"VAN" (Europe Bureau - Aleksey Vesyoliy) :: The mental health and wellbeing of humans around the world have been severely impacted by COVID-19 global pandemic. Isolation has a negative effect on mental health, mostly because self-isolation goes against human social instinct to seek comfort by surrounding ourselves with others. People being forced to stay into self-isolation feel overwhelmed with emotions like sadness, depression or anxiety. The intensity of these feelings often comes in waves. Emotions are cyclical. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Millions of people have lost or being at risk of losing their income and livelihoods. Domestic violence is rising, and health workers are reporting an increased need for psychological support. The uncertainty, added to the fear of contracting the virus in a pandemic make the situation even worse.
It is undisputed that the current COVID-19 global pandemic will have long-lasting consequences and effects on the mental health affecting global population with astonishingly heightened stress. Shortage of staff is already present due to the economic crisis placing mental health at the bottom of the list of health priorities.
"There is no health without mental health", as declared by the World Health Organization many years ago
The COVID-19 pandemic may be especially challenging for those who already have mental health problems. Their human rights, safety, protection, and even the environment, are at risk. These persons could be forgotten, neglected and exposed to additional suffering because of the shortage of mental health services. Cutting funds, diverting staff to other services, dedicating existing psychiatric facilities to urgent functions to the care of the outbreak are some of the factors that cause serious concern. As an immediate consequence, certain people with mental disorders who need "closer" care are the most affected by "physical distancing".
An increase in demand for involuntary treatments is beginning to surface in many areas
Families who have now become the primary careers of their relative with mental illness battle to cope without the necessary support that may have ordinarily been offered such as counseling, guidance or psychological support.
Self-isolation may trigger the feeling of loneliness, increased depressive symptoms, suicide, and other experiences affecting mental health. A lack of services or limited access to specialists and supportive relationships make it more challenging especially for people with mental health problems. The increase in people in need of mental health or psychosocial support has been compounded by the interruption to physical and mental health services in many countries. Stigma and discrimination create additional barriers addressing mental health issues and urgent need for investments in mental health services.
Even some countries are easing a number of restrictions, the effects of quarantine and self-isolation on mental health are continuing to draw concern. Numerous reports already indicate an increase in symptoms of depression and anxiety in a number of countries. Frontline health-care workers, faced with heavy workloads and risk of infection, are particularly affected. During the pandemic, in China, health-care workers have reported high rates of depression (50%), anxiety (45%), and insomnia (34%) and in Canada, 47% of health-care workers have reported a need for psychological support.
Children and adolescents are also at risk. Parents in 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.
Other groups that are at particular risk are women, particularly those who are juggling homeschooling, working from home and household tasks, older persons and people with already existing mental health problems. It is critical that people living with mental health problems have continued access to treatment. For example, in Madrid, when more than 60% of mental health beds were converted to care for people with COVID-19, where possible, people with severe conditions were moved to private clinics to ensure continuity of care.
A study carried out with young people with a history of mental health needs living in the United Kingdom reports that 32% of them agreed that the pandemic had made their mental health much worse. An increase in alcohol consumption is another area of concern for mental health experts. Statistics from Canada report that 20% of 15-49 year-olds have increased their alcohol consumption during the pandemic.
The COVID-19 pandemic highlights mental health crisis
We all have times when we feel down or stressed or frightened. Most of the time those feelings pass, but sometimes they develop into a more serious problem and that could happen to any one of us. Fear and stress are normal responses to perceived or real threats, and at times when we are facing uncertainty or the unknown. Underinvestment in addressing people’s mental health needs have been exposed by the COVID-19 pandemic. The COVID-19 pandemic is highlighting the need to urgently increase investment in services for mental health and raise awareness of importance of mental health.
People with mental illnesses who live in places such as mental hospitals, nursing homes, social care homes, correctional facilities and other institutions are at risk, as these places become more unsafe and provide less protection against contracting the virus. They are at higher risk as many are on medication requiring monitoring and may already be suffering from other physical conditions. Another group that is of concern would be the socially disadvantaged in the broader sense. I have heard from individuals suffering due to a lack of access to food saying that they will die from hunger before they die from the virus.
The global burden of disease associated with mental disorders is increasing and mental health issues affect billions of people across the globe, touching every community and almost every family
Studies show that half of those who will develop mental health disorders show symptoms by age 14. "If only" is a phrase we hear too often in mental health. If only we knew what was going on. If only they knew they weren’t alone. If only we had recognized the signs. If only we had access to treatment. If only. Unfortunately, the conversation tends to be short and after tragedy has already struck.
World’s population has reached 7.5 billion and the number is growing by 1.18 % per year, or additional 83 million people annually. Approximately 450 million people suffer from mental and behavioural disorders worldwide and 1 in 4 will develop one or more of these disorders during their lifetime according to estimates of World Health Organisation. Mental and behavioural disorders are not exclusive to any special group: they are found in people of all regions, all countries and all societies. Mental and behavioural disorders are present about 10% of the adult population worldwide. Evidence shows the issue is worsening.
Mental health problems range from the worries we all experience as part of everyday life to serious long-term conditions. Anxiety and depression are the most common problems. The majority of people who experience mental health problems can get over them or learn to live with them, especially if they get help early on.
Mental disorders comprise a broad range of problems with different symptoms. Most mental health symptoms have traditionally been divided into groups called either 'neurotic' or 'psychotic' symptoms.
'Neurotic' covers those symptoms which can be regarded as severe forms of 'normal' emotional experiences such as depression, anxiety or panic. Conditions formerly referred to as 'neuroses' are now more frequently called 'common mental health problems.' Less common are 'psychotic' symptoms, which interfere with a person’s perception of reality, and may include hallucinations such as seeing, hearing, smelling or feeling things that no one else can. Mental health problems affect the way you think, feel and behave. They are problems that can be diagnosed by a doctor, not personal weaknesses.
The mental health and wellbeing of whole societies have been severely impacted by this crisis and are priority to be addressed urgently. Nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives. Poor mental health is both a contribution to and a consequence of wider health inequalities. Even though so many people are affected from mental disorders worldwide, there is a strong social stigma attached to mental health problems, and people with mental health problems can experience discrimination in almost all aspects of their lives.
There’s a stigma attached to mental health problems. This means that people feel uncomfortable about them and don’t talk about them much. Many people don’t even feel comfortable talking about their feelings, but it’s healthy to know and say how you’re feeling.
We lose 1 person every 40 seconds by suicide somewhere in the world, according to latest United Nations Health Agency report
Over 800 000 people die by suicide every year. It is the second leading cause of death in 15-29 year olds, behind road injury, according to World Health Agency reports. There are more death from suicide than from war or homicide together.
79 % of suicides globally occur in low- and middle-income countries, however high-income countries have the highest rates of suicide. Incidents are three times higher among men than women in wealthier countries, while these rates are more equal in poorer nations. Addressing causes, the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness. Suicide rates are also high amongst vulnerable groups who experience discrimination. "Experiencing conflict, disaster, violence, abuse or loss and a sense of isolation are strongly associated with suicidal behavior" World Health Organisation outlines in its list of key facts.
Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need. The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it.
There are indications that for each adult who died by suicide there may have been more than 20 others attempting suicide. Every suicide is a tragedy. The impact on families, friends and communities is devastating and far reaching, even long after persons dear to them have taken their own lives. Unfortunately, suicide all too often fails to be prioritized as a major public health problem. Despite an increase in research and knowledge about suicide and its prevention, the taboo and stigma surrounding suicide persist and often people do not seek help or are left alone and if they do seek help, many health systems and services fail to provide timely and effective help. Suicides are preventable. For national responses to be effective, a comprehensive multi sectoral suicide prevention strategy is needed.
How to break mental health stigma?
The health status of each person in any age results from a combination of several factors: genetic characteristics, personal behaviour, socio-economic background and physical environment. The transition from childhood to adulthood is very specific period, thus it is important to have a clear picture of the particular health condition and risks affected by biological, psychological, economic, social and cultural circumstances.
Mental disorders often affect and are affected by other diseases such as cancer, cardiovascular disease and HIV infection/AIDS, and as such require common services and resource mobilization efforts. For example, according to World Health Organisation, there is evidence that depression predisposes people to myocardial infarction and diabetes. Many risk factors such as low socioeconomic status, alcohol use and stress are common to both mental disorders and other diseases.
There are also interrelationships between mental and physical health. For example, cardiovascular disease can lead to depression and vice versa. Mental and physical health can also be related through common risk factors, such as poor housing leading to both poor mental and poor physical health. Major understanding is needed of the relations between different mental disorders, between mental health and physical health, and on the developmental pathways of generic and disease-specific risk factors leading to mental health problems.
Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, living standards, working conditions, and community social supports.
Campaigning for better mental health support and investment is incredibly rewarding, but can be hard at times. Promoting mental health and preventing mental illness, can increase the number of people who enjoy good mental health and reduce, to the greatest extent possible, the number of people whose mental health is poor, who experience the symptoms of mental health problems or illnesses, or who die by suicide. Enhancing factors that are known to help protect people and having a sense of belonging, enjoying good relationships and good physical health and diminishing factors that put them at risk, such as childhood trauma or social isolation, can reduce the onset of some mental health problems and illnesses, reduce symptoms and disability, and support people in their journey of recovery.
7 tips to help you to cope better with life’s ups and downs and boost your mental wellbeing:
• Keep learning – many online learning platforms and universities are offering free access to their services. Learning new skills or language can give you a sense of achievement and a new confidence.
• Have a healthy life style - choose balanced diet, limit alcohol intake. When times are hard, it is tempting to drink more alcohol because it "numbs" painful feelings. Making healthy choices about your diet can make you feel emotionally stronger. You are doing something positive for yourself, which lifts your self esteem. A good diet helps your brain and body work efficiently as well.
• Get enough sleep – It’s no secret that sleep plays an important role in good physical and mental health. Lack of sleep is linked to a number of unfavorable health consequences including heart disease, type 2 diabetes, and depression. 7-8 hours is the average amount of sleep an adult needs for their body and mind to fully rest.
• Be mindful – be more aware of the present moment, including your thoughts and feelings, your body and the world around you. This is awareness called "mindfulness". It can positively change the way you feel about life and how you approach challenges.
• Art Therapy – no matter whether you choose to create it yourself or simply observe and enjoy it – is a relaxing and inspiring activity for many people. However, the particular benefits of artistic expression go much further than relaxation and enjoyment. Studies suggest that art therapy can be very valuable in treating issues such as depression, anxiety, post-traumatic stress disorder and even some phobias. It is a great way to express your emotions without words, process complex feelings and find relief.
• Give to others – even the smallest act can count, whether it's a smile, a thank you or a kind word. Larger acts, such as volunteering at your local community centre, can improve your mental wellbeing and help you build new social networks.
• Animals. Time spent with animals lowers the stress hormone - cortisol, and boosts oxytocin - which stimulates feelings of happiness. A pet can be a great source of comfort and motivation for their owners. In many ways, pets can help to live mentally healthier lives.
To reduce the health, social and economic burdens of mental health, it is essential that countries and regions pay greater attention to prevention and promotion of mental health at the level of policy formulation, legislation, decision-making and resource allocation within the overall health care system.
The distinction between health promotion and prevention lies in their targeted outcomes. Mental health promotion aims to promote positive mental health by increasing psychological well-being, competence and resilience, and by creating supporting living conditions and environments. Mental disorder prevention has as its target the reduction of symptoms and ultimately of mental disorders. It uses mental health promotion strategies as one of the means to achieve these goals. Mental health promotion when aiming to enhance positive mental health in the community may also have the secondary outcome of decreasing the incidence of mental disorders. Positive mental health serves as a powerful protective factor against mental illness. However, mental disorders and positive mental health cannot be described as the different ends of a linear scale, but rather as two overlapping and interrelated components of a single concept of mental health.
Addressing mental health as everyday issues will contribute to achieving broader goals such as increasing employability, improving physical health, helping people to do better in school and work, and reducing crime and community and overcoming personal insecurities, isolation and marginalization. It is a journey that won’t be easy.
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Publication author: Sintija Bernava
Chairwoman of the Board, Non Governmental Organisation "Donum Animus" (Latvia)
"Donum Animus" is the only Non Governmental Organisation from Latvia holding Special Consultative Status of the Economic and Social Council of the United Nations
Program Director "Creative Workshops" at the Children’s Central University Hospital of Latvia
Please find full article with photos at EUNetwork.lv.
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