At a time of suffering for everyone, the vulnerable are at risk of suffering exponentially. As we grapple with unprecedented events amid the Covid-19 pandemic, those facing mental health challenges are particularly vulnerable and the number of people who fall in this category will increase.
Judging by the trivialisation of the matter by the ministers of police and transport and the absence of provision for support for mental health challenges and exacerbations as a consequence of this situation, there appears to be little regard for mental health in the South African government’s lockdown plan. The country’s history of mental health neglect continues, even in the face of what is possibly its gravest threat to mental health to date.
The lockdown and extremity of the regulations released by the government on 25 March effectively strip people of their capacity to self-determination. According to the UN’s Inter-Agency Standing Committee, “persons in quarantine who can make choices during their day (eg meal choices), have access to structured activities, (and) have a routine… are likely to cope better than individuals confined to an isolated area with decreased autonomy.”
Amid the panic of an invisible mortal threat, armed forces being deployed to make sure people don’t live their lives as normal, with limited access to only the most basic of services and goods, and sudden financial insecurity for many, South Africans now also have very limited options in coping with their distress. They are separated from family and close human interaction. They are confined to one space with no chance of escape. The reason, I suspect, why many clung so passionately to the possibility of being able to go for a walk or a jog amid the initial confusion about the regulations is because it seemed to be their last available coping tool.
And though this may seem trivial compared to dying on a ventilator, it is not. In its advice on mental health during the Covid-19 outbreak, the World Health Organisation encourages people to “engage in healthy activities that (they) enjoy and find relaxing”, and to exercise regularly. While some — especially those who are well resourced and live on large properties — will still find ways to do this, many will not. Other governments have recognised this, and some have made specific provisions in their isolation approaches to include limited outdoor exercise and dog walking.
The sudden ban on alcohol sales and transportation will have mental health consequences as well. While an alcohol-free society may theoretically be a mental health panacea, such an abrupt change may have dangerous mental and physical health consequences. Sudden alcohol withdrawal may lead to aggressive behaviour, and can, in severe cases, be fatal. Those who had the means to stockpile alcohol prior to the lockdown may turn to excessive consumption as a coping mechanism.
It seems that the government is also underestimating the potential impact of this decision and has provided no indication of additional support for those suffering from alcohol misuse problems. The lockdown also means that Alcoholics Anonymous and other support meetings have abruptly halted. Many people in recovery from alcohol and other substance misuse problems are reliant on these. Yet, the minister of police simply warns people to stay sober.
While it is understandable that the government aimed to keep the regulations as simple as possible to ease enforcement, the derisive attitude of the leadership of the enforcers suggests a lack of appreciation for the gravity, extremity and potentially harmful consequences of the regulations. Whereas there has been recognition and an attempt to mitigate the economic impact, mental health has been treated with indifference.
While the grave suffering it can cause cannot be discounted, mental illness can be fatal too. Social isolation is a strongly associated risk factor for suicide. Coupled with unprecedented, worldwide anxiety and uncertainty, and the sudden stripping of normal coping mechanisms, it would be foolish not to expect dire and significant mental health consequences. Government has a responsibility to protect us all, and especially the vulnerable. Those with mental illness are particularly vulnerable under these circumstances.
As per the Inter-Agency Standing Committee, mental health and psychosocial support should be a core component of any public health response to the Covid-19 outbreak:
“Understanding and addressing mental health and psychosocial considerations will be key to stopping transmission and preventing the risk of long-term repercussion on the population’s well-being and capacity to cope with adversity.”
We can be sure of significant adversity facing our country in the coming years. We cannot afford to neglect our mental capacity to do so. While we engage in the most extreme measures to limit deaths from Covid-19, we cannot watch idly as suicide rates rise.
This article by the University of Cape Town’s Alan J Flisher Centre for Public Mental Health makes useful suggestions on mitigations of the mental health impact. Dying from Covid-19 disease is not our only present threat. This is not a time to continue our neglect of mental health. DM