Mental Health Problems: Pandemic Provokes Rethink of Ideas, Reset of Policies

Covid 19 swept like a cataclysmic cyclone through the world, leaving virtually no one untouched. It represented one of the biggest global convolutions in generations, and has had severe and far-reaching repercussions for health systems, economies, societies and individuals. Countless people have died, or lost their livelihoods; families and communities have been strained and separated; children and young people have missed out on important rites of passage and transitions in their education and socialising; many businesses have gone bankrupt; millions of people have fallen below the poverty line.

According to the World Economic Forum, 114 million people lost their jobs because of the COVID-19 pandemic in 2020. But every time it seemed the world was on the road to recovery, new variants like Delta and Omicron would emerge that ensured COVID-19 dominated the global economy for a second year.

Guy Ryder, Director-General of the International Labour Organization (ILO), says, “throughout 2021, the pandemic weakened the economic, financial and social fabric in almost every country.” As a result, in January 2022, the ILO downgraded its forecast for labour market recovery in 2022 and says it expects global unemployment to remain above pre-COVID-19 levels until at least 2023. Certain groups of people have been affected much more than others. With extended school and university closures young people have been left vulnerable to social isolation and disconnectedness- this in turn can fuel feelings of anxiety, uncertainty and loneliness and lead to debilitating behavioural problems. For some children and adolescents Covid captivity, the domestic quarantines imposed, may have increased the risk of family stress or abuse. Women have similarly faced greater stress in homes, with one rapid assessment reporting that 45% of women had experienced some form of violence, either directly or indirectly during the first year of the pandemic. The foregoing are all risk factors that can lead to serious mental health problems.

As people grapple with these health, social and economic and financial impacts of the Pandemic, mental health has been widely and deeply affected. Many people have become more anxious; but for some COVID-19 has triggered or amplified much more serious mental health problems. A great number of people have reported psychological distress and symptoms of depression, anxiety or posttraumatic stress. And there have been worrying signs of more widespread suicidal thoughts and behaviours, including among health care workers.

While mental health needs have risen, mental health services have been severely disrupted, and in some cases almost disabled. This was evident early on in the pandemic when staff, infrastructure and resources were often redeployed to the more medical areas of COVID-19 treatment and relief. Social measures such as enforced lockdowns, also prevented people from accessing care at that time. In many cases, a lack of, or poor knowledge and misinformation – often cynical and callous, and nearly always criminal - about the virus fuelled fears and worries that hindered people from seeking help.

COVID-19 has created an unprecedented global crisis in mental health, the scale of which probably won’t be fully understood for years and perhaps even decades to come.

The psychological effects of the Covid-19 pandemic include any one, or a combination of the symptoms below, triggered by Information overload, rumours and misinformation. These can contribute to a feeling that management of your life is out of your control and muddy your decision-making processes.

During the COVID-19 pandemic, many people experienced stress, anxiety, fear, sadness, depression and loneliness, initiating or adding to already existing mental health disorders, Since the start of the pandemic, mental health service providers have tried to mitigate service disruptions, by delivering care via alternative routes when public health and social measures were in place. Community-based initiatives were often faster to adapt, finding innovative ways to provide psychosocial support, including through digital technologies and informal supports. And international organisations have also provided guidance, tools and resources to help responders, public health planners and the general public.

The World Health Organisation (WHO) recommends integrating Mental Health and Psychosocial Support within all aspects of preparedness and response for all public health emergencies. To minimise the mental health consequences of the COVID-19 pandemic, WHO also recommends that countries:

• Apply a whole of society approach to promote, protect and care for mental health, including through social and financial protection to safeguard people from domestic violence or impoverishment, and by communicating widely about COVID-19 to counter misinformation and promote mental health.

• Ensure widespread availability of mental health and psychosocial support, including by scaling up access to selfhelp and supporting community initiatives.

• Support recovery from COVID-19 by building mental health services for the future.

‘In the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by a massive 25%,’ according to a scientific brief released by the World Health Organization (WHO) in March 2022. The brief also highlights who has been most affected and summarises the effect of the pandemic on the availability of mental health services and how this has changed during the pandemic. Concerns about potential increases in mental health conditions had already prompted 90% of countries surveyed to include mental health and psychosocial support in their COVID-19 response plans, but major gaps and concerns remain.

“The information we have now about the impact of COVID-19 on the world’s mental health is just the tip of the iceberg,” said Dr Tedros Adhanom Ghebreyesus, WHO DirectorGeneral. “This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their populations’ mental health.”

In Ireland new research, published by the Economic, Social and Research Institute (ESRI) shows that the COVID-19 pandemic has resulted in poorer mental health among young adults. Using data from the Growing Up in Ireland COVID-19 survey, carried out in December 2020, the findings show that four-inten 22-year-old men and over half (55 per cent) of 22-year-old women were classified as depressed. These were much higher figures than two years previously when 22 per cent of men and 31 per cent of women were depressed. The report shows that young adults reported very significant changes to their social activities during the pandemic. Over 80 per cent had less face-to-face contact with their friends than before the pandemic, even though restrictions on such contact had begun to ease at the time of the survey. Reduced contact with friends was linked to increased depression for young women.

Of those who were engaged in sports and cultural activities prior to the pandemic, the majority reported spending less time on these activities during the pandemic. This was more common for those who lost their job or found it difficult to study remotely. Spending less time on sport and less time outdoors during the pandemic were linked to higher depression rates among men. Some less healthy behaviours, such as alcohol consumption, declined for a large group of young adults but other behaviours, such as eating junk foods/sweets, increased for many.

How the COVID-19 pandemic has affected mental health cannot be taken lightly. In some ways, it is a health emergency almost as urgent and widespread as the disease itself; more than half of respondents (51%) to a seven-country survey by the International Committee of the Red Cross (ICRC) said the pandemic had negatively impacted their mental health.

Commenting on this report, the ICRC’s director-general Robert Mardini said: “The COVID-19 health crisis has exacerbated the psychological distress of millions of people. Lockdown restrictions, a loss of social interaction, and economic pressures are all impacting people’s mental health and access to care.”

However, among the evident doom and gloom of the negative repercussions of the Pandemic an unlikely positive twist in the tale is also starting to emerge. Around the world, mental health issues have never been more widely or openly discussed, or put under such a probing microscope. Previously poorly understood issues – such as how loneliness can trigger depression and the anxiety caused by overexposure to social media – are now the subject of public policy and mainstream debate by analysts, professional bodies and commentators.

Although the breadth and depth of this crisis in mental health should not be underestimated, the global community has also shown remarkable resilience in its response. The pandemic has taught governments, health professionals and ordinary citizens valuable lessons about their mental wellbeing that will hopefully endure long after the pandemic is over.

In particular, people have come to cherish human connection and the face-to-face, real world experiences that cannot be replicated online. “There have definitely been some positives, both on the medical and the social side. Especially in highlighting the importance of family. Some people might have previously taken their parents or grandparents for granted. But after being separated from them for so long, they appreciate the value of spending time with them.”.

Jagan Chapagain, Secretary General of the IFRC, is urging the world to seize this unique opportunity for action: “Now more than ever we must invest in mental health and psychosocial support for everyone – communities and carers alike – to help people cope, rebuild their lives and thrive through this crisis.”.

Thomas Mc Grath