Around a fifth of humanity is confined indoors in what is possibly the widest lockdown in history, including an estimated 1.3 billion Indians who have just entered three weeks of isolation. The enormous stress and uncertainty could take an unprecedented toll on mental health around the world, and experts expect a spike in cases of anxiety and depression, as a consequence.
Shekhar Saxena, Professor of the Practice of Global Mental Health at the Harvard T H Chan School of Public Health, spoke to The Indian Express from Geneva, which, like India, is under lockdown.
Why is it important to talk about mental health at this time?
Hundreds of thousands of people have tested positive for COVID-19, and thousands have died. People in India are under lockdown, constrained and restricted in their movements, and in their capacity to go to work. Many are stranded hundreds of kilometres away from home without transport, food, or money. We are experiencing a threat that can harm or kill us, and while all of us are concerned and anxious, some people will obviously feel it more than others. Mental health is a dimension. We are all somewhere on that dimension from very good mental health to very bad mental health. Imagine a spectrum with the left side being very good mental health and the right side being very bad mental health. We as a society are now moving towards the right, and that affects us all. From a public health viewpoint, a big problem for a small number of people is obviously a problem. But even a small problem to a very large number of people cumulates into a much bigger public health problem. Yes, the virus is a problem. It can affect people, kill people. But even a small deterioration in the mental health and wellbeing of a billion people in India is going to be a serious problem in terms of disability and distress.
You have written that “the mental and emotional toll of the virus is as much a threat to public health as the virus itself”.
In a cumulative way, the threat which means anxiety and depression plus the practical difficulties — financial and employment — as well as the effects of segregation from your loved ones, is going to take a toll on people in terms of their mental and emotional wellbeing. And cumulatively, for a very large number of people, that is going to be a problem.
Does social distancing impact mental health?
We are all talking about social distancing. Actually, what we need is physical distancing, not social distancing — because that conveys the wrong message. In fact, in this time of stress, we need more social togetherness; we need more social support than social isolation. And if that is possible without compromising on the steps we are taking (to fight the virus), it should be encouraged. We should always be giving the message of physical distancing, which is a safety measure, but social togetherness, which can still be maintained from a physical distance. You talk to people on the phone, on any other media, you support people in each other’s difficulties and that is what the community needs to fight it together. Saying ‘social distancing’, which means you are alone, is increasing stress. International organisations and national authorities are all exercising ‘social distancing’ when actually, what they should be saying is physical distancing but social togetherness.
What can governments do to prevent a full-blown mental health crisis in the wake of the pandemic?
Public education and messaging has to be very, very smart. The first fundamental principle is that government authorities should convey accurate and timely information to people. A vacuum leads to more anxiety. India is doing reasonably well on that front with the Prime Minister himself speaking.
Second, there is a large amount of misinformation on social media, WhatsApp groups, even in newspapers, which is completely non-evidence-based and is actually wrong. The WHO has called this an ‘infodemic’, an epidemic of wrong information. India is notorious for that, because most people are connected, especially in urban areas, and now they have time so they are disseminating this information without a thought to how it will affect people. It increases anxiety and concern, and needs to be curtailed. But the government alone cannot do that; we all have to do it — by not forwarding a message if it is not evidence-based.
Third, we all need to take a pause. We should not be consuming news round the clock because that increases anxiety. Even if we are at home, we should ensure we get enough sleep, nutrition, and do things that we find fulfilling.
What can be the effects of prolonged isolation?
Any change in our lives can cause anxiety. This is a massive, negative change. Instead of taking transport every morning to go to work, we are sitting at home. We are disconnected from our colleagues, friends, and even family in some cases. That can be very anxiety-provoking. We can still maintain clear communication with people that we have been in touch with. It is very important to check how they are feeling, whether you can support them, maybe not by being there practically, but by listening to them, being part of their difficulties. That is something we should do very actively. We don’t know if it is going to be weeks or months, but we need to be ready for the long haul.
Will isolation impact the elderly, children, and the disabled more?
Absolutely. We already know that the elderly have been feeling more and more isolated. Loneliness has been seen as a major determinant of people’s health, mental health, and life spans. The elderly may also not be able to use modern means of communication. They have no physical proximity to people. This can mean added anxiety or stress for them.
Similarly, children are accustomed to playing with friends and being surrounded by a number of adults, especially in joint families. Schools are closed. It is a massive change but young children may not understand why this is happening. That increases their anxiety.
People who are disabled — physically and mentally — may have more problems in communicating with others to get the right news, to be in touch with people, to get the social support they need. People who are mentally disabled in some way will feel a heightened sense of anxiety and abandonment. That will definitely increase their symptoms. Also, people who are living with a physical or a mental disorder will have great difficulty accessing the healthcare that they are used to.
You have said that parks should be kept open to allow people some physical activity. Is that viable in a densely populated country like India?
Obviously, there is a danger in allowing people to aggregate in large groups. That, of course, should not be allowed. But closing open spaces, parks, is denying people the possibility of physical exercise, to walk, to jog which is very important at such a time. So, in a regulated manner, that should be allowed. There are millions of people living in shanties where there are eight people to a room. It is criminal to confine them there. I think a compromise has to be found rather imposing than a blanket ban.
What kind of mental disorders are we likely to see on the other side of this pandemic?
The typical three disorders we will see are anxiety, depression, and stress-related disorders like sleeplessness. Studies have already proven that quarantine has increased anxiety and depression among people. We might also see more instances of smoking, alcohol, and drug use. When people do not have access to their usual entertainment, they might take solace in using substances.
(Shekhar Saxena is Professor of the Practice of Global Mental Health at the Harvard T H Chan School of Public Health, and former Director, Mental Health and Substance Abuse, World Health Organisation. He spoke to Mayura Janwalkar from Geneva, which, like India, is under lockdown.)
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