Psychological issues related to COVID-19 outbreak will contribute to global mental health crisis

Remote psychological support services are struggling to manage COVID-19 fear and stress, as experts warn a mental illness pandemic is on its way.

In places with histories of epidemics, such as Africa, psychological issues that commonly results from disease outbreaks are re-emerging. This will contribute to a global mental health crisis, scientists warn.

There are parallels between the mental health impact of COVID-19 and what was seen during African Ebola outbreaks, says Yuval Neria, a professor of medical psychology at Columbia University.

His research looked at the 2014-2016 Ebola outbreak in West Africa, which was the largest, longest and deadliest since Ebola was discovered.

"Those at the forefront are fighting the virus itself. That doesn't leave capacity to give comfort and counselling that should be a prerequisite," he says.

"Nearly 50 per cent of families, survivors and those who had contact with survivors of Ebola had PTSD and depression."

A recent survey in Uruguay found that people there feel three times sadder, almost four times more worried and 20 per cent more lonely than at the same time last year. The percentage of people who said they were stressed went from 26 to 46 per cent, with a corresponding drop in reports of feeling tranquil.

These data are particularly concerning for regions with shortages of skilled caregivers. Africa has just 1.4 mental health workers per 100,000 people, compared with a global average of nine workers.

There is a deep-seeded misunderstanding of the unknown that we are currently experiencing, and that's driving a stigma attached to COVID-19, People do not identify themselves as being at risk of COVID-19 or possible sources of contact because of the stigma from others in their communities."

Lochandra Naidoo, President of the South African Federation for Mental Health

Stigma and fear

Ncebakazi Willie, a 27-year-old survivor of COVID-19 in a rural community in the Eastern Cape of South Africa, tells SciDev.Net: "I was having an emotional break down, and it affected me and my family. People started calling my son 'corona kid' and they called my house 'corona house'."

Willie says she felt anxious and became afraid from the moment she was tested for COVID-19, feelings that continued throughout her positive test results and a 14-day isolation period.

"I was scared because people are dying from this. It's a deadly disease," she says. The feelings intensified when she received death threats.

"People wrote on social media that they were planning to kill me. I also got anonymous phone calls from someone saying they were planning to kill me in the hospital so that I wouldn't come back to the community," she says.

Remote therapies bring help closer

In Africa, at least 50 per cent of people with depression do not receive treatment and a lack of information, stigma and cultural issues are significant barriers to people seeking help, says Matshidiso Moeti, World Health Organization regional director for Africa.

But, online and phone-based therapies are being established across the developing world to plug the gaps in health systems and provide support to those struggling with their mental health.

Substance abuse and gambling support groups, as well as regular counselling services are offering psychological support via phone, email and video conferencing tools.

The Argentine Psychoanalytic Association created a free helpline for referrals to counsellors. In Latin America, calls to domestic violence hotlines have increased up to 70 per cent, leading some services, such as those in Brazil, to expand online.

The Costa Rican Social Security Fund began a pilot plan for virtual visitsby relatives to hospitalised patients, using tablets and phone calls, to improve patients' moods and health.

In Argentina support is also being offered to another group vulnerable to psychological stress — frontline health workers.The Ministry of Health has set up a telemedicine system for workers who are distressed or need support.

Ongoing consequences of COVID-19 crisis

"Pandemics like these are not just medical phenomena;they also affect everyone's quality of life, causing social dysfunction," says Debanjan Banerjee, a psychiatrist at the India's National Institute of Mental Health and Neuroscience, in a letter to theAsian Journal of Psychiatry.

Biologist Bettina Tassino, from Uruguay's University of the Republic, tells SciDev.Netpeople are experiencing disrupted sleep as body clocks are altered from spending more time inside.

"Being indoors leads us to be less exposed to natural light during the day and this has consequences for the secretion of melatonin [the hormone that helps regulate the sleep cycle] at night," she says. "Where every day and hour seem the same, we function uncoupled from the environmental keys that adjust circadian rhythms."

Mental health practitioners agree the world is facing a desperate psychological situation.

Saths Cooper, president of the Pan-African Psychology Union, attributes the lack of attention to mental health issues in Africa to ailing health systems, which will compound pandemic-driven restrictions such as social distancing and isolation.

"A second pandemic of mental health problems related to COVID-19 is coming and we are not ready," says Neria.