This week, the world celebrates Mental Health Awareness Week and, amid the global pandemic of COVID-19, it means that individuals with pre-existing mental health conditions such as anxiety, mood and substance abuse disorders are likely to have their symptoms worsen on account of the pandemic.
Since the outbreak of the pandemic, national lockdowns and physical distancing preventive measures directed across the world, coupled with the multiple uncertainties confronting people, have spurred an observed increase in addictive coping strategies, such as the abuse of alcohol, drugs, tobacco, and online gaming. According to the United Nations, “Many people who previously coped well are now less able to cope because of the multiple stressors generated by the pandemic.”
In Canada, there have been reports that 20 per cent of the population aged 15 to 49 have increased their alcohol consumption during the pandemic, and the UN Women, early on in the pandemic, highlighted heightened cases of physical and mental risk experienced by women and children as a result of increased domestic violence and abuse. To mitigate acts of violence such as these, several Southern African countries, including Botswana, Lesotho, Madagascar, Malawi, Namibia, South Africa, Zambia and Zimbabwe, have in addition to other preventive measures, resorted to placing restrictions on the sale of alcohol during the pandemic.
The uncertainties surrounding the widely spreading infection include but are not limited to fears of infection, fears of death and fears of losing loved ones. Coupled to these, for millions around the world, there are additional fears over sustenance and survival, as many have lost their means of livelihood following the pandemic and preventive measures implemented to curb its spread.
At the same time, widely spreading misinformation about the virus and prevention measures, conspiracy theories, in addition to uncertainties about the future, are major sources of distress, while prospects of losing loved ones without having a chance to say goodbye or hold funerals for them are other sources of angst. Global reports appear to show that no continent is spared, with details of high levels of psychological distress from China, United States, Iran and Ethiopia emerging.
According to Matshidiso Moeti, the World Health Organisation (WHO) regional director for Africa, about 50 per cent of people with depression do not receive treatment, and barriers such as lack of information, stigma and cultural issues prevent many people from seeking help for psychological disturbances. The relationship between escalating mental health disorders and infectious diseases is not new, and previous research has shown parallels between the mental health impact of COVID-19 and what was observed during the 2014 to 2016 outbreak of Ebola in West Africa, where it was reported that up to half of individuals infected with Ebola experienced fear, depression, post-traumatic stress disorder (PTSD) and stigmatisation in their communities.
With COVID-19 preventive measures such as lockdowns, physical distancing, and social isolation, it is little wonder that there have been reports of widespread loneliness worldwide. Health insurance data released in January reported that about 60 per cent of American adults felt some degree of loneliness and this was even before the pandemic hit, and, from adults to teenagers, the number of those who have admitted to feelings of increased loneliness has substantially increased since COVID-19.
Research has shown that quarantines lasting 10 days or more increase the risk of PTSD afterwards and, additionally, research following the SARS epidemic revealed that quarantined healthcare workers were significantly more likely to experience alcohol or substance abuse than the general population and global reports of suicides among frontline health workers hint at the looming mental health crisis.
The WHO, together with its partners, has since the declaration of a pandemic of COVID-19 regularly provided guidance on mental and psychological healthcare for health workers, people in isolation and the general public. While it is reassuring that these guidelines are included in the management of infected individuals in many treatment centres, including in Nigeria, the road to mental health and wellbeing during this pandemic and whenever it ends will be a long and arduous one. So, several steps will need to be taken to protect the health and wellbeing of Nigerians, going forward.
First, mental health needs to be properly integrated into primary healthcare, with increased distribution of trained health workers, coordinated care, and systems for referral when more specialist care is required and should also be considered a healthcare priority for national and state governments. According to the WHO, the treatment gap for severe mental disorders in low and middle-income countries can be as huge as 75 per cent. In Nigeria, as is common in many sub-Saharan African countries, there is a large inadequacy of mental health specialist services. Nigeria has approximately one psychiatrist to every one million people, the majority of whom work in a few urban centres, leaving the vast majority of the country’s communities with no specialist service. A recent study in several countries (including Nigeria) revealed that only about 20 per cent of persons with common but serious mental disorders (such as depression with suicidal risk) had received any treatment in the previous one year, with only 10 per cent receiving minimally adequate treatment. Widespread provision of mental health care services at the primary care level will help close this gap.
Secondly, because of widespread stigmatisation of mental disorders, people with emotional, psychological and mental challenges tend to avoid seeking help even when these facilities are available. This same stigmatisation has affected self-reporting to Nigeria Centre for Disease Control (NCDC) by individuals at risk of infection with COVID-19. Tackling stigma of mental health and infectious diseases will rely on widespread and targeted enlightenment messages in communities through primary care clinics, meetings with community opinion leaders and the enhanced use of technology.
Third, the COVID-19 pandemic has highlighted the benefits of information and communication technology, as maintaining social connections via voice calls, video calls and instant messaging, education through online learning platforms and providing healthcare via telemedicine are just some of the myriad possibilities of technology. Across Africa, less than one-third of the population have access to broadband connectivity, and achieving universal, affordable, and good quality Internet access will require huge investments to provide regular access to power and achieve increased connectivity on the continent. This will require governments to provide an enabling environment for private sector investment, support from development partners, and active engagement of civil society to successfully achieve steady and reliable power and Internet connectivity across socio-economic divides.
Lastly, the importance of self-care cannot be over-emphasised. Individuals must take protective actions such as limiting the amount of news consumed, being careful of news sources and taking regular breaks from social media in the relentless COVID-19 news cycle. Staying virtually socially connected to family and friends, keeping physically active and healthy, getting sunlight, and establishing a routine with regular sleep schedules greatly aid mental wellbeing. Now, more than ever, is the time to not only maintain positivity but to also remember to be kind to oneself and to others.
In the words of Aristotle Onassis, “It is in our darkest moments we must focus and see the light.” COVID-19 has set upon the world one of its darkest moments in history. Let us focus, see the light and work together to curb the rise and spread of a mental health crisis of unprecedented proportions.
•Dr. Oreh is a family physician and public health expert based in Abuja. She is also a Senior Aspen New Voices Fellow with the Aspen Institute in Washington, D.C.