Covid-19 and mental health: ‘Constant worrying is not helpful’

There is significant concern about the ability of people to cope with the psychological stresses caused by the Covid-19 pandemic.

During the past six months, many people across the world have experienced a range of mental health symptoms and emerging mental health conditions associated with Covid-19. These include the stress of under-employment and unemployment, isolation, restrictions imposed by the lockdown and the fear and trauma of themselves and those close to them being infected.

The pandemic affects different sections of the population differently. People with comorbidities such as diabetes, hypertension, HIV, obesity and respiratory conditions or disease are at higher risk, and should be expected to have greater concerns about being infected and requiring hospitalisation. Similarly, the elderly – those older than 60 years of age – are at higher risk of severe illness and mortality (though not exclusively so).

Health-care providers and care home workers are also at higher risk for infection because of their increased exposure. They, too, can be expected to experience greater levels of stress and anxiety about the possibility of infection, and the possibility of infecting their families and close contacts.

An important risk to consider is that health-care professionals may experience burnout, compassion fatigue and vicarious trauma associated with caring for patients, many of whom are themselves traumatised by the pandemic.

It is essential that we prioritise the mental health of our frontline worker,s and not assume they are coping in the face of this protracted stress. Such debilitation can be hidden for a period of time and only emerge when least expected during periods of high demand, compromising our most precious resource at this time. Self-care, debriefing, supervision and seeking help can be very beneficial.

Additionally, people who test positive for Covid-19 positive or have Covid-19 symptoms are also likely to be concerned for themselves and their contacts. Their concern will increase if they are at higher risk for hospitalisation and mortality given comorbidities and age. Their concern about hospitalisation or even death may not just be for themselves, but for anyone who could have potentially contracted Covid-19 from them.

They may be equally concerned about stigma – being shunned by their contacts for potentially infecting them and then further stigmatised by families and loved ones for potential infection. While they fear for their own lives and those around them, stigma plays a huge role in feelings of anxiety while they are infectious, and even after the 10 days of isolation or quarantine.

While research suggests children do not get severely ill when they are infected, it is important to note that children do get infected, and are significantly affected by the pandemic.

Children feel its social implications despite not necessarily understanding why. Isolation and/or limitations around contact is particularly difficult for children and youth when peer support and interactions are especially important to their development, and they simply have the need to have fun.

Moreover, the loss of school structure, disruption to education and the need to adjust to virtual learning, as well concerns about the virus and its impact on their families, may create feelings of worry, anger, frustration, sadness, uncertainty and loss for children and adolescents.

One of the difficulties associated with coping with Covid-19 is understanding the real risk to oneself and others. This is especially because many people may be either asymptomatic or pre-symptomatic. Additionally, it is not possible to predict how one’s own body will respond to the infection. Incidentally, being asymptomatic, pre-symptomatic and unpredictable in its course of illness is also true of tuberculosis.

It is normal to respond to the disruptions caused by the pandemic with a range of psychological reactions. However, it is important for individuals and families to know what to do about them to promote healthy coping mechanisms. Realistic, logical, fear in proportion to the real risk of infection and of severe disease is needed. Constant worrying about the negative consequences of Covid-19 and a reliance on alcohol, drugs and nicotine to manage stress and negative emotions are unhelpful ways to deal with the situation.

The easiest response may be to limit access to information about the rising infections rates and mortality associated with Covid-19. However, this may also result in a false sense of security.

While it is important to be informed of the facts, if you find you are becoming stressed by watching the news or using social media, reduce your exposure, especially before going to sleep. However, the use of mobile services, including FaceTime and video conferencing with family and friends, will enhance social connectedness which will help with isolation.

Given the rate of transmission of the coronavirus, vigilance is important. The prevention toolbox President Cyril Ramaphosa spoke about weeks ago is critical for each person to know and implement.

Similar to the prevention toolbox, a useful toolbox of mental health coping strategies that individuals, families and communities can use include relaxation exercises, meditation, listening to soothing music, increasing physical activity and engaging in creative activities. Maintaining a daily routine and engaging in physical activity are also important to  restore balance. The World Health Organisation (WHO) says it is normal to feel anxious during lockdowns, and cautions against the use of alcohol and drugs to cope.

Showing care and support for people working in high-risk areas is important to help them cope. This is important for managers in the health sector, care workers in homes for the elderly and prison management to be aware of.  

It is equally important for parents and caregivers to be supportive of children in their care, and be mindful that unusual behaviour may increase especially during lockdown periods. Validate your child’s feelings or concerns, provide realistic assurance, balance flexibility with maintaining a daily routine, manage your child’s social media and internet access, and help your child avoid blame and stereotyping. Parental self-care (looking after your own emotional and physical well-being) is critical to being able to support your child.

While the coping strategies presented above may work to prevent stress and may be useful, when symptoms persist or are felt to be debilitating, referral to a helpline or mental health practitioner should be considered.

It is essential that we invest in the mental health system to support recovery from Covid-19 by ensuring more widespread availability of psychosocial support, with a focus on vulnerable groups including those with pre-existing mental illness, children, women, frontline workers and the elderly.

The Covid-19 pandemic has highlighted the fact that mental health support is essential for all forms of illnesses. It may be an opportune moment to motivate for the integration of mental health into all types of health-care services to ensure we are able to take care of people’s physical and mental health holistically.

Authors: Yogan Pillay (Clinton Health Access Initiative country director for SA) on behalf of members of the Mental Health Thinktank

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