by a sense of loss of control.
- As people are given basic advice on public health responses like handwashing and where to seek help, these might be routes where reassurance, counselling, and advice on techniques such as relaxation can be offered.
- Persons who would have lost love ones, or survivor of COVID-19, would require a more tailored mental health support form a well-trained team.
- People who are perceived as to blame for causing infection may be stigmatised. And in the recovery phase, it is necessary to ensure that the public have an understanding of clear facts about the pandemic, which also provides an opportunity to improve preparation and planning for any possible future crises.
It should be noted that COVID-19 does not discriminate, we are all facing these unprecedented circumstances together, but together we can rise to these new challenges and help each other.