Much has been said about the Covid-19 pandemic’s effects on people living with underlying health conditions and immune suppression, but not so much about how it affects people living with mental illness. People living with mental illness are some of the most vulnerable people in our society and often face stigma. Studies show that stigma often prevents mentally-ill patients from seeking healthcare. So, in response to Covid-19, we must be aware of this and ensure that testing and treatment processes are sensitive to the needs of people living with the dual burden of mental illness and stigma. 

Even for people without pre-existing mental health conditions, this is a particularly uncertain and distressing time. People in self-isolation or quarantine may feel stressed, anxious or depressed and social distancing may leave many people feeling disconnected and lonely. This may become even more so during the imminent 21-day lockdown. 

Countering panic

Appropriate mental health and psychosocial support interventions are needed to counter panic and foster the “social solidarity” President Ramaphosa called for when he declared a national state of disaster on 15 March. There is evidence which suggests that mental-health interventions strengthen emergency health responses and mitigate panic. Studies have shown that psychosocial well-being and physical health are interlinked, and that mental health interventions may encourage positive clinical outcomes in terms of physical recovery and wellness. 

Ideally, a mental health support response to the pandemic should address the needs of those with existing mental illnesses, as well as those affected by the new uncertainties of living through Covid-19. Particular focus should be paid to people affected with the virus itself, elderly people who are likely to be isolated at the moment, and health workers who are on the frontline of emergency medical responses. An integrated care approach – which pairs mental wellness with emergency medical responses – is necessary.

The Department of Health has said nothing about psychosocial support, and it’s unclear whether mental healthcare is their responsibility. Operations director at the South African Depression and Anxiety Group (Sadag) Cassey Chambers explained that neither the Department of Health nor the Department of Social Development have adequately taken responsibility for mental health care in the past, calling it the “unwanted stepchild” of the two departments.

But encouragingly, on Monday, Minister for Social Development Lindiwe Zulu said the Department of Social Development (DSD) would “render statutory services such as counselling services to infected and affected persons”. But what that process looks like – and who is classified as an “affected person” – remains unclear.

In a radio interview on Thursday night, the minister and deputy director-general of the DSD made no mention of people living with mental illnesses and did not address psycho-social support at all.  The majority of DSD’s statements have pertained to the distribution of social grants during this pandemic, a plan which has been criticised by civil society organisations for failing to explain how social grant beneficiaries would be protected throughout the pandemic.

National Department of Social Development spokesperson Lumka Oliphant told SECTION27:

“The DSD understands that Covid-19 amongst many factors can result in panic, anxiety, stress, depression and trauma… The Department will be conducting trauma debriefing, trauma counselling, containment of infected and affected persons and overall support in terms of services to be offered in the quarantine sites. Education and awareness campaigns will be conducted.”

Questions

Chambers questions the DSD’s commitment. Referring to the Life Esidimeni tragedy in 2017, Chambers commented:

“We already have a mental-health crisis in South Africa – we’re lacking resources for mental health, there are psychiatric medicine stockouts and there’s not enough support in general. How is the department of Social Development going to implement these psychosocial support measures?”

Already, Sadag’s mental helpline is receiving more calls than usual. “We have people with chronic mental health conditions calling, feeling very panicked – they’re worried about how to get food, their medication and how to meet with their therapists… but also, as a country, we’ve never done social distancing before, so we’re getting calls asking what that looks like and how to deal with increased stress.” Chambers anticipates even more calls coming through to the Sadag mental health helpline. 

Chambers explains that Sadag offers multiple services to the public. These include a 24-hour mental-health hotline, a WhatsApp counselling line, and question and answer services with mental health professionals streamed live via Facebook. There are also a number of resources and toolkits on their website, which give advice as to how to cope during this time. Sadag has also worked to ensure that medical aids cover e-therapy and telephonic therapy sessions for patients with severe mental illnesses. 

Instant messaging-based counselling services were offered in parts of China affected by the Covid-19 outbreak, which reportedly had positive mental health outcomes. The South African government has rolled out a WhatsApp line for accurate updates about Covid-19 (you can join this broadcast list by sending a message to 0600 123 456). This is an important measure to ensure clear communication about the virus, counter fake news and calm people down. Extending this to include mental health support, however, may also be beneficial. 

Social distancing, not isolation

The World Health Organisation (WHO) has developed a set of guidelines for how to deal with mental health concerns during this time. They include recommendations for people with existing mental health conditions, addressing stigma towards newly infected Covid-19 patients and ensuring mental well-being of medical staff who are dealing with the pandemic. They also set out general advice to counter panic and stress in this period of social distancing and potential isolation. 

For people with pre-existing mental health conditions, effort must be made to ensure an uninterrupted supply of essential psychiatric medicines and medical care. For people caring for people with severe mental illnesses, according to Sadag, maintaining routine and stability is very important. There is evidence which illustrates that certain mental health conditions like bipolar disorder and schizophrenia have high comorbidity rates with pulmonary diseases, diabetes and asthma and so, people with these mental disorders may be particularly vulnerable to Covid-19. 

People infected with the Covid-19 virus are likely to feel anxious or depressed, or possibly even guilty. Such feelings may be worsened due to isolation. Health Minister Dr Zweli Mkhize has estimated that between 60%-70% of the population may become infected. In this time, therefore, we need to draw together as opposed to shaming those who are infected. The WHO reiterates that “people who are affected by Covid-19 have not done anything wrong, and they deserve our support, compassion and kindness”. 

For health workers, this is an exceptionally stressful and distressing time. A study showed that in China, medical professionals experienced increased rates of anxiety, stress, panic and depression during this period. Furthermore, research has shown that health workers in China didn’t want to go home at the risk of infecting their families, so in some hospitals, private rest-areas were set-up to ensure that medical professionals get enough sleep. Elsewhere, research has shown that medical workers often experience post-traumatic stress disorders after working in emergency settings. Steps must be taken to mitigate this. 

Overall, panic and fear jeopardise effective health responses. Research shows that limiting intake of information to verified sources (like the NICD website or DOH’s Covid-19 website, for example) can prevent information overload and alarm. Chambers suggests limiting interaction with news to a few times a day, and filtering what you read to ensure you are only reading credible sources. 

In the meantime, there are resources that can help mental well-being. Organisations like Sadag, Lifeline and the SA Federation for Mental Health all have helplines to call for help. 

Services such as these need to be strengthened with adequate support from the DSD and Department of Health. Civil society has called on private health institutions to provide support to the public health sector. Private providers of mental health and psychosocial support could contribute to “social solidarity” in this time by offering digital and telephonic mental health support to the public at pro-bono or reduced rates. 

Social distancing need not necessarily mean social isolation, Chambers points out. Remaining in contact with loved ones via telephonic or digital means can limit feelings of disconnection. 

To give meaning to President Ramaphosa’s plea for social solidarity, support for mental health is critical. Social solidarity means countering stigma against those who are ill – either with Covid-19, or with chronic mental health conditions – and upholding human dignity and humanity for all. DM

Julia Chaskalson is a communications officer at Section 27.

This article was produced for Spotlight – health journalism in the public interest.

Sadag is providing support through:

1. Online Toolkit on the Sadag website (www.sadag.org) with free resources, online videos, reliable resources, coping skills, online tools and info on social distancing, self-isolation, etc.
2. Chat online with a counsellor 7 days a week from 9am – 4pm via the Cipla WhatsApp Chat Line 076 882 2775.
3. FREE online #FacebookFriday “Ask the Doctor” chat on Friday, 27 March 1pm-2pm and 7pm-8pm answering all your questions on Mental Health.
4. SMS 31393 or 32312 and a counsellor will call you back – available 7 days a week, 24 hours a day.
5. Sadag Helplines providing free telephonic counselling, information, referrals and resources 7 days a week, 24 hours a day – call 0800 21 22 23, 0800 70 80 90 or 0800 456 789 or the Suicide Helpline 0800 567 567.

Who to call:

Lifeline 24-hour counselling numbers: 0861 322 322 or 0800-150-150.

Adcock Ingram Depression and Anxiety Helpline — 0800 70 80 90.

Suicide Crisis Line — 0800 567 567 or SMS 31393.

Cipla 24-Hour Mental Health Helpline — 0800 456 789 or WhatsApp: 076 88 22 77 5.