Written by Vaisnavi Mogan Rao, Senior Research Executive of IDEAS
First published in The Malaysian Reserve on 28 April 2020
The current COVID-19 crisis the world is facing is unprecedented. Nations around the world have rolled out drastic social distancing measures in response to this crisis and are working hard to flatten the curve. Being likened to wartime, with healthcare professionals serving in the frontline battling the virus, it is the responsibility of civilians to adhere to the protocols of the lockdowns to help win this COVID-19 battle.
Globally there are around 2.6 billion people in some form of lockdown, with an estimated 32 million in Malaysia – excluding essential services workers. The layers of other problems that are arising from this pandemic and lockdown – a looming economic crisis, loss of employment and leaders around the world telling us to embrace a “new normal” of continued social distancing measures – are all added factors that contribute to higher emotional and mental distress. A lockdown of this scale is arguably the largest psychological experiment ever, with mental health consequences we are yet to understand.
Lessons from quarantines due to previous epidemics such as SARS self isolation can lead to increased rates of anxiety, depression and PTSD. A fragile economic landscape can lead to financial stress, unemployment, homelessness, and relationship breakdowns, further exacerbating these conditions. These findings may be somewhat unsurprising, however, the sheer scale of lockdowns we are currently facing is unparalleled. Along with the psychological effects of these extended lockdowns, the uncertainty of what a “new normal” could look like can pose considerable long-lasting effects.
The initial effects of COVID-19, prior to lockdown included a surge in absenteeism, as fear of contracting the disease at workplaces was heightened. This is likely to increase after lockdown restrictions are lifted as anxieties of contracting the virus may naturally, still be present. Navigating symptoms of mental health issues, whilst trying to adapt to a “new normal”, could impact productivity in workplaces. Without appropriate interventions in place, these conditions can further deteriorate, causing absenteeism and burnout.
Adapting to the considerable changes that may await us beyond movement control restrictions can be challenging. As we are still unaware of how this “new normal” may unfold, understanding effective and individualized ways of coping with these changes are of utmost importance. As we recover from this pandemic, more than ever we need able workers to revive the social and economic downturns we are already facing – another public health crisis must be prevented at all costs.
Preventing a public mental health crisis
The core value of a public mental health service is adequate public accessibility, barriers to which Malaysia already faces. To begin with, mental health care in Malaysia is still very much in its infancy and mental health literacy is generally low – a survey by Relate Malaysia found that 62% of respondents would not want people to know if they suffered from mental health problems, and only 29% of people viewed them as true medical illnesses. To address the low levels of awareness that may discourage people from seeking help during this crisis, we need to think about mental health as part of the current public health response.
For example, following the 2005 MERS outbreak, the Korean government saw the need to establish mental health service systems for infectious diseases. Proactive monitoring systems were implemented for MERS victims, individuals quarantined and families of patients. They used an approach of active administering by contacting people with problems, resulting in a higher mental health service utilization rate.
Rolling out programs like these may not be practically feasible in the short term for Malaysia. However, it could be adapted to tackle specific at-risk groups, including frontline healthcare workers, families and people directly affected by COVID-19. Other vulnerable groups include older adults dealing with loneliness, children and adults with developmental disorders facing substantial disruptions to their usual support and routines.
To address the mental health in the general population amidst this crisis, Belgium recently launched an online tool – Everyone OK. The platform uses existing protocols and interventions to assess an individual’s mental wellbeing and provide self-help tools. Creating locally relevant online platforms and promoting them on mainstream and social media can help integrate mental health into the current public health response. Providing the general public with the tools to develop a sense of awareness of their own symptoms can encourage people to proactively seek treatment.
In Lebanon, the National mental health program is working on integrating WHO’s mental health and psychosocial support program into the COVID-19 response by mainstreaming mental health in the national response. Measures include the development of social media campaigns on mental health targeting the general population, caregivers of children and workplaces to support employees with flexible work arrangements.
The Ministry of Health in Malaysia continues to do a great job at fighting this pandemic through timely and rightful, unprecedented measures. However, there are other layers of problems that we may be creating on the journey to win this war. As a nation that is already facing a gap in mental health treatments, we need solutions that go beyond reporting of statistics on rising mental health disorders. We need to take the path that builds the resilience of our people to adapt to a “new normal” – whatever that may look like. To prevent another public health crisis in the midst of this challenging time, targeted mental health interventions should be integrated into the current public health response.