COVID-19 adds to Mental Health challenges
By Clement Nhunzvi, AMARI PhD Fellow
In January 2020, the World Health Organization (WHO) declared the outbreak of the Coronavirus, Covid-19, to be a public health emergency of international concern. As at May 18, 2020, the world had seen more than four million people being infected and lost more than 300 000.
Against the backdrop of the extensive physical health coverage about the pandemic, we need to be reminded that the world was already seized with a major mental health crisis before the Covid-19 pandemic. About one in every four people already experience some form of mental health condition.
However, it remained unjustly ignored, partly because of faulty understanding of the matter and lack of resources to properly mitigate it. In some parts of the world, governments are starting to act after realizing the economic cost of ignoring the mental health crisis — something we cannot afford to do in these trying times.
Even more with the knowledge that without Covid-19, depression and anxiety alone were estimated to cost the global economy US$1 trillion each year in lost productivity. As the Covid-19 pandemic continues to grow, so will be the mental health crisis. Unfortunately the later will be with us for much longer, with some cases only becoming apparent in months and even years to come.
So, as we plot our ways in the uncharted territories of Covid-19 response, we need all players to be reminded of the chronic nature of the mental health crisis and that there will be “no health without mental health”. Even more when the pandemic is like in our case complicated by poverty, stigma, and inequality, and set to have a more devastating impact on mental health that will be long lasting.
Evidence on the actual mental health impact of the Covid-19 pandemic in Zimbabwe is still emerging, and we need to be proactive about applying it. It is interesting to note that responsible players are already working on it, with some organizations providing telehealth where it is feasible.
The early picture developing from our setting and other severely affected regions like China, America and Europe is showing increased moderate-to-severe post-traumatic stress symptoms, stress, depression, anxiety, and substance use disorders.
This is largely because the Covid-19 pandemic is coming with exposure to some known risk factors for stress, depression and anxiety, including high mortality rate, resource and food insecurity, discrimination and experience with infected and sick individuals, which can lead to more adverse mental health outcomes.
These mental health challenges have been reported among healthcare workers, people affected by Covid-19, caregivers, and the generality of those exposed or at increased risk. In addition to the human toll, these mental health challenges also have implications at the workplace, resulting in decreased productivity.
People will have difficulty concentrating, take longer to accomplish tasks, have difficulty in thinking and problem-solving, procrastinate on challenging work assignments and have difficulty multi-tasking and fulfilling responsibilities.
Part of the management strategies to contain the spread of the Coronavirus including the lockdowns, quarantine and isolation measures will have adverse psychosocial impacts on some people. People will respond to these in different ways depending on their circumstances. However, what is constant is that our lives will be disrupted and we need to adjust. Unfortunately many do not have the mental and economic resources to adapt to new situations.
Some negative mental health impact will kick in and these are signs to look for:
Drastic changes in sleeping patterns — mostly insomnia
Changes in appetite
Extreme mood changes — Easily angry, agitated, or irritable or feeling extremely sad
Severe tiredness and feeling easily fatigued
Losing interest in the things you loved to do
Withdrawal from family members and friends
Difficulty in focusing or concentrating
Urge to increase alcohol or tobacco use
The mental health services remain available, and people are encouraged to seek help early for optimum results. The Ministry of Health and Child Care has also constituted a psychosocial treatment working group to respond on the psychosocial impacts of Covid-19.
Mental health impact on professionals
The mental health of the general population also depends on that of people who serve them in crisis times like these. For the mental health of our frontline workers, WHO advises that responsible authorities should be proactive in meeting their basic needs.
By protecting our health and social care staff from chronic stress and poor mental health, we protect our own health and promote societal well-being. This will boost their ability to perform their duties. Responsive and ethical leadership that delivers quality communication and accurate information updates to all staff can also help avert mental health challenges in frontline workers.
Covid-19 will also definitely have its mental health toll on our national leadership and line managers. Most of them will be forced to make difficult decisions as they operate from a survival mentality mode. This will increase the risk for work-related stress, burnout, fatigue and other occupational disorders. If not addressed, mental health challenges will rise in this group and manifest as absenteeism and poor performance.
It is, therefore, crucial that our Covid-19 response incorporate preventative mental health strategies for all key groups. The levels of stress they encounter can be significantly lowered by applying coaching, mentorship and basing their decisions on sound scientific evidence.
The inequality dimensions
While we understand that Covid-19 does not discriminate and so is the mental health impact, inequalities are quite evident in the way we are affected. In our situation of a predominantly informal economy, people with the most precarious livelihoods, those with pre-existing mental health conditions, the elderly, persons with disabilities and those in abusive relationships are at greater risk and should be given special consideration.
Informal traders fear for their financial future which was already strained by prevailing economic hardships. They have few or no resources to fall back on, and they foresee worse health outcomes for their colleagues. The mental health impact will intersect with all this and other injustices, resulting in increased risk among the already marginalized.
Attending to stigma
Against the backdrop of all these challenges that we are faced with, we must deal decisively with stigma. Stigma towards persons with Covid-19 and those with already existing mental health conditions will derail our progress in fighting this virus.
There is no use in stereotyping, discriminating, harassing and or bullying those affected or at risk. Stigma can lead people to hide symptoms of illness and falsify information to avoid discrimination. It can also result in people not seeking medical attention when needed, or they may further self-isolate.
We are all called to be “empathetic to all those who are affected, in and from any country”. This is WHO’s warning against stigmatizing anyone who has or had the virus. We, therefore, need to invest in sound community and public engagement to fight the stigma.
New equilibrium
When catastrophic pandemics like Covid-19 happen, it is understandable to feel the way we are feeling. Public health emergencies demand we adjust, adapt, and find a new equilibrium. Mental health is critically important for individuals, for teams, for companies and for society in this new order. While these are traumatic times, they do not have to be damaging.