The Rise of Mental Health During a Pandemic

Leeynesh Sooriyapiragasam MD (NDUM), DCHyp (UK)

The Coronavirus Disease 2019 (COVID-19) Pandemic has changed our normal routine of life.
Even though the pandemic portrays directly to major physical health crises, it has actually
given a profound and concerning impact to mental health crises as well. Strategies such as
controlled movement, working or studying from home and public health awareness such as
encouraging face masks, physical distancing and good hygiene were implemented to
mitigate the effect of the virus.

When the Malaysian government declared Movement Control Order (MCO), most people
had many losses including jobs, health services, freedom, connections, opportunities,
incomes and even privacy. All these may have led them into some kind of shock, anger,
bargaining or even some forms of depression and uncommonly, some kind of acceptance.
During a loss, many people will usually face breaking points especially when there’s multiple
external and internal stressors reflected on them. Those with poor coping mechanism tend
to have poor anger management, unhealthy eating habits, and even abusing illicit drugs or
substances contributing to poor well-being and increasing the number of domestic violence.
Unfortunately, all these have reflected in the growing incidence of mental health illnesses
especially in anxiety, panic attacks and depression.

The United Nations (UN) and World Health Organization (WHO) have reported that even
before the COVID-19 emerged, more than 1 in 5 people living in a conflict setting are
affected by a mental health condition. In low- and middle-income countries, over two-third
of people with mental health conditions receive no treatment despite the evidence that
efficacious interventions can be conveyed in any resource context. [1] Importance of health is
a basic human right.

Stress is a normal physiological and psychological pressure in life. There can be good stress;
eustress and bad stress; distress. Everyone reacts differently to difficult situations, and it's
normal to feel stress and worry during a crisis. But multiple challenges daily, such as the
effects of the pandemic, can push you beyond your ability to cope. Many people may have
mental health concerns, such as symptoms of anxiety and depression during this time. And
feelings may change over time.
Despite your best efforts, you may find yourself feeling helpless, sad, angry, irritable,
restless, hopeless, anxious or afraid. You may have trouble concentrating on typical tasks,
changes in appetite, body aches and pains, or difficulty in sleeping or you may struggle to
face routine chores.[2] You may also excessively worry about yourselves and people around
you. These are all common symptoms of anxiety. Restricted movements and lockdown can
also be a contributing factor to increase anxiety. Being anxious of being infected in public
may also be a perpetuating factor in anxiety issues.
Panic attacks are also said to be on rise especially at this crucial time. One may have
palpitations, sweating, trembling, shortness of breath, feeling of being choked, chest pain or
discomfort, feeling nauseous or dizziness, fear of losing control or dying as well as feelings of
being detach from oneself (depersonalization) or feelings of unreality (derealization); these
are all the common symptoms of panic attacks.[2]
Apart from all these, depression cases may increase among our society. The loss of stable
jobs, incomes and connections may eventually exacerbate the mood of feeling excessive
sadness, feeling empty or tearful. There might also be associated symptoms such as loss of
interests (anhedonia), significant weight loss or gain, insomnia or excessive sleeping
(hypersomnolence), psychomotor agitation, fatigue, feeling of worthlessness or
inappropriate guilt, diminished ability to think or concentrate along with recurrent thoughts
of death may be present.[2]

When these signs and symptoms that last for several days in a row, it can make you feel
really miserable and cause so many problems in your daily life until you may find that it is
hard to carry out normal responsibilities; all these definitely show that it's time to ask for
help. All these signs and symptoms can also affect your interpersonal relationships, working
life and your social circle too.

What can Public do?

One should create a new routine in our new norms; such as making oneself busy with useful
things, learn new skills, sign up for online learning, get a new workout routine, trying a new
recipe, learning about a new business plans, etc. Self-care and self-love are vital during this
crucial times so that one will lead a happy life in a positive environment. Mindfulness
practice is essential for all of us at all times. Other than that, eating a balanced and healthy
diet as well as adequate sleep are vital to make sure we’re energized all the time.

Call or talk to your loved ones or people around you. Just check on them if they are doing
alright or if they’re having a rough day. Sometimes all they want are to be heard. Sometimes
a kind gesture like a text, card or flowers can elevate their mood. If you think they are
having severe symptoms that are affecting their social life, relationships and work, suggest
them to meet a therapist or psychologist. If one is feeling suicidal or extremely low mood,
services like Befrienders, Mentari Programmes and Mental Health Psychosocial Support
(MHPSS) should also be encouraged. Everyone deserves a healthy mind and body. We
definitely have to help each other to lead better lives together. If you’re suffering this alone,
please do seek help, there is always someone who is willing to help you at all times.

What can Healthcare Professionals and Mental Health Providers do?

Globally, there is less than 1 mental health professional for every 10,000 people.
Psychosocial issues education and training should be provided to health system leaders, first
responders, and healthcare professionals. The mental health providers and emergency
management communities should collaborate together to identify and disseminate
evidence-based resources related to disaster mental health, mental health triage, special
needs for certain populations along with bereavement care. Healthcare professionals and
mental health providers should provide supportive psychotherapy by assessing the
stressors, being empathy and compassionate to the patients as well as implementing
psychological first aid if needed.
Questionnaires such as DASS that measures depression, anxiety and stress can also be used
as guidance. Post-Traumatic Stress Disorder (PTSD) and increased substance abuse should
also be the differential diagnoses, apart from other associated medical conditions.
Wherever is possible, referral to therapists, psychologists or psychiatrists should be done if
the scenario is not within our limits.

Apart for the affected individuals, mental health support should also be readily available to
healthcare professional and mental health providers. These group of people tend to be
more exhausted as they are overworked, have some kind of fear of being infected and
infecting others, external stigma, moral injury and some may even have poor social support.

Biopsychosocial and spiritual approach should be implemented in all management for

mental health services as it is sustainable and is said to bring out better outcomes.

Summary

As a conclusion, mental health is not something to be taken lightly. It is still seen as a taboo
in certain communities. It does not only affect a single individual but as a community in
whole. Being mentally ill, it may forces one into thinking that they are less capable of
achieving things or push them to the brink of hopelessness and helplessness. Some might
not even want to open up because they are afraid that they might be judged. Such
individuals may be more prone to risky health behaviours such as substance abuse,
sedentary lifestyle and poor diet; all of which can lead to non-communicable diseases
(NCDs) like diabetes mellitus, hypertension, coronary artery disease and metabolic
syndrome which eventually will affect their physical health and also lead into a much severe
mental illness. Positive mental health with good coping mechanism is essential for the
society and mental health must also be a priority to be attended urgently and adequately.

REFERENCES

1. United Nations. (2020, May 13). Policy Brief: COVID-19 and the Need for Action on Mental Health.
Accessed on 30th May 2020, from https://www.un.org/sites/un2.un.org/files/un_policy_brief-
covid_and_mental_health_final.pdf

2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th
ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm05