Coronavirus Op-ed

Love in the time of Covid-19: The mental health and well-being of individuals and communities

By Alan J Flisher Centre for Public Mental Health, University of Cape Town 20 March 2020

South Africans are slowly coming to grips with the new Covid-19 reality. Overcoming fear, anxiety and uncertainty are very real challenges for many people.

On Sunday, President Cyril Ramaphosa announced a far-reaching and proactive plan to limit the transmission of the coronavirus in South Africa. This plan is based on available evidence and largely follows the emerging best practices internationally. We strongly support the rapid execution of the plan and the president’s view that “although we may be limiting physical contact, this epidemic has the potential to bring us closer together”.

The global crisis has catalysed international and local examples of social solidarity and mutual aid. People in the midst of quarantine, self-isolation and social distancing have found creative ways to reach out to others and to provide encouragement and support. Some examples include Caremongering Facebook groups in Canada that link people in need with those close by who can help; cosplayers worldwide dressing up as their favourite characters and recording themselves reading stories to children and then posting them online, people applauding healthcare workers from their balconies in Spain, and Cape Town Together that has created mutual aid groupings in various neighbourhoods.

These initiatives can enhance physical and mental health during a time when many are experiencing fear, uncertainty and anxiety. Additionally, while the general population is vulnerable to feelings of stress or hopelessness, some groups such as the elderly, people with existing conditions or disabilities, frontline health workers, those with mental health problems and quarantined individuals are particularly vulnerable.

While evidence on the effects of quarantine on individuals are sparse, this rapid review “suggests that the psychological impact of quarantine is wide-ranging, substantial, and can be long-lasting”.

Yet, South Africa’s official responses to Covid-19 make little or no provision for the mental health implications of the pandemic. The proactive measures to prevent transmission and containment overlook the importance of mental health and the need for psycho-social support – an essential component of a mental health response. In a context in which 16% of South Africans live with a common mental health condition (depression, anxiety or substance misuse), the anxiety and social isolation brought about by the Covid-19 pandemic can exacerbate conditions. Feeling overwhelmed by anxiety can make it difficult to cope with the new lifestyle changes that are required, or may lead to people using unhealthy ways of coping, such as substance use.

The Inter-Agency Standing Committee (IASC) for Mental Health and Psychosocial Support in Emergency Settings advise that Mental Health and Psychosocial Support (MHPSS) “should be a core component of any public health response”, in a briefing note on addressing mental health and psychosocial aspects of the Covid-19 outbreak.

The South African government needs to provide its healthcare cadre with a MHPSS strategy for Covid-19 cases, survivors and contacts that are integrated into their response activities and the systems in which they work. Patients in quarantine should have access to mental healthcare if they need it. By mapping existing MHPSS service providers and institutions, efforts can be pooled to address the need for mental healthcare that’s very likely to increase.

We must make an effort to create safe and protected environments for care and make use of existing resources and strengths. We need to encourage physical distancing along with social solidarity. And any MHPSS intervention during this time needs to include key psychosocial principles, including hope, safety, calm, social connectedness and self- and community efficacy. We have identified key interventions that can help general populations, people exposed or infected and healthcare workers.

General populations

The IASC states that as in the case of any epidemic, people can experience boredom, anxiety and depression due to isolation. Additionally, the fear of being infected can not only lead to severe anxiety, but also cause individuals to avoid seeking healthcare to prevent being exposed to the virus. The committee also lists possible stressors specific to Covid-19, such as confusion of symptoms with other health problems (like the flu) and an increase in health workers’ and caregivers’ responsibilities.

Individuals and communities can play a crucial role during this time. It’s clear from the positive news stories trickling in that communities across the world are showcasing their resourcefulness. This sense of community can aid in relieving the mental health burden during this time in a number of practical ways.

Individuals can think of others in their community who may need support, call or text often, have food delivered to the vulnerable and keep children occupied with fun activities.

Individuals and their communities can use existing resources, such as a neighbourhood watch or use existing WhatsApp groups to disseminate verified news, messages of hope and support.

At home, we agree with the IASC and Psychological Society of South Africa, that there are certain basic steps that people can take to look after their mental health:

  1. Practice self care: Get enough rest, be physically active, take prescribed medications as advised and practice daily hygiene.
  2. Stay connected: check in with friends and family.
  3. Limit your exposure to social media: set aside only a limited time to check news and social media for updates. It’s vitally important to check only trusted and official sources for news. Covid-19 can spread quickly, but fake news and misinformation will spread faster.
  4. Use healthy coping strategies: Stick to a basic routine, find a hobby to occupy your mind and do not turn to substances as an escape. The Australian NGO Smiling Mind has developed a useful resource that can help develop the skills to cope.

People exposed or infected

As for those who have been exposed or infected and are in quarantine or self-isolation – a range of mental health difficulties can arise. The Psychological Society of South Africa states that it’s “common for quarantined individuals to experience stressors such as stigma, boredom and frustration, inadequate information and supplies, fear and financial loss.” Here are some suggestions to consider:

  1. Reach out and connect with others. Many people are in isolation or quarantine and feeling the same way as you are and it’s OK to not be OK. Use the phone, email, instant messaging and various forms of social media to connect. Talk about your experiences and feelings if you find it helpful.
  2. Use practical ways to help you cope and relax. Stretching, taking deep breaths or any activity that helps you relax. Treat quarantine as an opportunity to do some things you never usually have time for.
  3. Try to stay positive. Keep a journal or diary and write down all the things that you are grateful for.

Healthcare workers

Healthcare workers play a critical role in our healthcare system and in controlling the outbreak. We need to make sure they are supported as they face additional physical and emotional stressors coupled with long working hours and reduced contact with loved ones, together with the fear accompanying their higher risk of contracting Covid-19 and possibly passing it on. In addition to the suggestions described above, here are some suggestions that healthcare workers could consider:

  1. Take breaks: Despite the heavy workloads and long hours, taking breaks is essential to allow you the time to recover and work optimally.
  2. Keep yourself healthy: Sleep and eat well and manage stress to help you avoid burnout.
  3. Seek support – you’re not alone. Many of your colleagues are experiencing the same fears as you. Talk to colleagues whom you trust if you find this helpful.

With technology seemingly being the most available and sensible option to deliver MHPSS, we hope that telecom companies such as Telkom, MTN, Vodacom, Rain, CellC and others will consider making access to WhatsApp free for the duration of this outbreak.

We encourage the South African Department of Health to act swiftly to integrate a strong mental health and well-being component into their response to the virus. Regardless of the approach that the government and the private sector decide to take, we need to emphasise the strength and resourcefulness of the South African community.

During the struggle against apartheid, in the fight against HIV and other challenges such as load shedding and droughts, we have demonstrated our massive capacity for solidarity. Crisis has brought out the best in many, and we are positive that our fellow citizens will learn from and educate other nations in unity, ubuntu and building resilience. MC

Authors: Katherine Sorsdahl, Ashraf Kagee, Marguerite Schneider, Crick Lund, Claire van der Westhuizen, Marlise Richter, Qhama Cossie, John Parker and Maggie Marx.

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