What experts from China, US, Lebanon told me about COVID-19 impact on mental health

Novel coronavirus has affected the mental health of the public, of nurses and doctors in the frontline and those in isolation.

Representational image | Photo: Manisha Mondal | ThePrint

Last week, my brother, who is a priest, said in our family’s WhatsApp chat that he was considering cancelling worship among his congregation at his Episcopal church in a suburb of Omaha, Nebraska, US. This would be a “huge deal,” as he put it, because people go to church (or mosque, or synagogue, or other gatherings for worship) at least partly for a sense of community.

Still, given the public health risks of COVID-19, that would likely be the decision for his church. There are a fair number of older adults, who are at higher risk for the novel coronavirus, who regularly attend his services, and he faces pressing decisions about how to safely provide care and support his congregation – as well as his wife and eight-month-old daughter.

This decision raises an important issue: connection to people and good mental health are intrinsically linked, and both things are at risk during this pandemic.

I spent the past week talking to experts on mental health and COVID-19: a young woman with lived experience of anxiety and panic disorder who lives in Seattle, a Beijing-based colleague who has been working from home since 3 February, the Director of Mental Health and Substance Use and her team at the World Health Organization, the Dean of the Boston School of Public Health, and the Head of the National Mental Health Program in Lebanon.

While their backgrounds vary, their perspectives were strikingly similar. Here’s what I learned.

‘Facts minimize fear.’

Above all, the common thread among all these experts was that we need to stay informed by trusted sources. “There are two sources,” explained Aiysha Malik, Technical Officer, Department of Mental Health and Substance Use, World Health Organization. “One is WHO (World Health Organization); the other is your national authority. … A repeated message for managing fear in the COVID-19 response is to get facts. Facts minimize fear.”

The danger is that with headlines blaring around us, news outlets vying to be the first to break news, and our social media feeds locking us in echo chambers, there’s a risk of an infodemic, in which misinformation spreads.

Megan Silvestri, Program Manager of the Stability Network in Seattle, Washington, who lives with anxiety and panic disorder and is based in one of the epicentres of the outbreak in the US, described it best: “At the beginning, I was feeling almost panicked about the whole thing. I had tried working from home, and I went down a spiral of reading different news articles. I started to enter into a panic state.”

She said her experiences with anxiety over the years affect how she has managed her own feelings during the outbreak, and her journey the last two weeks in Seattle speaks to the broader human need to feel connected. “What’s been really helpful is people who I trust who I know will listen, without judgment,” she said.

She said she grounded herself with three things: knowing credible facts, speaking to people she trusts and grounding herself in prayer. She explained: “I’ve tried to stop reading headlines. I’ve tried to be intentional about what I’m reading.”

‘You must always return to yourself.’

With many healthcare workers around the world stretched by demand, how can they deal with emotions and stress?

Many consultants have headaches and nausea when they deal with stress and emotion, said Yu Lei, a psychological consultant at Daqing Oilfield General Hospital, Daqing, Heilongjiang Province, China. “Consultants are easily overly involved and fall into a sense of powerlessness.”

There are also times when there is nothing they can do. For example, at times, they cannot provide beds, masks and other needed supplies. In times like these, psychological counselling for crisis intervention tests the personal growth and skill of a consultant, Lei said.

“You must always return to yourself, be aware of yourself, and distinguish which emotions are yours, which are the patients, and which are your empathy,” Lei said.

‘Think about mental health as part of the public health response.’

As Aiysha Malik, a Technical Officer at the World Health Organization’s Mental Health and Substance Use Department, explained in a live-streamed Q&A session this week, “It’s really important to think about mental health as part of the public health response to COVID-19.”

She argued: “People who might be vulnerable to experiencing stress during this time might include people who have preexisting mental health conditions, or substance use conditions, or who might represent other vulnerable groups. We’re not just talking about protection from COVID-19, but we’re also talking about prevention of stress and fear during this event.”

In Lebanon, for example, the National Mental Health Programme in the Ministry of Public Health is closely collaborating with WHO and UNICEF to integrate WHO’s Mental Health and Psychosocial Support programme (MHPSS) into the COVID-19 response. This implementation requires coordination and mainstreaming mental health in the national response, in line with the global MHPSS framework.

Dr Rabih El Chammay, Head of Mental Health Programme, Ministry of Public Health, Lebanon, explained that these measures include:

• Integration of key messages related to mental health and stigma in the training material of frontline workers from health and non-health sectors; the training of the national COVID-19 call centres; the Ministry of Public Health (MOPH) guidelines to the public on self-isolation, including on social media; and the communication messages targeting the general public, health care workers, and others
• Development of a social media campaign on mental health targeting the general population, caregivers of children, persons in self-isolation, and workplaces to support employees with flexible work arrangements
• Self-care and support for health care staff and front-liners during this period
• On-call, phone-based mental health support for persons in quarantine

‘Social isolation is associated with poor mental health.’

Sandro Galea, Dean and Robert A. Knox Professor at Boston University of Public Health and a population health expert who has focused on the social causes of health, mental health and trauma, said he does not dismiss the risk of spread of the novel coronavirus, but it’s also important to consider unexpected risks associated with the response to the outbreak. “The fact that social isolation is associated with poor mental health is unquestionable,” he explained.

In addition, macro-level stress across society could have an undue social burden on specific populations. “There will be medium and long-term consequences on people whose employment is in sectors like retail and transportation” he explained “Adding economic pressures will inevitably result in worse mental health.”

Galea also noted the effects of quarantining on people’s mental health. Though quarantining measures and guidance vary by country and are still evolving, Galea pointed to a study of the 2003 SARS outbreak of the psychological effects of quarantining on residents in Toronto, which found that a substantial portion of those quarantined displayed symptoms of post-traumatic stress disorder and depression.

If quarantining is necessary, there are steps that can mitigate the effects of being isolated, including:

• Staying connected with your social and family networks via technology
• Keeping your daily routines as much as possible
• Exercising regularly and practicing habits that you enjoy and find relaxing
• Seeking practical, credible information at specific times of the day

  Online tools and services offer support and connection:

  Many people are using technology to manage their mental health, which will likely become more common and necessary as the need to practice “social distancing,” maintaining a physical distance from others to avoid the spread, increases.

  Leaning on technology – from hotlines to apps to telemedicine – is not new in the mental health field. Preliminary research from Deloitte shows that there are over 3,000 mental health apps on the market, with varying degrees of efficacy. One of them, Ginger, which connects people to specialists and information, recently published data that shows an increase in weekly mentions of COVID-19-related keywords in text-based conversations between its clients and their behavioural health coaches.

  For example, in China, many cities and universities opened psychological assistance hotlines, Beijing News reported. According to the head of the Beijing Normal University Epidemic Psychological Support Hotline in an interview, the general public had the most psychological consultations (about 50%), followed by those who were isolated (about 15%), frontline medical staff (about 10%), those were quarantined at home (5%), and other cases (about 20%).

  ‘Shift narratives away from number of deaths toward number of recoveries.’

  There often seems to be a dearth of positive stories about coronavirus and those who recover.

  “We’re not seeing the stories of recovery,” said Ken Carswell, Technical Officer, World Health Organization. “We need to shift narratives away from number of deaths toward number of recoveries.”

  Additionally, the negative effects of stigmatizing language – such as attaching region or ethnicity to the virus or blaming people for transmission – exacerbate the sense of fear at a macro level. Journalists, news outlets and everyday citizens can help to increase hope and allay fear by being cognizant of the language they use in speaking about COVID-19.

  In fact, a sense of hope instead of fear could allow leaders and everyday citizens to better cooperate with one another – a vital element in defeating this outbreak. Dr Tedros Adhanom Ghebreyesus, the WHO Director-General, tweeted on March 9:

  We are not at the mercy of #coronavirus. The great advantage we have is that the decisions we all make – as governments, businesses, communities, families and individuals – can influence the trajectory of this epidemic.

  — Tedros Adhanom Ghebreyesus (@DrTedros) March 9, 2020

  In the coming days and weeks, fear and anxiety will likely increase as our lives continue to be disrupted and social distancing becomes necessary. As a society, we must work together with a sense of empathy. As individuals, we must inform ourselves of the facts, stay connected to the people we love and be kind to each other.

  • Wen Mao, Project Lead, Precision Medicine, World Economic Forum Beijing, contributed to this piece.

    This article was originally publish in the World Economic Forum.