We face a post Covid-19 tsunami of men­tal ill­ness

Re­cov­ery will re­quire that we re­store the so­cioe­co­nomic driv­ers of good men­tal health

The Irish Times - - Opinion & Analysis - Tony Bates is ad­junct pro­fes­sor of psy­chol­ogy at UCD Tony Bates

We’ve been through a lot. Grief, So­cial iso­la­tion, dis­rup­tion, and un­cer­tainty have up­turned all our lives. Only now, as we be­gin to feel safe, can we ac­knowl­edge the ef­fects of the pan­demic on our col­lec­tive men­tal health.

Based on re­ports world­wide, one thing is sure: there will be a sig­nif­i­cant in­crease in emo­tional dis­tress as a re­sult of Covid-19. Tra­di­tion­ally, one in five of the pop­u­la­tion ex­pe­ri­ence men­tal health chal­lenges. In the com­ing year there will be many more.

Pre­vi­ous re­search on the psy­cho­log­i­cal im­pact of nat­u­ral and hu­man dis­as­ters help us an­tic­i­pate what may hap­pen as we come out of lock­down. A fol­low-up study on the emo­tional im­pact of the Sars [se­vere acute res­pi­ra­tory syn­drome] epi­demic found that one-third of those who con­tracted the dis­ease sur­vived the cri­sis and did well. This find­ing – repli­cated many times in stud­ies of ma­jor dis­as­ters – re­minds us that there is a re­silience within all of us that needs to be tapped.

An­other third of the pop­u­la­tion didn’t do well. Much has been writ­ten and spo­ken about this group. Peo­ple with­out work, with­out homes and with­out a voice. Fam­i­lies un­der chronic stress with few re­sources, sin­gle iso­lated par­ents, mi­nori­ties, peo­ple liv­ing with en­dur­ing men­tal ill­ness, dis­abil­ity, or ad­dic­tion. But the ideal sup­port they re­quire is rarely achieved.

Ser­vices in our so­cial and health­care sys­tems should be pre­pared for the tsunami of need which will emerge from within this pre­vi­ously at-risk group.

The fi­nal third of the pop­u­la­tion is made up of peo­ple we can de­scribe as the new at-risk. These in­clude chil­dren, young peo­ple, adults and older peo­ple whose lives have been dis­rupted by eco­nomic and so­cial up­heaval.

Their dis­tress may be im­me­di­ately ap­par­ent or de­layed. About half of this group will show signs of acute dis­tress as we exit lock­down, but make a steady re­cov­ery over the next 12-18 months. In­ter­est­ingly, the other half will present as fine ini­tially, but ex­pe­ri­ence a de­layed re­ac­tion and de­cline over the same time pe­riod.

Nor­mal ac­tiv­i­ties

Many chil­dren and young peo­ple strug­gled with lock­down. They’ve missed the se­cu­rity that school, friends and nor­mal ac­tiv­i­ties gave them. Manag­ing their lives on­line and meet­ing study de­mands has been im­pos­si­ble for some. Sleep hasn’t come eas­ily as they’ve wor­ried about their fu­tures. They’ve had to ne­go­ti­ate tran­si­tions in or out of school and col­lege that are stress­ful mile­stones at the best of times, but much more so now. Their men­tal health is­sues may be hid­den but they could sur­face when they re­turn to the se­cu­rity of rou­tines and rit­u­als. Teach­ers will wit­ness stu­dent dis­tress and will need sup­port as to how to re­spond ap­pro­pri­ately and re­fer if nec­es­sary.

Fam­i­lies are reel­ing from the im­pact of job losses and re­duced in­come. Some have yet to face the full im­pli­ca­tions of un­em­ploy­ment and lim­ited em­ploy­ment op­por­tu­ni­ties. Job loss is hard for ev­ery­one but par­tic­u­larly those whose iden­tity and self-es­teem is closely linked to hav­ing gain­ful em­ploy­ment and sup­port­ing their fam­ily. Re­sult­ing anger and frus­tra­tion may lead to sub­stance abuse, re­la­tion­ship prob­lems, di­vorce, do­mes­tic vi­o­lence, self-harm or sui­cide.

Peo­ple in the new at-risk group may be less re­silient that the pre­vi­ously at-risk group. They have no play­book for deal­ing with the cor­ro­sive stress that loss of in­come, loss of iden­tity, and shat­tered con­fi­dence brings. Be­ing strangers to the emo­tional ter­ri­tory they now find them­selves in, they may feel em­bar­rassed about seek­ing help and end up suf­fer­ing in si­lence.

Covid-19 has re­minded us that men­tal health is not solely an in­di­vid­ual mat­ter. It is shaped by re­la­tion­ships and liveli­hoods

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Teach­ers will wit­ness stu­dent dis­tress and they will need sup­port as to how to re­spond ap­pro­pri­ately

that en­able us to be­long and con­trib­ute to com­mu­nity. Re­cov­ery will re­quire that we re­store the so­cioe­co­nomic driv­ers of good men­tal health (food, shel­ter, ad­e­quate in­come, so­cial con­nec­tion), em­power lo­cal com­mu­ni­ties to sup­port vul­ner­a­ble in­di­vid­u­als and fam­i­lies, and en­cour­age each of us to recog­nise our own dis­tress and take re­spon­si­bil­ity for our men­tal health.

Bo­nanno iden­ti­fied three fac­tors that help when we are af­fected by po­ten­tially trau­matic events:

1. Peo­ple need to be lis­tened to so that they can ac­cept their emo­tional re­ac­tions to what has hap­pened as valid. Know­ing and trust­ing our­selves is key to re­silience;

2. Peo­ple need to face their wor­ries, as­sess them re­al­is­ti­cally and fo­cus on what they can do, rather than worry about what might hap­pen;

3. Peo­ple need to know who and where they can turn to for sup­port, and have that step made as easy as pos­si­ble.

Covid-19 has shaken us up but it has also opened our eyes. We are kinder, more aware of how frag­ile we are, clearer about our val­ues and ap­pre­cia­tive of peo­ple whose ser­vices we pre­vi­ously took for granted. As well as deal­ing with the stresses this pan­demic has brought into our lives, can we also hold on to and nour­ish the in­sights we learned dur­ing lock­down about how we want to live?

PHO­TO­GRAPH: NICK BRAD­SHAW

Tra­di­tion­ally, one in five of the pop­u­la­tion ex­pe­ri­ence men­tal health chal­lenges. In the com­ing year there will be many more.

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