Mental Health In The Age Of Coronavirus

The Covid-19 crisis has not just disrupted lifestyles and work patterns. It has also shaken the emotional balance and wellbeing of many people, including school-going children. As a result of measures put in place to contain the virus, including social distancing, self-isolation and restricted travel, more people face the prospect of mental health issues worsened by widespread loss of livelihoods.

The Africa Sustainability Matters caught up with two clinical psychologists, Gathoni Mbugua and Adrian Adagi, to shed light on this timely topic. They are practitioners at Nairobi-based Chiromo Lane Medical Centre (CLMC). Below are the excerpts:

What effects could this pandemic have on people’s mental health, parents, children, employees, employers and businesses operators as well as leaders? How can they cope and avoid excessive tension and anxiety?

I will narrow myself down to areas/systems most affected. First, we have the education system, schools are closed.

Circumstances have now forced us to embrace e-learning. Personally, as a parent it’s not easy. Bear in mind that some parents still have to go to work, so how are you going to leave your child with a computer to go through classwork on their own? And that’s not even the worst case scenario; how many children have access to computers, tablets and even the internet in the first place?

So what we’re going to see is a lag in academic progression. Schoolwork has been the first victim, causing a lot of anxiety within the home set-up. Notice that children only work best when they have structures in place, when their impressionable minds are engaged in a productive way. Lately, they have become anxious and I have received a lot of reports involving regression in behaviour among minors. Previously obedient kids who would help around with house chores are now slacking, throwing tantrums.  Some are even back to urinating in bed and being clingy to their parents.

Basically, what this communicates is that this child is looking for attention due to anxiety that they cannot express. And this is something new to parents to handle.

Next, financial uncertainty has become a big stressor in the family system. How are breadwinners expected to provide for their family yet many people are out of work?  People are being forced to go on mandatory unpaid leaves, while others have lost their jobs. Most people live hand to mouth, in rented houses. To make it worse, we don’t even have a time structure, like by June or July the pandemic will be over.  Not knowing what’s going to happen is causing a lot of anxiety within the family set-up and affecting the emotional wellbeing of parents.

Also, the health sector has been greatly affected. With the dusk to dawn curfew in place, what happens when someone falls sick at night and they urgently need medication? Most affected of all are pregnant women and newborn babies.

For people with obsessive compulsive disorder (OCD), who may already have extreme fear of germs, how are the frequent campaigns to wash hands and avoid contamination likely to affect them as a result of coronavirus?

Being afraid of germs is one aspect of OCD; there are many different other manifestations. But an increase in paranoia is likely to happen among these people because they were already excessively conscious of germs even before this pandemic happened.

This crisis is certainly going to increase their anxiety. With the repetitive messaging on hygiene measures like hand-washing, this is likely to cause more dysfunctionality to such an individual.

Besides, there are people without OCD, but who are going to develop that kind of behaviour after the pandemic is over, always wanting to wash their hands and reacting in a certain way when someone sneezes around them.

This is something that should be brought to such an individual’s attention for them to start self-evaluation – is this getting in my way of functionality, for instance? If you can’t be in a space of more than four people because you are afraid you are going to get germs or you are afraid of even greeting people or touching door knobs, then we can say that this is affecting this person’s functionality. And maybe they may need therapy to help them cope before it becomes a mental illness.

How has the Covid-19 threat affected your hospital operations?

Patients are having a challenge accessing medication. With the curfew in place and restrictions of movements in and out of Nairobi, it has become difficult for someone outside the city to access specialised care in Nairobi.

So we have to write letters for some of the patients to enable them come over and refill medications. This has affected the dosage dispensed. The dosage is usually issued to cover a maximum of 30 days but that has dropped to a three week cover. Due to the curfew limitations, we can’t comprehensively ascertain the state of that individual and you don’t want to send them home with a lot of medication. Traditionally, we are used to face-to-face consultations and now due to the social distancing, we have to rely almost entirely on e-therapy and consultations.

Speaking of e-therapy sessions, is it something new?

We actually serve East and Central Africa, not just Kenya, so we haven’t started the e-therapy now. We have been using Skype to serve our patients across the region, be it Tanzania or Rwanda especially for checkups after they have been discharged. However, it’s true that we have only now gone full-throttle with e-therapy and are training more psychologists to use it.

How has the feedback been so far?

The feedback is encouragingly good; the Zoom video calls are cutting down on travel costs no matter the distance.

Interestingly, we have noted people are more willing to open up to us when they are far away than being around. I don’t know why. Maybe they feel like it’s less judgmental.

On the flip side, some patients have been on long term treatment with their psychiatrists and for them, the shift is a bit tricky in regards to having to change how they will be communicating with their therapists. Previously, they were used to face to face sessions, but now they have to rely on telepsychiatry.  Additionally, people who are much older are also having a challenge compared to the younger generation because they are not as tech-savvy.

Have you introduced new fees?

With regard to fees, nothing has changed for our patients, including those under NHIF and any other insurance covers.

How best can people then cope?

To begin with, we have to take care of ourselves and stay safe. As much as some may think that indulging in junk food and drinks is a form of self-care, it’s not. Take care of your body, do some exercise. And it doesn’t have to be anything extreme, exercising for just a couple of minutes can do. Also, watch what you eat because it affects your mental health. Get information from the right sources such as World Health Organisation (WHO) to help ease anxiety. Be mindful of yourself and notice if anything is changing within your mental health. Perhaps lately you are not sleeping well, and you may be experiencing emotional outbursts or finding yourself zoning out a lot. Those are some of the things that you should watch out for and they should be able to raise the red flag. Self-assessment will help you know if something is amiss with your mental health and then you can seek help where necessary.

How can the government help reduce people’s anguish during this crisis?

I think the government is doing quite a good job but there’s definitely room for improvement like being more transparent and having targeted communication. How the message is delivered is key to helping reduce anxiety among people during such situations.

Also, the government seriously needs to consider how the mental health and emotional wellbeing of Kenyans is going to be affected after all this. This is a load that people are going to carry even in December. It’s going to take a lot of our energy both physically and mentally to actually even get back on track financially, education-wise, relationships. The government should provide toll-free lines for people to actually get mental health assistance.

Following your online panel discussion on the impact of Covid 19 in Africa covering different countries across Africa, what were some of the common challenges brought up?

There is definitely the issue of anxiety surrounding not just Africa but the entire world. There is also a lot of government distrust in Africa given our past. Also, there is a rise in domestic violence; people are being locked up with people who are not safe to be with. Also, social isolation, for some people this is a tough time for them, and is causing a lot of damage to their mental health. And then there’s the issue of financial strain. We can overcome these challenges in different ways, definitely for the anxiety we can get our information from the right sources, checking on ourselves and having a growth mindset to address anxiety. As for the government, the distrust has been there for several years but with improved responses and social safety nets, I believe they can re-earn people’s trust. For domestic violence, there are various hotlines that people can reach out too for help. I have also noticed that on Facebook and other social media platforms, some people have put up coded messages where you can send messages to them, it looks totally harmless but when the receiver reads that message that the person is in danger they are able to alert the authorities.

On social isolation, it’s really tough right now because some people thrive on physical connection and being around others. To this end, let’s use what we have and what we can – technology and digital platforms to stay connected with each other, albeit virtually. Call someone, video call them, play online games. Finally on the financial front, it’s very tough for people. To this end, it helps to prudently use the little that we have, limiting our spending on essentials. We have to cut out extra costs just to keep afloat because we are not entirely sure how the economy will look like in the coming days, weeks, months.

Apart from actively sharing mental health tips around covid-19 on your social media platforms, are there other ways you are helping people to cope?

We also use our social media platforms to offer referrals to organisations that are offering relief food to those in need, mostly churches like CITAM and Parklands Baptist church.

The pyschologists can be reached via 0786 265143 or info@clmc.co.ke

Read also: There Is No Health Without Mental Health

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