COVID 19 and its mental health consequences

The global community is concerned about Coronavirus disease 2019 (COVID-19) and its long-term consequences. It is going to impact various spheres of life such as the economy, industries, global market, agriculture, human health, health care, etc. At present, the focus of States and the World bodies such as the World Health Organization (WHO) is on controlling and mitigating the impact of this pandemic by identifying, testing, treating infected people, developing drugs, vaccines and treatment protocols. However, despite such efforts to defeat this pandemic, we are not very sure what direction the pandemic will take in the coming days.

The WHO has also expressed its concern over the pandemic’s mental health and psycho-social consequences (World Health Organization, 2020d). It speculates that new measures such as self-isolation and quarantine have affected usual activities, routines, and livelihoods of people that may lead to an increase in loneliness, anxiety, depression, insomnia, harmful alcohol, and drug use, and self-harm or suicidal behavior (World Health Organization, 2020c). The lockdowns around the world have led to an increase in cases of domestic violence where women and children who live with domestic violence have no escape from their abusers during quarantine (Abramson, 2020; Chandra, 2020; Graham-Harrison et al., 2020; World Health Organization, 2020a). The recent survey by the Indian Psychiatric Society shows a twenty percent increase in mental illnesses since the coronavirus outbreak in India (Loiwal, 2020). Psychologists and mental health professionals speculate that the pandemic is going to impact on the mental health of the population globally with the increase in cases of depression, suicide, and self-harm, apart from other symptoms reported globally due to COVID 2019 (Li et al., 2020; Moukaddam & Shah, 2020; Yao et al., 2020). Closing of outlets selling alcohol has also led to withdrawal symptoms and suicides by alcohol addicts, reported in states like Kerala in India (Jayakumar, 2020). They speculate about the chances of developing neurotic disorders such as generalized anxiety disorder and obsessive-compulsive disorders (OCD) in large population groups. Overemphasis on consistent handwashing (for twenty seconds) may affect a significant population group globally considering people are not aware of when and how many times to wash. In such a scenario, many people are washing their hands on a regular interval (Times of India, 2020). It is a sanitary fight against an invisible virus and sources of infection. In such a scenario, OCD and related maladaptive behaviors particularly due to consistent promotion of handwashing to mitigate the coronavirus infection and its spread is a serious concern. Besides mood-related and emotional outbursts especially panic, fear, avoidance and fear in meeting other people, fear of death (Thanatophobia), fear of getting isolated, stigmatization, fear of even not getting essential items, food, etc., may have its psychological manifestations. In many states, due to anxieties, people have been hoarding essential items which has led to shortages. Millions of People have lost their jobs. People employed in the informal and unorganized sectors are worst hit as they are struggling for, food, shelter and their livelihoods which created uncertainty leading to depression, suicide, self-harm etc. The lockdown may be an important strategy to break the chain of transmission. But it has also created boredom and monotony among office goers and children. In many households, children who end up staying indoors become restless and, in some cases, violent. Many households have even closed windows and doors due to wrong notions regarding the infection.

Interestingly the Coronavirus pandemic has another feature in this age of social media, where people are getting overloaded with rumors and misinformation which are not authentic and verified. Such rumors and unauthenticated information create fear, anxiety, and stress with a sudden and near-constant stream of news reports about an outbreak. In India, many people got exposed to positive people or to those traveled abroad and who are at risk. However, they are not coming forward for testing due to social stigma and social isolation. They are scared and fearful that they will be blamed, isolated and taken away from their family members. It is important that these people receive counselling from psychologists and other mental health professionals that they have not done anything wrong, and this is just a protocol to mitigate and control the pandemic. Their doubts need to be clarified; they deserve social and psychological support, counseling, compassion and kindness in such a distressful situation. Such stigma and social isolation have negatively impacted HIV prevention in the past and we need to learn from that. The stigma associated with mental health problems may cause reluctance to seek support.

To date, over one hundred thousand people have died worldwide, and we do not know how many more will die due to this pandemic. In such a scenario, providing psycho-social support and helping bereaved family members is important. Children may respond to stress in different ways such as being more clingy, anxious, withdrawing, angry or agitated, bedwetting, etc. Children need adults’ love and attention during difficult times. They need extra time and attention. It is important to keep children close to their parents and family and avoid separating children and their caregivers to the extent possible. If separation occurs (e.g. hospitalization) regular contact (e.g. via phone) and re-assurance are required (World Health Organization, 2020b). Particularly young children who have lost their parents are more vulnerable. Every child experiencing such loss needs a safe and supportive environment, guidance and help to express their feelings such as fear and sadness.

The mental and psychological wellbeing of healthcare providers is another concern. Healthcare providers are continuously working in fearful, stressful, resource constrained settings where they are under the continuous threat of getting exposed and infected. In such a condition the healthcare providers’ mental health and psychosocial well-being are as important as managing the health of the infected population. The WHO has issued a thirty-one-point guidance for mitigating these problems. These include guidelines to safeguard the mental health of the population of different age groups affected with COVID-19 with a special focus on children, women and service providers, suggesting measures to mitigate anxiety, depression, and stigma, etc.

There are various resources available online which can be helpful in managing and coping with the stress arising out of the pandemic. It is important for people to take care of themself, their family members and friends. Helping others to cope with their stress makes the community stronger. Nevertheless, the biggest challenge in mitigating mental health consequences of the COVID 19 pandemic is the lack of mental health professionals, practitioners, counselors, and health facilities where one can approach for such help. It is going to be a real challenge for a country like India where only 0.29 Psychiatrists, 0.07 Psychologists, and 0.36 other paid mental health workers are available per 100,000 people (World Health Organization, 2018). In such a situation, it is important to evolve a simple counseling package that can be delivered by givers at home or in the hospital. The package should contain a number of dimensions, such as being empathetic and supportive to all those who are affected. They need to be listened with compassion and kindness. Establishing online mental health and counseling services at hospitals, community health care centres, and at university departments of psychology could be an opportunity to address such a crisis (Liu et al., 2020).

China has been implementing emergency psychological crisis interventions to reduce the negative psychosocial impact on public mental health. However, challenges exist (Dong & Bouey, 2020). One can hope that States will learn a lesson from this pandemic and recognize public mental health as an important priority area that needs to be formally integrated into public health preparedness and emergency response plans.