OPINION
With all the anxiety, isolation and job losses it has inflicted upon us, the Covid-19 pandemic is understandably taking its toll on the nation’s mental health. So it is no surprise that I am already seeing the direct effects of this in my work as a psychiatrist.
Whilst I have been on call for my hospital, people have attended the emergency department with severe anxiety about catching the virus or fearing that this disaster may lead to the collapse of civilised society.
Fear and uncertainty are a breeding ground for anxiety and Covid-19 has provided plenty of both. The infectious process of pandemics is in fact mirrored in the psychology of the affected populations, so just like Covid-19 infects the body and is spread from person to person, anxiety can work its way in to your mind and be spread to others, then disseminated at scale by the media.
The pressures of being in lockdown are also having a grave impact. Many are struggling to cope with the feelings of isolation or being trapped at home, especially those with particularly negative thought patterns whose .
Many are struggling to cope with the feelings of isolation or being trapped at home, especially those with particularly negative thought patterns whose inner critics are relentlessly attacking their self-esteem.
The job losses caused by the lockdown is yet another stressor, with people coming in feeling suicidal after their businesses have closed down. Sadly the full economic impact of the pandemic is still to come. Experts predict a worse outcome than the global financial crash of 2007 and studies have estimated there were after that catastrophe.
Symptoms of mental illness are often influenced by the socio-cultural context, so coronavirus is also featuring in the delusions of those with psychotic disorders. For those with social anxiety and obsessive compulsive disorder who have made progress in overcoming their symptoms, all this handwashing and social isolation could lead to real setbacks.
In the mental health department where I work, we are rallying together to address all this; changing the way we work to continue caring for our patients whilst trying to protect them and our staff from the virus.
One priority is moving our practice to telehealth. In my community mental health team we are reviewing most patients by telephone or video conference, seeing them face to face only when necessary. There is still much to be done - many of our patients do not have the equipment or skills to use videoconferencing and we have yet to implement telehealth on the wards, but we are making rapid progress through sheer necessity.
In my community mental health team we are reviewing most patients by telephone or video conference, seeing them face to face only when necessary.
Another consideration is the possibility of our colleagues falling ill with the virus. By continuing to work we are exposing ourselves to the risk of infection particularly since protective equipment is scarce, which can be anxiety-provoking. As well as the obvious concern of a colleague getting infected, staff members who have been in contact with them may have to self-isolate which could debilitate our service. So where possible, we are splitting into teams that have no contact with each other to avoid cross-contamination. If one team has to self-isolate, the other will have to cover.
Whilst making these changes we are, to some extent, also bracing ourselves for a potential mental illness pandemic. After previous similar outbreaks like SARS there was an increase in mental health issues in those affected, including after quarantine.
Despite all this, morale in the mental health department is high. We are all feeling a strong sense of purpose by virtue of the fact that we are helping in the fight against Covid-19. Altruism is a recognised ‘defence mechanism’ – an unconscious way of dealing with challenging situations, and one that healthcare professionals often call upon in times of stress. Helping others is also known to improve and maintain mental health in general, so if you can also do something to help those around you in this difficult time you will be helping yourself as well as them.
We are all feeling a strong sense of purpose by virtue of the fact that we are helping in the fight against Covid-19.
According to the ‘stress - vulnerability’ theory of mental illness, the stress it takes to trigger an episode in someone depends on how vulnerable they are. So more people will become mentally unwell during this extremely stressful time and those with existing mental illnesses are at particular risk. So the more you can do to look after your own mental health, the less likely it is that services will be overwhelmed. In the spirit of altruism - you will be helping us mental health professionals out too.
Kamran Ahmed is a psychiatrist and writer. Follow him on Twitter @DocKamran
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