World over the mental health effects of the lockdown is being discussed and valuable suggestions being made. Online seminars and training can be accessed by many. The authors here present the reports and evidence of the increased mental trauma during a lockdown of vulnerable communities and suggests the way forward.
THE rise of coronavirus across the globe led to countries introducing methods to curb its physical ramifications. One of the most common modes adopted by nations was mandatory social distancing, lockdowns, closure of educational institutions and offices, public places, etc. The social lives of millions came to a standstill overnight. For instance, in India, on 24th March 2020, at 8 p.m., the Prime Minister announced a complete nationwide lockdown commencing from midnight. This caused a country of 1.3 billion to launch into survival mode and gave them four hours to gird up their loins for a life-altering reality. The imposition of re-defined social norms, although necessary to control the virus, invisibly affects the mental health of the masses.
Pandemic and mental trauma
The physical symptoms of a person affected by a disease, especially COVID-19, reflect within a fortnight. However, the diagnosis of mental trauma caused due to a pandemic may be prolonged. The rise, subsistence and fall of a pandemic directly impact the mental health of those living through it.
According to Mark Henick, a mental health strategist, when a person faces trauma his nervous system has a “peak” and “valley” response. When the trauma due to a pandemic is thriving, a majority of people throw themselves into survival mode, which is extremely taxing on mental health. People are left with limited time to process the trauma and immediately occupy themselves to get through the unwelcomed incident. This is called the peak response. When the trauma ends, people kick into the valley response, which is reflected through post-traumatic stress disorder (PTSD) and behavioural alterations. It causes people to find methods of disassociating themselves with the trauma experienced.
After the pandemic ends, there is a high probability of exposure to residual stress, depression, financial pressures, the uncertainty of the future, and anxiety of re-engaging with the new definition of “normal”. These additional challenges make it difficult for a person to return to the “baseline” (lifestyle existing prior to the trauma), in the absence of professional help. This proposition stood the test during the SARS outbreak in 2003. A study[i] published in the Canadian Journal of Psychiatry reflected that that one year after the outbreak of SARS-2003, survivors had elevated stress levels, and showed worrying levels of depression, anxiety, and post-traumatic symptoms.
The trauma caused due to a pandemic not only adversely impacts the mental health of the individual struggling with it, but also affects his / her immediate social circle. The consequences may include strained inter-personal relations, increase in domestic violence, child abuse, disassociation from existing social groups, and even agoraphobia.
Causes and impact on vulnerable social groups
There cannot be a straightjacket formula to determine whether the mental health of a particular section of society may or may not be adversely impacted due to the outbreak. However, some groups are more vulnerable in comparison to others. For instance, persons with existing mental illnesses would find it more challenging to cope with the pandemic. Similarly, persons who survive the disease may suffer from anxiety of re-entering the society, and the fear of the probable stigma attached to their condition.
Healthcare service personnel and first responders such as police officials, essential service providers, etc. may demonstrate signs of societal withdrawal, increased emotional stress, and depression. Lower-income groups and migrant labourers may suffer from anxiety due to prolonged unemployment, and reduction in means of survival. Persons recovering from alcohol/substance addiction may find mandatory lockdowns to be an additional challenge in their journey towards sobriety.
Excessive exposure to information about the outbreak on social networks, or other media platforms may trigger a person to exhibit irrational behaviour, such as hoarding excessive supplies. Another cause of mental stress is the practice of extreme social distancing instead of physical distancing, which leads to people isolating themselves due to the fear of contracting the disease. The degree of mental trauma may differ from person to person; however, when levels of anxiety reach alarming heights, it is imperative to seek professional / assistance.
The way forward
The world is presently at an active trauma stage, insofar as COVID-19 pandemic is concerned. The battle towards strengthening our community mental health is yet to begin. Fortunately, with increased awareness of methods to cope with psychological issues, the taboo surrounding mental health is on a downward trajectory.
The World Health Organization published a Report suggesting measures to address mental health and psychosocial considerations during the COVID-19 outbreak. It inter alia recommended that individuals must minimize watching, reading or listening to news about COVID-19, and must access news only once or twice a day. The public must amplify positive stories and images of local people who have survived the outbreak. Conscientious steps must be taken to refrain from referring to those diagnosed as “COVID-19 cases” or “victims”, and must identify them as “people recovering from COVID-19”. It is important to separate the identity of a person from the disease, in order to reduce social ostracization.
Similarly, in an attempt to effectively address mental health concerns of Indian citizens during the pandemic, the Ministry of Health & Family Welfare, Government of India through the National Institute of Mental Health and Neuro Sciences suggested tips to manage mental health titled “Minding our minds during the COVID-19”. The Ministry uploaded a short video series known as “Lockdown to Knockdown” proposing steps which may be adopted by individuals to overcome emotional or psychological stress. In addition to the above, the Ministry announced a Psycho-Social Toll-Free Helpline number[ii] to ensure access to professional help for those in need.
Dr.Peter Yellowlees, Professor of General Psychiatry at University of California, recommends focusing on physical health, meditation and virtually contacting one’s supportive social network to reduce emotional distress. He suggests that reasonable degrees of anxiety are beneficial, as they ensure conformity to conditions of the lockdown. However, extreme anxiety may cause a person to become agoraphobic. He advises maintaining a schedule to keep anxiety levels in check. Suggestions made by Dr Yellowlees may aid in restricting adverse impact on mental health. However, there can be no substitute for professional medical help.
There is a window of opportunity for the society to implement steps to mitigate the mental health crisis likely to follow the pandemic. In these testing times, it is not a cakewalk to train our minds into following a schedule or participating in productive activity. Nonetheless, taking one step at a time to ensure mental safety and emotional stability at an individual level can contribute to the health of society at large.
[Prastut is a practising advocate at the Supreme Court of India and Vidhi is a Law Clerk-cum-Research Assistant at the Supreme Court of India]
[i] Lee, A. M., Wong, J. G., McAlonan, G. M., Cheung, V., Cheung, C., Sham, P. C., … Chua, S. E. (2007). Stress and Psychological Distress among SARS Survivors 1 Year after the Outbreak. The Canadian Journal of Psychiatry, 52(4), 233–240. https://doi.org/10.1177/070674370705200405.