Mental Health during COVID 19 Pandemic

             Mental Health during COVID 19 Pandemic

After the 1918 influenza pandemic ('Spanish flu'), COVID 19 is the most devastating and uproaring pandemic people are facing worldwide. This might be the first upheaving pandemic experience in lifetime for almost all people, first pandemic of the social media age, affecting 213 countries and taking lives of almost 4 lakhs people worldwide.

In times of a crisis, existing mental health problems can flare up, as can the generalised anxiety we feel in our daily lives. It undermines the peace of mind necessary for robust mental health, and compounds the challenges of people already prone to mental health struggles. Evidences from previous pandemics have shown that among quarantined persons there is a high prevalence of psychological distress, including symptoms of depression, posttraumatic stress disorder (PTSD) and substance abuse comparable to levels experienced after natural disasters and terrorist attacks. 

As of Nepal, the psychological stress in people is arising more from response measures such as social distancing, unemployment, economic hardships, fear of being quarantined, fear of being socially excluded than from the disease itself. The major causes of mental disturbance are fear of falling ill and dying, avoiding health care due to fear of being infected while in care, fear of losing work and livelihoods, feeling of powerlessness in protecting oneself and loved ones, fear of being separated from loved ones and caregivers, refusal to care for vulnerable individuals due to fear of infection, feelings of helplessness, boredom, loneliness and depression due to being isolated.

Poor social security system, inability to seek help and service, loss of access to transport and health services, unpredictable lockdown period, no solid plans about lockdown and reopening by government has increased stress level even in normal people.

This has resulted the increase in the number of offensive activities, suicide, homicide, rape and so on. The data shows that in the period of 80 days, there have been about 1100 suicide cases, murders, many rape cases, self- harm and accidents. These might be the ways of venting the anger and frustrations, coping with stress. Incidence of domestic violence, sexual violence and intimate partner violence has increased. Many cases of inflicting self-harm by burning, due to loss of a job, increased rape incidence, brutality , homicide due to unexplained reasons, murder of own father, mother and family members and later committing suicide, running away from the quarantine zones, death due to starvation and emotional breakdown have increased. May be these events had their root causes, but they are superimposed by the stress due to the pandemic.

Frontline health workers, such as doctors and nurses experience additional mental health problems. They are stigmatized towards working with COVID-19 patients, stressed from unavailability of PPEs, forced to work in spite of no personal safety and security, threatened, forced to leave the rented place out of blue. Also they face stress due to need for constant awareness and vigilance, strict procedures to follow, preventing autonomy, physical isolation making it difficult to bond with family, higher demands in the work setting, reduced capacity to use social support due to physical distancing and social stigma, insufficient payment according to increased workload.

Insufficient knowledge about the long-term exposure to individuals infected with COVID-19 and fear that they could pass infection to their families can put frontline workers in additional stress.

School going children and other students are facing uncertainty about the reopening of institutes and pending examinations. They are more vulnerable to mental breakdown due to fear of COVID as well as the extending lockdown and restricted movements. Inaccessibility to the internet and online classes have taken life of an adolescent in neighboring country itself. Mental stress level also increased in the office-going women who have been working double jobs, managing households and working from home. Psychological stress and anxiety have increased in people of all age groups specially old, differently abled and vulnerable groups.

The World Health Organization and the Centre for Disease Control have issued guidelines for preventing mental health issues during the COVID-19 pandemic. Nepal government itself have introduced guidelines and policies to minimize the physical and emotional stress caused due to the pandemic. The government has been focusing, currently on saving lives and mitigating the short-term consequences of Covid-19, but the long-term consequences may be equally, maybe more, important.

 Even if we can halt the physical spread of a disease through the expeditious use of quarantine and social distancing, we will still have to contend with its mental health effects in the long-term. Thus, the plans and policies the government made during this pandemic should vision the long term health, economic, and social consequences of COVID and be in the best interest of public.

In account of safeguarding mental health, first, it is important to disseminate accurate, up-to-date information on Covid-19, to counter the misinformation that can lead to undue fear. Second, we can care for populations at special risk of stress. These include people with preexisting mental health conditions such as depression and anxiety, and children. Third, we have a special responsibility to ensure we are responsive to the mental health needs of people acting as first-responders and care providers for populations affected by the pandemic.  

The government has to ensure support to the longer-term wave of poor mental health that can follow the Covid-19 pandemic. For this, the plans should focus on sustainable and affordable health care services, proper quarantine, proper testing and diagnosis of the risk groups, appropriate model for lockdown ending, sustainable economic budgeting and programming.

On our personal account, we should also involve ourselves in creative, worthy and skillful works to keep our minds occupied, reassure and morally support COVID positive cases and people at risk. Our health, both physical and mental, is linked. When crisis strikes a society, it does not just strike a group of individuals who happen to live in the same place, it has a pronounced effect in the health, economy and safety of the society.

The Guidelines on Mental Health and Psychosocial Support of the Inter-Agency Standing Committee of the United Nations recommends that the core principles of mental health support during an emergency are "do no harm, promote human rights and equality, use participatory approaches, build on existing resources and capacities, adopt multi-layered interventions and work with integrated support systems" social connectedness, their trust in people and institutions, their jobs and incomes, as well as imposing a huge toll in terms of anxiety and worry.