In the weeks following the announcement of the national lockdown in March 2020, Lifeline South Africa recorded over 4 000 calls a day — the number they usually get in a week. Calls to the South African Depression and Anxiety Group (SADAG) more than doubled, while calls to Childline and gender-based violence centres also increased.  

It’s no wonder experts are calling it a ‘mental health’ pandemic and predict that depression as well as post-traumatic stress disorder, which has been on an upward slope, will increase.

Even before Covid-19, it was estimated that one in three people would be affected by mental illness in their lifetime. Statistics indicate over 17 million South Africans are dealing with anxiety disorders of various forms. And although great strides have been made in understanding and treating mental illness – stigmatisation and ignorance remain powerful obstacles to effectively battle this threat. 

Despite its prevalence, we remain unprepared to deal with mental illness. Lee Callakoppen, Principal Officer of Bonitas Medical Fund, gives us some insights into mental health, the signs as well as how and why you should seek help.

What is mental health?

Mental health refers to the cognitive, behavioural and emotional well-being of an individual.  It’s an essential component of health, necessary for us to function effectively.  It helps to determine the way we handle stress and make choices. Preserving good mental health helps us balance activities, efforts and responsibilities to achieve psychological resilience and enjoy life. However, the mental health of an individual is not static, it changes from time to time. 

Mental illness refers to the health conditions involving changes in emotion, thinking or behaviour. It affects the way a person experiences and behaves in the world around them. Issues with mental health disorders are of huge health concern and can contribute to the development of mental illnesses such as depression, anxiety, bipolar mood disorder or schizophrenia. 

According to Karestan Koenen of Harvard T.H. Chan School of Public Health, adults with small children or who are helping care for elderly parents, are typically experiencing the worst mental health issues during the coronavirus pandemic.

How is Bonitas assisting its members with mental health issues get through this global pandemic?  

Our predictive identification model puts us at an advantage as we are able to identify members who are at a higher risk, thereby ensuring early intervention to give them the support and tools they need to manage their mental health status, during this pandemic and beyond. 

We continue to raise awareness of the mental health programme we offer, which includes hospitalisation, treatment of substance abuse, consultations and visits, procedures, assessments, therapy and/or counselling (in and out of hospital). Our mental health care managers contact members to discuss symptoms and provide guidance with steps on how to manage their condition.  

We provide access to digital support tools and engage with members on all platforms to provide educational material on mental health, to help them identify early warning signals and ensure quality care and appropriate referrals. Our resource hub helps people understand the condition and steps they can take to remain mentally healthy. 

What are the emerging trends and predictions in mental health and how will they impact the healthcare industry? 

A recent web-based survey identified Post-Traumatic Stress Disorder (PTSD) symptoms, depression, anxiety, insomnia, perceived stress and adjustment disorder symptoms as mental health issues due to Covid-19.  

PTSD is a common mental disorder caused by psychological trauma. Previous epidemic studies have reported high prevalence rates amongst people exposed to trauma in terms of losing loved ones, being hospitalised for Covid-19 and experiencing the realistic or unrealistic fear of infection, social isolation, stigmatisation. 

Why has Covid-19 made the focus on wellness more important now than ever?

Covid-19 has touched everyone’s life, regardless of status, race or gender. It has made us reflect on many aspects of our lives, including the importance of health and wellness. It has made us realise how vulnerable we are. What is clear is that a more holistic view – both physically and mentally – and a preventative and self-care approach to wellness will greatly assist when we are faced with a pandemic such as Covid-19. 

Do you think that people with mental health issues may not have asked for help because of Covid-19? 

National lockdown, which was something new to all of us, may have resulted in some people being reluctant to seek medical care, for fear of contracting the disease. But, on the whole, our members who have been battling with mental health issues have reached out to seek help.  

We introduced virtual care in April last year and offered it free to all South Africans, until the end of 2020. To help people battling to deal with the stress of the pandemic, we expanded it to include psychiatrists and psychologists.

Our psychiatric and substance dependency and rehabilitation admissions and out of hospital treatment data show a direct correlation between when lockdown was instituted, the various levels of the lockdown, as well as the first and second wave. Although the number of admissions decreased over time, we noted the substance dependency rehabilitation cases have markedly increased in Quarter 1 of 2021. 

Also, it helps that recently we have seen a positive shift in more people actively seeking treatment, this as a result of a better understanding and education about the disease. A number of public figures have also come forward to raise awareness of mental illness, sharing their personal stories and experiences. 

Recognising the signs

The signs and symptoms can vary but, in general, you may find you, your loved one, a family member or friends experiencing any of these:

• Struggling to concentrate and make decisions
• Loss of energy and lack of motivation
• Constant stress and anxiety over work, finances, life, friends and family
• Emotionally distant
• Frequently tearful
• Having difficulty sleeping, or sleeping more than usual
• Loss of interest in activities
• Being easily irritated or more aggressive
• Having thoughts of death or suicide
• Drug or alcohol abuse may also be a sign of underlying mental illness

If you recognise or experience any sign of mental illness, it’s important you seek help as soon as possible.  Go and see your doctor, a psychologist or even a social worker – support is available. There are specialised mental health programmes available through private medical aids or NGOs to help identify the problem, offer the right treatment, support you through the process and help you manage your condition to improve your quality of life. 

For the past few years, there have been warning signs that mental health has become more prevalent. People are becoming more comfortable about accessing care and the stigmatisation seems to have declined as it is more recognised in the clinical arena. However, more can be done and we will continue to focus on developing benefits to support mental health.

It is not an imaginary disease, but a disease where the biochemistry of the brain is impacted and, due to the devastating impact it has on individuals and their direct contacts, (ability to be employed, fully productive, add value to society, on family and friends) it is critical that we support everyone through their journeys, both from a curative as well as preventative perspective.

There is no doubt that Covid-19 is exacerbating mental health issues on a global scale and we know that mental and physical health are co-dependent, which is why it’s important to look at integrated care now, to prevent this becoming the next pandemic.  DM