It's no secret that I take on paid-for writing work. Like all gigs for clients, sometimes one hits the mark and sometimes one doesn't. One job involved looking at the impact of the pandemic on people's mental health. I admit to having found myself in a rather deep rabit hole. A function, I suspect, of what was going on at home and close to home.
My convoluted covid musings
When South Africa went into lockdown, I wrote a series of posts about the situation. For most, I tracked the numbers and drew on what was known - then - about the virus. For those who've not read them, and who might be interested in a retrospective, here is the full list. Some are rants, some are humorous; as I look at the list, they reflect the rollercoaster of lockdown emotions. From angry ravings (probably not entirely rational) to mildly hysterical humour. It did occur to me to review and edit them, but I decided not to.
7 April 2020: Lockdown survivors' guide
8 April 2020: Bullies: Virtual hiding in plain sight
11 April 2020: A re-imagining: life after this Corona
16 April 2020: Countering Covid-19: South Africa 21 days in
1 May 2020: Balancing Act or Slippery Slope?
14 May 2020 - I'm tired...
4 June 2020 - Common sense: Not so common
29 July 2020 - Beleagured and Confused
The impact of the pandemic on mental health and people with mental illness
Regular readers will know that someone in our friendship circle committed suicide about a month ago. He was bipolar and it was his third attempt. Lockdown and a system failure had a role to play. After the first attempt, he spent a week or so in hospital and was seeing a psychologist. He was discharged - because of Covid. The therapy ended. Because the local public hospital was not geared for teletherapy.
The second attempt was so serious that he had to be rushed to a hospital two towns away and where he was put into an induced coma. It was touch and go. Then there were the consequences of organ damage from the poisons he took. He was placed in the psychiatric ward and stayed there for some weeks. Again he was discharged.
The environment was not conducive.He should have gone to a therapeutic ward in Cape Town.
Sorry, there are no beds. He'll have to go home.In addition to his mental illness, the Covid lockdown robbed him of people interaction and work. He was a gifted potter.
The pottery was closed. No tourists to the studio, no commissions, no customers. No reason. For. Anything.
So less than two weeks after he returned from hospital the second time, he did go to his ultimate home.
What the research reveals*
Since March 2020, the discourse in most households, workplaces and social spaces – physical and virtual – has been dominated by COVID-19. That this disease has had an enormous impact on society and medical systems all over the world and the UK, is stating the obvious. It has also taken its toll in other areas of life, including the economy and equally importantly, on the unseen, invisible and often little acknowledged aspect of life: mental health. Some are suggesting that this is a critical time in the history of mental health, with UN Secretary-General António Guterres making exactly that point: "The COVID-19 virus is not only attacking our physical health; it is also increasing psychological suffering: grief at the loss of loved ones, shock at the loss of jobs, isolation and restrictions on movement, difficult family dynamics, uncertainty and fear for the future."1
Lockdown restrictions hamper already stretched mental health services
The British Medical Association (BMA) has long been concerned about the extent to which mental health services are stretched. In its update on the parity of esteem of services in the UK, the association points out that social isolation can result in symptoms of post-traumatic stress, confusion, and anger, with people often resorting to unhealthy coping methods like alcohol and substance abuse. The report goes on to note that the cancellation of standing appointments for medical and health care was not uncommon and that during the enforced stay at home, many patients had been unable to get help at all.2 In the same report, the BMA expresses concern that, generally, people’s lived experience of the pandemic could have necessitated their needing to find help. The report goes on to suggest that some people may develop a mental illness for the first time, including as a consequence of surviving COVID-19 disease, while for others, existing conditions for example, eating disorders, could be exacerbated.3
Staying at Home – not normal life
Common threads are emerging from research into how populations are reacting to the stay-at-home orders or lockdowns. Not, in living memory, have people effectively been imprisoned in their own homes in an attempt curb the rampant spread of a disease. Families have been separated, livelihoods decimated, and people’s lives irrevocably interrupted. In April 2020, the UK Household Longitudinal Study found that levels of mental distress had increased by nearly ten percent, from 18.9% in April 2018 to 27.3% this year, which was directly attributed to the lockdown.4,5 In the same survey, about 60% of people interviewed, said that they were anxious about catching COVID-19 and getting sick. Add to these worries, the impact of job losses and isolation.
Most people tend to think of their lives as ordinary and humdrum, until their they are profoundly disrupted. The protracted period of enforced stay at home has robbed people of half a year’s worth of “ordinary” social interaction: every day, with friends and colleagues in the workplace; visits to and from family and friends; dropping in at the “local”, not to mention birthdays, religious and/or traditional celebrations. Plans have been scuppered – milestone and life events like weddings have been postponed, pared back to the bare minimum, and even cancelled. Lockdown has also cheated people of significant rituals associated with death and dying, as well as of the activities that are essential to rites of passage like finishing school and moving into adulthood.
The loss is more than missing school or university
As a measure for curtailing community transmission of the novel corona virus, by April this year, more than 188 countries had closed schools. The consequences have included truncated academic years, the cancellation of exit and entry examinations. This has affected upward of 1.5 billion learners, many of whom are worried about their futures. Consequently, children and adolescents are living without internet services (their connections to the outside world) and suffering from anxiety, worry, and depression, all of which can lead to long term mental health consequences.
Schools and education institutions are integral to children's (and families’) support systems, and the knock-on effect of closures goes without saying. The negative impact is exacerbated for children and young adults with special needs (like those on the autism spectrum) who, if their treatment regimens and routines are interrupted, can stagnate if not regress. In addition, for those children who are at risk of abuse, going to school provides a safety net and an avenue for help. So, with schools closed, not only are the avenues through which they can seek help, effectively shut off, but they are trapped in a home where they could be in physical and emotional danger.7
The triple PSL whammy: Parenting, Separation and Lockdown
When the pandemic was at its peak – around May 2020 – more than 80 countries had instituted lockdowns of some sort, affecting roughly six out of every ten children in the world. This included closing childcare centres and, coupled with the pressure of either working from home or furlough, families have had to chart new waters, often confined in small spaces. It is well documented, and generally accepted that, proportionately, the burden of childcare and domestic work, falls on mothers. Women generally earn less and are often the first to cut back on work to care for children. The knock-on effect is that women are therefore often the first to lose their jobs, adding economic stress to an already toxic mix. This has also been the case in the pandemic.8
The third, often forgotten element in childcare after the primary caregiver and school, is the important role of the extended family – even when the families are not under one roof. Stay-at-home orders have restricted movement precluding aunts, uncles and grandparents from spending time with nieces, nephews and grandchildren. This social time, seen by some as a nice-to-have, is often an important part of parents’ childcare and support systems – even when childcare centres are functional. This interaction is equally important for the grandparents: the social and mainstream media have been awash with the grief and pain of elderly grandparents who have been prevented from seeing grandchildren for as long as six months, further exacerbating the mental anguish of enforced isolation..
*This was written as part of a commission and for a UK-based audience and which the client chose not to use. It reflects my own experience and what is being reported in other countries.
It's not over
Back in my friendship circle: we have friends who've missed significant milestone events in their and their families' lives, whether it's the first year of a grandchild's life or marking Grandad's milestone birthday. My heart bleeds for young people who cannot live their lives to the full. It occured to me, early in this thing, that I was fortunate at my age and stage in life to have found my life partner. What about the folk who haven't and are looking? It's about biology - and mating is normal human behaviour - with all the ritual and angst that goes with it.
We were at the local on Friday evening and bumped (not literally) into friends who regularly visit the village but hadn't seen for a while. It turns out that she, and their daughter had COVID-19 disease before the first case was recorded in South Africa. She was diagnosed with that "European flu" which they worked out, had travelled from North Italy with one of the daughter's friends after a skiing holiday. H works in the life insurance business. They have seen a 40% increase in claims associated with suicide - among professionals (lawyers, doctors, particularly). And, it would appear, it's a trend. Notwithstanding the country having moved to "level 1 lockdown".
But that's not all
The research also shows that there is physical mental trauma associated with having had, and recovered from, COVID-19 disease. There are lingering effects of long term ICU stays and ongoing fatigue as well as residual cardiac and gut problems among those who might have been severely affected and recovered. The latter, we hear about first hand from a survivor in our friendship circle.
A possible vaccine and sensible social
We are fortunate in the village in that we've not had many cases. That said, we are continuing to be sensible in our social interactions which includes keeping a greater physical distance than before. Yesterday's news of significant progress on a vaccine is cause for hope, but we're not out of the woods. We still have to be vigilant and the aftermath - in terms of our collective mental health - will be with us for some time.
Care, compassion and kindness is what we all deserve.
Hayley will Change the World - despite Covid - thank you
Less than a week ago, I put together a crowdfunding campaign for Hayley. She's heading to New York - either in March or in May. That depends on Covid, but go she shall.
Hayley graduated with a Bachelor in International Affairs from the University of Stellenbosch at the end of 2019.
As she's still writing exams, neither she nor I are working it very hard. Yet. Nevertheless, after the soft launch and having told a little of the back story in this post, funds have started to trickle in. Although there is a long way to go, as Hayley said herself, every little helps.
I want to say a personal thank you to people in my childhood and virtual friendship circles who have contributed to this campaign. You know who you are, and I admit to having shed a quiet tear of gratitude.
Just goes to show: good things happen. Even when the world seems full of ick.
Until next time, be well
The Sandbag House
McGregor, South Africa
Post ScriptI am doing my best to post every day for November as part of @traciyork's twice yearly #HiveBloPoMo challenge. This is my third attempt. All my posts are to the the Hive blockchain, but not all from WordPress. Details about the challenge (on the blockchain) are here and on WordPress, here.
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formal grammar, spelling and punctuation
more information here
- United for Global Mental Health. 2019. Covid 19 And Mental Health — United For Global Mental Health. [online] Available at: <https://www.unitedgmh.org/covid19>.
- British Medical Association. 2020. The Impact Of COVID-19 On Mental Health In England; Supporting Services To Go Beyond Parity Of Esteem. [online] Available at: <https://www.bma.org.uk/media/2776/emb07072020-bma-mental-health-paper.pdf>
- Konstantinovsky, M., 2020. COVID-19-Era Isolation Is Making Dangerous Eating Disorders Worse. [online] Scientific American. Available at: <https://www.scientificamerican.com/article/covid-19-era-isolation-is-making-dangerous-eating-disorders-worse/>
- Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., Kontopantelis, E., Webb, R., Wessely, S., McManus, S. and Abel, K., 2020. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. The Lancet Psychiatry. [online]Available at: <https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30308-4/fulltext>
- Gramigna, J., 2020. Mental Health Has Significantly Worsened In UK After Pandemic Lockdown. [online] Healio.com. Available at: <https://www.healio.com/news/psychiatry/20200723/mental-health-has-significantly-worsened-in-uk-after-pandemic-lockdown>
- Otai, S., 2020. COVID-19 Mental Health Effects On Children And Adolescents. [online] Psychology Today. Available at: <https://www.psychologytoday.com/za/blog/hope-resilience/202005/covid-19-mental-health-effects-children-and-adolescents>
- Gromadai, A., Richardson, D. and Rees, G., 2020. Childcare In A Global Crisis: The Impact Of COVID-19 On Work And Family Life. [online] UNICEF-IRC. Available at: https://www.unicef-irc.org/publications/1109-childcare-in-a-global-crisis-the-impact-of-covid-19-on-work-and-family-life.html
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