As the coronavirus pandemic rapidly sweeping across the world, it is inducing a considerable degree of fear, worry, stress, anxiety and concern in the population at large and among certain groups in particular, such as older adults, people with underlying health conditions and caregivers. The biggest psychological effect so far in terms of public mental health is elevated levels of stress or anxiety. But as new measures and impacts are introduced – especially quarantine and its effects on the usual activities, routines or livelihoods of many people – levels of loneliness, depression, harmful alcohol and drug use, and self-harm or suicidal behavior are also rising.
Now, mental health problems are likely to increase exponentially both at the individual and community levels as the impact of the coronavirus disease (Covid-19) deepens over the next few months. The lives of many people were turned upside down entirely in the wake of the virus.
Specific population groups are at particular risk of COVID-related psychological distress. Frontline health-care workers, faced with heavy workloads, life-or-death decisions, and risk of getting infected, are particularly affected. During this pandemic, survey was done in China which showed that health-care workers have reported high rates of depression (50%), anxiety (45%), and insomnia (34%) and also in Canada, 47% of health-care workers have reported a need for psychological support. As per the World Health Organization, report from UK and India further showed the suicidal cases among frontline health care workers.
Children and adolescents are also at risk. Parents of different country like Italy and Spain have reported that their children have had difficulties concentrating, as well as irritability, restlessness and nervousness. Stay-at-home measures have come with a heightened risk of children witnessing or suffering violence and abuse. Children with disabilities, children in crowded settings and those who live and work on the streets are particularly vulnerable. -World Health Organization
Similarly, women are at particular risk, particularly those who are juggling home-schooling, working from home and household tasks, older persons and people with pre-existing mental health conditions. A study carried out among the young people with a history of mental health reports that 32% of them agreed that the pandemic had made their mental health much worse. Statistics from Canada reported that 20% of 15-49 year-olds has increased their alcohol consumption during the pandemic.
Along with the fear of contracting the virus in a pandemic such as COVID-19, also brought the significant changes to our daily lives as our movements are restricted in support of efforts to contain and slow down the spread of the virus. While at first things like working from home sound like a great idea, it can pose problems for many such as feeling isolated, facing technical problems that affect productivity, or even triggering domestic problems, another is temporary unemployment, home-schooling of children, and lack of physical contact with other family members, friends and colleagues. So, it is important that we look after our mental health, as well as our physical, health.
As per the report given by JAMA Psychiatry (2020), The COVID-19 pandemic has brought several alarming risk factors like social isolation, anxiety and depression, inadequate treatment availability, and poor seasonal timing. Researchers throughout the world warn that a suicide tide might supervene during a pandemic and more importantly, after this public health emergency.
At the same time, the restrictive measures followed by lockdowns have tremendous effects on worldwide economic activity, increasing the unemployment rate. As per the report by the International Labor Organization (ILO, 2020), the unprecedented number of job losses due to the COVID-19 pandemic is estimated at 24.7 million in the high scenario, and 5.3 million in the low scenario. To varying degrees, people have already started facing the economic effects of the pandemic. The stock market is lagging, some local businesses are struggling, peoples are struggling to repay their loans and the uncertainty surrounding when life can get back to normal is taking its toll on all sectors of the workforce.
These all Big, sudden changes to daily life is now triggering feelings of fear, stress, and anxiety and aggravating mental illness.
Reports given by World Health Organization also indicated an increase in symptoms of depression and anxiety in a number of countries. A study done in Ethiopia, in April 2020, reported the prevalence of symptoms of depression has increased by 3-fold compared to estimates from Ethiopia before the epidemic.
Now, the COVID-19 pandemic is highlighting the need to urgently increase investment in services for mental health or risk a massive increase in mental health conditions in the coming months, according to a policy brief on COVID-19 and mental health issued by the United Nations.
Reports from different countries of globe indicates that the issue of mental health during the pandemic has come to the fore not only in Nepal but worldwide as well. “The impact of the pandemic on people’s mental health is already extremely concerning,” said by Dr Tedros Adhanom Ghebreyesus, director-general at the World Health Organization. “Social isolation, fear of contagion and loss of family members is compounded by distress caused by loss of income and often employment” he added.
As per the public health experts, the COVID19 pandemic and the nationwide lockdown in Nepal which has enforced since 24th March are taking a toll on people’s mental health, triggering new problems while exacerbating existing ones. These issues culminate in a number of cases in people taking their own lives, they say.
A total of 1,227 people (16 a day) across the country have ended up in the first 74 days of the lockdown in Nepal. According to the data compiled by the Nepal Police, the suicide cases across the country increased by 16 percent in the first month of the lockdown. A total of 482 suicide cases were filed during mid-March to mid-April in police stations across the country against 414 cases for the period between mid-February and mid-March. The data compiled by Nepal Police suggests that the number during the lockdown is considerably high and 38 people had committed suicide in the Kathmandu valley alone. The highest number, 742 died by hanging themselves followed by 114 people who committed suicide by consuming poison.
In an article Published in Republica in May 21, Dr Ritesh Thapa, consultant psychiatrist at Rhythm Neuropsychiatry Hospital said “If the government doesn’t do something about it, people will suffer from mental health problems for years after this pandemic. The government has only focused on containing the spread of the virus. At this time, the government must think about mental health problems people are facing,”
Dr Sagun Ballav Pant, assistant professor of psychiatry at the Tribhuvan University Teaching Hospital also told to Republica that the modern world has many other requirements than “food, shelter and clothes. Young people have missed recreational activities. Movie theaters are shut. Also, couples have not met for a long time. Modern world has modern problems, so the government needs to come up with new lockdown modality.”
The World Health Organization has already predicted that there will be a rise in the number of mental health problems due the global pandemic, Dr Pant also said that the scenario of Nepal will be different after six months as the pandemic will leave a negative psychological impact on people.
He further added that the government should focus on mental health problems people are facing. He also gave the examples of suicide cases among frontline health care workers in the United Kingdom and India. So, those working in frontline are more at risk and the government must think before it’s too late.
Many people have already started to feel hopeless because of the uncertainty surrounding this pandemic. A great deal of them have taken loans and now suddenly they find themselves unable to pay because their businesses are closed and at risk of shutting down entirely. They are at risk of stress and depression, the government should come up with a financial safety net in order to help the people and businesses affected by the pandemic.
The current pandemic is not only a medical tragedy of this century; it might also, unfortunately, leave psychological scars for years. Therefore, it is of paramount importance to develop effective suicide prevention strategies and strategies to promote mental health in population. The suicidal ideation and thoughts are often momentary and can effectively be dealt with support, therapy, and coping behaviors.
As per Prof. Lohani, the Founder and Academic Director of Nobel College, the professionals who come in contact with vulnerable people at the beginning of the problem such as female community health volunteers, police personnel, teachers, community, and religious leaders should be sensitized and trained to identify people in need and provide them with basic psychosocial counseling. The availability and use of suicide prevention lifeline become more important during and after the pandemic. Mental health professionals ranging from psychological counselors to clinical psychologists, suicidologists, and psychiatrists need to come forward to tackle suicide upsurge, and manage increasing mental illness among population that is very likely to occur during and after the COVID-19 pandemic.
The government should also focus on developing and funding national plans that shift care away from institutions to community services, ensuring coverage for mental health conditions in health insurance packages and building the human resource capacity to deliver quality mental health and social care in the community.
Mental health is not just an issue of an individual feeling good. In the time of the Covid-19 pandemic, mental health disorders could take on the form of another inevitable pandemic. So many lives depend on how we respond to this challenge. We must remember that like Covid-19, mental health, too, has no vaccine in sight.
(Tripathi, working as a Lecturer in Nobel Medical college Teaching Hospital (NOMCTH), Biratnagar.)
