As the coronavirus pandemic rapidly sweeps across the world, it is inducing a considerable degree of fear, worry and concern in the population at large and among certain groups in particular, such as older adults, care providers and people with underlying health conditions. In public mental health terms, the main psychological impact to date is elevated rates of stress or anxiety. But as new measures and impacts are introduced – especially quarantine and its effects on many people’s usual activities, routines or livelihoods – levels of loneliness, depression, harmful alcohol and drug use, and self-harm or suicidal behaviour are also expected to rise.
In populations already heavily affected, issues of service access and continuity for people with developing or existing mental health conditions are also now a major concern, along with the mental health and well-being of frontline workers. As a result of the COVID-19 pandemic, it appears likely that there will be substantial increases in anxiety and depression, substance use and abuse, loneliness, and domestic violence; and with schools closed, there is a very real possibility of an epidemic of child abuse. However, according to experts, a few steps, taken now, can help us proactively prepare for the inevitable increase in mental health conditions and associated sequelae (a pathological condition resulting from a prior disease, injury, or attack) that are the consequences of this pandemic. First, it is necessary to plan for the inevitability of loneliness and its sequelae as populations physically and socially isolate and to develop ways to intervene. The use of digital technologies can bridge social distance, even while physical distancing measures are in place. Normal structures where people congregate, whether places of worship, or gyms, and yoga studios, can conduct online activities on a schedule similar to what was in place prior to social distancing. Particularly relevant here is the developing and implementing routines, particularly for children who are out of school, ensuring that they have access to regular programmed work. Online substitutes for daily routines, as mentioned above, can be extremely helpful, but not all children have access to technologies that enable remote connectivity. Needed are approaches for ensuring structure, continuity of learning, and socialization to mitigate the effect of short- and long-term sheltering in place.
Second, it is critical that we have in place mechanisms for surveillance, reporting, and intervention, particularly, when it comes to domestic violence and child abuse. Individuals at risk for abuse may have limited opportunities to report or seek help when shelter-in-place requirements demand prolonged cohabitation at home and limit travel outside of the home. Systems will need to balance the need for social distancing with the availability of safe places to be for people who are at risk, and social services systems will need to be creative in their approaches to following up on reports of problems.
Third, it is time to bolster our mental health system in preparation for the inevitable challenges precipitated by the COVID-19 pandemic. Stepped care, the practice of delivering the most effective, least resource-heavy treatment to patients in need, and then stepping up to more resource-heavy treatment based on patients’ needs, is a useful approach. This will require that systems are both well designed and well prepared to deliver this care to patients, from screening to the overflow of mental illness that will inevitably emerge from this pandemic.
Even small signs that someone cares could make a difference in the early stages of social isolation. And health systems, both public and private sector, will need to develop mechanisms for refill and delivery of essential medicines, including psychiatric medicines. A concerted effort will be vital in establishing a new and better system which can adapt and scale up as and when required. Understanding, cooperation and empathy can win this battle.
