Resilience - The Zine

Resilience A zine exploring COVID-19 and Mental Health

resilience

the capacity to recover quickly from difficulties; toughness.

The National Mental Health Alliance states the following: “Resilience is the process of finding healthy ways to adapt and cope with adversity and distress. Building resilience can be key to helping us get through the Coronavirus crisis and its aftermath. It can help protect us from various mental health symptoms, such as depression, anxiety and traumatic stress. And it can help those of us who already have mental health conditions cope better.

Prior tragedies have shown the power of resilience. Knowing this, and how to build resilience, can be a source of great hope for many people.

In fact, people can even experience emotional growth after a tragedy.”

Acknowledgements We would like to use this moment to thank all those who contributed their time, voices and stories to this zine.

Thank you to Comic Relief who have so generously funded this publication.

Thank you to all of our Mental Health Societies and their mental health care users who have shared their time and stories with us over the past 20 months.

Thank you to Rose Boswell for allowing us to share two of her poems from the anthology Pandemix, published by RPCIG: Bamenda, Cameroon and New York (2020). *All References Available on Request

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Contents Page Definitions Acronyms Opening Letter SECTION ONE: Research Themes COVID-19 Impact Poem - Through the Window COVID-19 and Those We Serve Poem – Buried Alive COVID-19 and Global Mental Health

SECTION TWO: Our Work World Mental Health Day 2021 Poem - Life in the times of COVID Innovation in Services The Speak Your Mind Campaign Poem - Everyone Deserves to Fly

SECTION THREE: Our Voices Personal Testimonials Poem – With You All the Way You Are Not Alone Happy 100th Birthday to us!

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Definitions Autism: a group of compounded neurodevelopmental disabilities Bipolar Disorder: mood cycles between periods of mania and periods of either normal mood or depression Borderline Personality Disorder: marked by an ongoing pattern of varying moods, self-image, and behaviour Community-based Mental Health Services: encompasses a wide variety of programs and services designed to meet local needs. These programs are delivered primarily by community agencies and sometimes through hospitals or health clinics COVID-19: an infectious disease caused by the SARS-CoV-2 virus Deinstitutionalisation: the policy of discharging patients with mental health problems and/or intellectual disability from hospitals so that they can be placed in the community, and the decentralisation of mental health services [that] thus integrates into primary health care Human Rights: the basic rights and freedoms that belong to every person in the world, from birth until death Impulse Control Disorder: condition involving problems in the self-control of behaviour and emotions Intellectual Disability: disability characterised by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behaviour, which covers a range of everyday social and practical skills

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Mental Disorders: there are many different mental disorders, with different presentations. They are generally characterised by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others Mental Health: a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community Mental Health-Care User: a person receiving care, treatment and rehabilitation services or using a health service at a health establishment aimed at enhancing the mental health status of a user Oppositional Defiant Disorder: condition involving problems in the self-control of behaviour and emotions Psychosocial Disability: an internationally recognised term under the United Nations Convention on the Rights of Persons with Disabilities, used to describe the experience of people with impairments and participation restrictions related to mental health conditions Protective Workshops: generally run by NGOs at community level, these are a means through which people with disabilities who otherwise would not have the opportunity to acquire gainful employment can gain skills and receive support to empower them for the open labour market Schizophrenia: an illness of the brain that affects how a person perceives the world, thinks, and behaves

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Acronyms ITTC: International Technology Transfer Center South Africa NACOSS: National Coalition for Social Services SADA: South African Disability Alliance SADAG: South African Depression and Anxiety Group SAFMH: South African Federation for Mental Health SYM: Speak Your Mind UGMH: United for Global Mental Health WFMH: World Federation for Mental Health WHO: The World Health Organisation

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Opening Letter H. P. Lovecraft once said: “The oldest and strongest emotion of mankind is fear, and the oldest and strongest kind of fear is fear of the unknown”.

2020 was the year that most of us, regardless of social status, income level, ethnicity, geographical location or creed, came to know fear of the unknown all too well. In our wildest dreams, 12 months prior, we would never have imagined that we would be facing and living through a global pandemic, the scale of which plunged the entire globe into disarray and brought entire communities, economies and countries to their knees.

But while the sudden onset of the pandemic and the fear of the unknown that came with it certainly caught us off guard, the World Health Organisation (2021) told us that stress, worry and fear were normal reactions to real or perceived threats, or during times when people faced the unknown or uncertainties. It was therefore to be expected that people were feeling fearful during the COVID-19 pandemic. And because of all this, the WHO urged people to take care of their mental and physical health while dealing with challenges such as the home-schooling of children, unemployment, working from home, and reduced contact with friends, families and colleagues.

So what did we learn from this? Apart from the fact that good mental health was essential during the pandemic, the World Health Organisation also gave us a resounding endorsement that “it is ok not to be ok”, because the reality was that, along with the fear related to contracting the virus, people were also experiencing significant changes to their daily lives due to movement restrictions aimed at slowing down and containing the spread of COVID-19 (WHO, 2021).

During July 2021, SAFMH and our 17 Mental Health Societies ran a campaign for Psychosocial Disability Awareness Month, built around the theme “See me, hear me, include me – the impact of COVID-19 on persons with psychosocial disabilities”.

During the campaign, a number of persons with psychosocial disabilities graciously shared their perspectives with us, reflecting on the impact that COVID-19 had had on them.

One quote from a gentleman named Peter* really stood out for me: “It was terrible. I was alone during the lockdown, soul alone. I had no voice because I couldn’t use it. I couldn’t talk to anyone which made me feel even more depressed. I went days without food as I wasn’t able to work. No work, no pay. My bakkie [truck] is my prized possession but I couldn’t pay it and now they want to repossess it. COVID changed people’s characters. It changed mine. I was invisible”. Peter’s words stuck with me because they made me realise that, despite excellent literature and research on COVID-19 and mental health being publicised in highly acclaimed journals and by peak bodies such as the World Health Organisation, persons with psychosocial disability were not yet feeling the benefits of this at community level.

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And this made me think: “Imagine feeling invisible during a time when the whole world is in upheaval and people are literally fearing for and losing their lives around you, while you yourself are trying your best to manage a mental illness?”PsychCentral tells us that persistently feeling invisible may lead to a person feeling unaccepted and not belonging, rejected, worthless and insignificant. Unwanted invisibility may also erode the person’s self-confidence and self-esteem.

As a mental health and human rights organisation, SAFMH has a duty to fight for the rights of any and all persons with psychosocial and intellectual disabilities, and if the pandemic has in fact led to even just one person feeling invisible, mentally unwell, insignificant or undignified, that’s one too many in our books. We therefore have a duty to talk about mental health and wellbeing in the context of COVID-19.

SAFMH’s goal with this publication is to put into practice our brand of “carpe diem”.

We wish to seize the moment and capture important learnings, but in contrast to traditional carpe diem, which doesn’t place much focus on the future, we wish to take what we have experienced and learned during the pandemic and apply it to how we approach our work going forward. We want to grab the opportunity, build on the inadvertent focus that COVID-19 has placed on mental health, and ensure that mental health, whether during emergency situations or just during plain, everyday living, will no longer be invisible. We don’t want anyone with psychosocial or intellectual disability to ever feel invisible again, and we want to ensure that mental health is recognised as a critical component of overall health and wellbeing. Mental Health is

something we ALL have, and something we should ALL aspire to cultivate and treasure.

We hope you enjoy reading this publication, and that you will take something away from it and apply it to your own life. We hope that it will inspire you to make a more concerted effort to look after your mental health, that it will motivate you to speak up more and thus help break the silence around mental health. And we hope that it will help you understand that, during times such as these, and at any point in the future, it’s acceptable for you to admit that your mental health might be fragile – “it’s ok not to be ok” – and asking for help is not a sign of weakness or defeat. It is the first step towards a journey of good mental wellbeing.

Be brave, look after yourself and those around you, and take care of your mental health. * name changed in the interest of confidentiality

Leon de Beer Deputy Director SA Federation for Mental Health

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SECTION ONE: Research

Themes COVID-19 Impact Poem - Through the Window COVID-19 and Those We Serve Poem – Buried Alive COVID-19 and Global Mental Health

Key Themes emerging from current research into mental health and COVID-19 Isolation

Suicide

Stigma Fear

Trauma

Confusion

Discrimination Anxiety Forgotten COVID-19

Bereavement

Inequality

Lockdown

Divisions in class and race Task-sharing Virtual Counselling Innovation Human Rights We need more investment in community-based health care Scale up mental health care There is no health without mental health

Speak Your Mind

Summary about impact of COVID-19 “We are living in unprecedented times.”

We have all heard this phrase more times than we can count over the past two years, but it truly is the perfect way to encapsulate everything that has happened during and how we’ve all been affected by the COVID-19 pandemic.

Our world has become filtered, diluted through multiple lenses, in the interest of protecting us from COVID-19. And while most of us have begrudgingly accepted this as our new way of life for the foreseeable future, it has had a profound and undeniable impact on our individual and collective mental health. Even those of us who thought ourselves mentally-healthy and resilient before 2020, have probably come to know the meaning of isolation, anxiety and depression in some way or another. Let's be honest… COVID-19 has left nobody's mental health untouched.

The uncertainties and unpredictability of the COVID-19 pandemic, along with enforced lockdowns and containment measures, physical distancing, and the economic downturn resulting from the pandemic are all risk factors for increased mental health problems and health inequalities, with mental health problems manifesting in persons who previously did not have such problems, but especially also in persons who had pre-existing mental health conditions.

Even before the COVID-19 pandemic struck, mental health services in low and middle income countries were insufficient, and access to services were negatively affected by factors such as poverty, poor infrastructure and service provision, and stigma. These insufficiencies have become worse since the pandemic began, exposing health and social care systems as ill-equipped and unprepared to deal with the pandemic’s demands. This has led to further disruptions in mental health services, coupled with increased human rights violations against persons with mental illness.

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Over the past 20 months, SAFMH managed to identify recurring challenges affecting members of the public in accessing mental health services.

These challenges were recorded and reported to the Department of Health to note and address these challenges. Some of these included: • The need to develop more community-based mental health services that offer psychosocial support and other types of community-based mental health support services required by mental health care users and their loved ones • Lack of residential facilities for young people with severe • behavioural problems • Poor referral pathways for learners with special educational needs due to the fact that most mainstream schools do not provide referral path ways to professionals and organisations that could offer psycho-educational assessments • • • •

Lack of choices available between private and public services as persons making enquiries noted that they had little faith in the public health system, once they had no access to private services (due to, for example, loss of employment)

• Involuntary admissions to hospital for persons with a mental disability due to being a danger to themselves or others. This was a challenge because of the difficulties in carrying out an involuntary admission, mainly because of the involvement of the South African Police Service (SAPS), the negative perceptions people sometimes had about SAPS, and SAPS not always fully grasping their responsibility as per Section 40 of the Mental Health Care Act • Medication shortages (such as psychiatric or chronic medicines) as • people's health and well-being are threatened by the chronic shortages • of essential medicines • • • •

Hospital treatment and the “revolving door pattern”, which involves a person being hospitalised, but being discharged prematurely, only to relapse and end up in hospital again because of their mental health problems not being adequately dealt with during the first hospitalisation

• Inadequate support services for students with mental health problems at • institutes of higher learning

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Through the Window I sit by the window With a candle beside me While rain softly falls outside.

Outside is such a foreign concept now Like lighthouses and sailing dhows What would it be like To be free, to walk or bike Anytime, any day, anyhow?

The memories are fading Of screeching gulls And of ships with rusted hulls I look through the window There comes my dog, low and slow Paws heavy with experience.

His rheumy eyes tell me New memories are waiting.

- Rose Boswell

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COVID-19 and its impact on the people we serve COVID-19 AND PERSONS WITH DISABILITIES As COVID-19 spread around the world, affecting any and all in its path, the WHO stated that actions needed to be implemented to ensure that persons with disabilities – including those with intellectual and psychosocial disabilities – were able to access the necessary healthcare services and public health information they require.

• This was important as persons with disabilities may be at greater risk of contracting COVID-19 due to: • Challenges in terms of ensuring basic hygiene measures [e.g. handwashing facilities being inaccessible or specific disabilities preventing a person from rubbing their hands to gether to enable the cleaning process] • Difficulty in ensuring physical distancing due to support needs, or because of being institutionalised • The person’s need to touch objects to obtain information about their environment and/or through physical support • Barriers to accessing public health information • Persons with disabilities may have underlying health • conditions, which could put them at greater risk of •developing more serious health problems if diagnosed with • COVID-19

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COVID-19 AND PERSONS WITH INTELLECTUAL DISABILITIES As the COVID-19 pandemic swept rapidly across the globe, putting health systems of all nations to the test due to millions of people contracting the virus, the plight of persons with intellectual disabilities (ID), who have specific vulnerabilities, have unfortunately gone largely unnoticed.

Persons with ID experience higher co-morbidities related to poorer health outcomes from contracting COVID-19, which include illnesses pertaining to circulatory, respiratory and endocrine systems, along with metabolic diseases. These individuals are also at higher risk of passing away from infection, particularly younger people with ID. Persons with ID are also a vulnerable group due to their dependence on service provision and support from other people, and a higher prevalence of mental and physical disorders within this group than other persons across the entire age span. However, Inclusion International (2020) states that COVID-19 has not brought about any new challenges for persons with ID and that it has in fact only amplified the existing exclusion they historically faced. This pertains to a loss of support systems, exclusion from education, the inaccessibility of information, and the need to deal with intensified financial consequences of the pandemic.

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Persons with ID are some of the individuals who COVID-19 has impacted on in the most adverse ways, due to the fact that many of them require face-to-face care and/or therapeutic interventions within their residential environments, with little in the way of fall-back options during times of prolonged service interruptions. Many of these individuals have lost access to their service providers or caregivers and, due to uncertainties within state budgets, are faced with growing threats to their support services returning back to normal.

Among other interventions, such as providing more adequate and accessible health care, providing adequate verbal explanations of health conditions - appropriate to the person’s developmental level - along with the provision of accessible information for persons with ID, are all essential interventions during the COVID-19 pandemic.

Families and carers of persons with ID have become concerned that persons with ID may be forgotten as the pandemic continues, therefore it is essential that measures be implemented to include persons with disabilities in all health interventions.

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COVID-19 AND PEOPLE WITH PSYCHOSOCIAL DISABILITIES The COVID-19 pandemic has caused anxiety and fear, with prevention measures such as quarantining and isolation also leading to uncertainty, fear and anxiety for persons with psychosocial disabilities (PD). These factors may in turn lead to increases in illnesses related to stress, while simultaneously also exacerbating pre-existing mental health conditions. This is important as persons with mental illness (and thus PD) are more vulnerable to stress than the general population.

Research confirms that factors such as physical distancing, fear and self-isolation have impacted negatively on persons with PD and also on the mental health of the general population. Furthermore, there may be an increased risk of suicide due to stigma aimed at persons who have contracted COVID-19 and their families. Persons with PD may experience a worsening of their symptoms, while others may develop new problems related to their mental health, particularly anxiety, depression and post-traumatic stress, which are all linked to higher suicide risks. While COVID-19’s impact on mental health may be profound and a possibility exists that suicide rates might rise, this is not inevitable. However, suicide may become a greater concern as the virus spreads and starts having more long-term impacts on economies, vulnerable groups and general populations. It is thus essential that suicide prevention becomes an urgent priority, with responses utilising but also extending beyond general mental health practices and policies.

Persons with PD may also be more affected emotionally by the COVID-19 pandemic, which may lead to relapses and deteriorations in their conditions. Relapses may in turn lead to poorer hygiene, an inability to follow distancing guidelines or other prevention strategies, not reporting symptoms timeously or seeking medical assistance, together with non-adherence to necessary treatments.

As we continue to live through the pandemic, it is essential that all health interventions include persons with PD.

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Buried Alone

People were not allowed to go and bury their families.

People were not allowed to walk around.

Maybe it will get better when lockdown is lifted?

I will visit lost loved ones and be happy.

Be cared for and loved.

So, wear your mask and take precautions, because I don’t want to get this virus.

-Phiwokuhle Musasa

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COVID-19 and Global Mental Health Impact on mental health The COVID-19 pandemic led to unprecedented hazards to mental health, globally, for front-line hospital staff, patients and the general population.

For example, a systematic review of population data from 8 countries showed the COVID-19 pandemic was significantly associated with symptoms of anxiety, and depression, post-traumatic stress. The rapidly evolving pandemic and responses necessitated changes in people’s living arrangements and livelihoods. This too greatly impacted on people’s mental wellness. For example, suicide cases associated with joblessness in Canada were projected to increase from 418 to 2114. In South Africa, a national online survey of 5,693 youth aged 18 - 35 years found 72% reported being at risk of depression and this prevalence was higher for the unemployed (73%) and those living in urban informal areas (75%), indicating that limited access to resources may compounded mental health issues.

Mitigating the hazardous effects of COVID-19 and associated socioeconomic changes to mental health became an international public health priority.

Impact on mental health care and services Globally, already limited mental health services and resources were greatly impacted. According to a WHO study, out of 130 countries, 60% of countries reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%), and women requiring antenatal or postnatal services (61%). Thirty percent reported disruptions to access for medications for mental, neurological and substance use disorders. More than a third (35%) reported disruptions to emergency services, for example, for people experiencing prolonged seizures and severe substance use withdrawal syndromes.

Mental health community based organisations are included in the above mentioned services, which faced severe disruptions. Many of these civil society run organisations lost donors and were forced to reconfigure their services from preventative to mostly crisis management.

Now more than ever, we need more resources and innovative, evidence-based services to respond to the impact that COVID-19 has had on mental health around the world.

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SECTION TWO: Our Work

World Mental Health Day 2021 Poem - Life in the times of COVID Innovation in Services The Speak Your Mind Campaign Poem - Everyone Deserves to Fly

World Mental Health Day 2021: Mental Health in an Unequal World World Mental Health Day (WMHD) 2021 saw the World Federation for Mental Health (WFMH) call on countries to actualise accessible, quality mental healthcare for all. The theme for 2021 was ‘Mental health in an unequal world’. For South Africa, the most unequal country in the world in 2019, this call was especially pertinent. Less than 1 in 10 people living with a mental health condition in our country receive the care they need. This access largely depends on if the person has medical aid and where they live (e.g. the province, rural or urban area).

For example, in the Western Cape spending on mental health per uninsured person is R307.40 while in Mpumalanga it is R58.50 – that’s nearly a R250 variation.

Importantly, our call this year is not one of doom and gloom. It is one of hope. We must continue to build upon excellent precursory efforts and ensure that all relevant stakeholders work synergistically to reduce inequality by enhancing access to mental health care. With key improvements in our policy, human resources, and financial resources from a human rights based approach, we can make mental health services more accessible.

This WMHD we continued to be inspired by community-based mental health NGOs who work tirelessly to ensure mental health care users can access services and economic opportunities within their communities. We remain in awe of academics and people with lived experiences of mental health conditions who generate evidence regarding best-practices for mental health care in South Africa. And we are hopeful that policymakers will amplify their support for mental health through strategic human and financial resource allocation. There has been much advancement made in the country when it comes to mental health care, so it is imperative that we continue striving for all to enjoy this progress.

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Life in the times of COVID The sudden uninvited stalker, ready to kill.

The elderly become prey, likewise the weak.

New, unwelcomed, unwanted added mental challenges through to the physical.

Covid19, oh Corona…you brought devastation, Destruction, disappointment.

Pained feelings of isolation and alienation Walking on hot coals then suddenly ice cold thin ice.

Lonely, yet not alone.

The progressive variants overwhelmed many a person.

A sense of paranoia, social withdrawal, sadness, apathy, misery, hostility.

Anger because of unwarranted deaths.

A new understanding of the meaning of “treat me in life as you would in death”.

A reminder for all of how fragile life is.

Appreciation of humanity, patience, kindness, gentleness, goodness, harmony, peace, joy.

May the Lords face shine down upon us in this present day and always.

- Renee Scheepers

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INNOVATIONS IN SERVICES How did mental health services adapt?

COVID-19 posed immense challenges to the way mental health services could be carried out, both nationally and internationally.

However, we have also seen an incredible effort when it comes to how services were redesigned with innovative and person-centred work being done by community-based mental health service providers, despite challenges related to funding and resources.

Mental health care services adapted across the world, but not at an equal rate. While more than 80% of high-income countries reported deploying telemedicine and teletherapy to bridge gaps in mental health, this happened in less than 50% of low-income countries.

Examples of other innovative adaptions include: • In India, a local NGO partnered with Government and the Medical Research Council UK to develop a scalable telemedi-cine model that allows patients to access medical care while following social distancing during the pandemic.

• In Bangladesh, a web-based online platform was developed to provide virtual mental health counselling services nationally to both health care providers and Covid-19 patients. At the time of publication, 1,693 Covid-19 patients and 1,443 healthcare workers had received counselling services in four months.

• In Pakistan, Pursukoon Zindagi (“Peaceful Life”), adopted a three pronged approach to provide integrated Covid-19 and mental health counselling, through: placing proactive calls to patients tested for Covid-19; offering support groups for front line workers; and implementing a crisis helpline for general population. Thus far, over 20,000 people have been reached through these mediums.

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In South Africa, there were a number of incredible examples of this, specifically in the Northern and Western Cape.

Northern Cape Mental health

This video details the diverse protective workshops, residential facilities and empowerment services offered by Yonder, the protective workshop arm of Northern Cape Mental Health.

Cape Mental health

The video depicts the variety of programmes offered by Cape Mental Health and how they adjusted to meet the needs of the communities due to the restrictions imposed by COVID-19 adjusted to meet the needs of the communities due to the restrictions imposed by COVID-19.

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The Speak Your Mind Campaign Speak Your Mind (SYM) was a nationally driven and globally united campaign, advocating for ending the silence around mental health. This campaign aimed to put pressure on governments to invest in, educate, and empower people so citizens have the support and resources for looking after their mental health. SYM was an initiative of United for Global Mental Health a UK-based not-for-profit organisation, founded to create a united, worldwide effort for greater action in global mental health. SAFMH has been honoured to be the country lead for SYM South Africa.

As part of its SYM activities, SAFMH facilitated a community engagement filming project in collaboration with community-based mental health organisation affiliates across the country.

The project aimed to: • Raise awareness about important community issues pertaining to mental health, • Advocate for increased mental health resourcing, and • Amplify the voices of mental health care users during the COVID-19 pandemic.

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Key themes that emerged: • The need for greater investment in mental health services • The importance of ensuring equality, inclusion and human rights of mental health care users • COVID-19 had a profound impact on the mental health of everyone • Community-based mental health service providers were incredible, as they responded to and helped mitigatethese challenges caused by COVID-19, despite a lack of financial and human resources In October 2021, the project concluded with the production of the “SAFMH Presents Speak Your Mind” documentary, which captured and consolidated these themes and added a national perspective from SAFMH.

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SAFMH Presents Speak Your Mind

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Everyone deserves to fly Playing with a kite is fun, I went out on my own, and accomplished something.

But doing things on your own is not as interesting as having people join you.

It will be better for us when we beat this disease.

-Luzuko Meltafo

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SECTION THREE: Our Voices

Personal Testimonials Poem – With You All the Way You Are Not Alone Happy 100th Birthday to us!

Scrapbook Testimonials In 2020, SAFMH started collecting reflections from people about how their mental health was impacted by COVID-19.

One person told us the following, which illustrated the immense impact that COVID-19 was having an individual level: “I am 35 years old living in Johannesburg, South Africa. Living during the COVID-19 pandemic has been hectic for me, especially regarding my mental health. I live alone so I find myself alone and isolated from my friends and family. Even though I call them and video chat during the week, it’s not the same.

I find myself being very complacent when I need to do things for my mental health. For example, I’ve stopped exercising, stopped reading novels. I find myself laying on the couch day in and day out watching series. It’s worse over the weekend because I don’t even bother to wake up to clean the house or do my laundry.

There are a few instances whereby I will not communicate with anyone for three to four days in the week. I don’t know whether that is depression or what, but I’ve been struggling to maintain my mental health.

I’m the kind of person that needs to be around people in order to function; I’ve just realised that about myself during the COVID-19 lockdown. I’ve been struggling to sleep two to three nights during the week. I envy those who are in a relationship, who are staying with their partners. It would be nice to receive a hug again, but unfortunately I do not have that luxury.

My mental wellbeing has not been great at all during this COVID-19 lockdown. I find myself forcing myself to eat, forcing myself to shower and get dressed. Doing the most mundane things is quite an effort for me right now. So just to feel normal again I hop into my car and take a 30 minute drive around my neighbourhood, just so I can see people and to get out of the house.

I have the right information at my disposal to get my mental health right but the will to do so is not as strong, so I end up in front of the TV. I’ll keep trying to be active and to do my best to maintain a good mental health attitude. I guess I just have to keep my head up and keep moving forward.”

Contributions from other individuals further highlighted additional fears and struggles people were facing, along with examples of how people were coping and trying to maintain a sense of hope; “When the government announced the national lockdown that was shocking and scary. It felt like the end of the world.

And indeed it was the end of the world as we have come to know it. The lockdown restrictions were extremely harsh for most industries and caused irreparable damage to industries, the job market, the economy and families. Hearing how loved ones and friends were losing their jobs and how people who rely on “piece jobs” were going hungry was a disaster and a nightmare.”

“I think having a job has brought solace to my mind. Having some form of responsibility and accountability to look forward to every morning has been motivating. Creating predictability/routines have help me a lot with maintaining my wellbeing. I would love to say eating healthy and exercising has given me peace; unfortunately most of the time I am not motivated to eat healthily. One of these days I hope I tick eating fruits & exercising on my daily to do check list!”

“As the lockdown began to ease up, some of the dark clouds seemed to be disappearing but I realised that I will still be dealing with the consequences of the lockdown for some time to come.”

Other contributions showed how families have grown closer because of the pandemic:

“…it has changed my lifestyle socially, emotionally and of course, financially […] It has taught me to prioritise my family and to note all their needs, as I used to be a little careless sometimes. I have learned that life is too short and I want to be around my family and check that everyone is OK around safety precautions and are adhering to lockdown regulations. I have learned to take care of myself and to be aware of this pandemic and its experiences”

“The pandemic has made me realise that some things are not as important as I thought them to be.

Now, family, love, health and positivity is the new in.

It also helped me to take note of the people around me and to be sensitive to their needs”

In certain instances though, the pandemic brought about severe mental health problems for some: “The COVID-19 pandemic brought about an emotional tsunami for me as l never realised how l had not begun healing from my childhood and my adult traumas. I only realised during this time how scared I am of spending time in my bedroom.

In 2019 my brother committed suicide in my room. It was such a difficult time for me as l was in my exam period. Preparing for the funeral and preparing for my exams meant that I did not have an opportunity to grieve.

Working from home forced me to spend more time in my bedroom and confront my biggest fears. I suffered anxiety attacks that l could not comprehend as l wasn’t aware what was happening to me.”

Pietermaritzburg Mental Health worked with their service beneficiaries to capture the views of persons with psychosocial disabilities early on during the initial lockdown:

“It was so difficult because we were unable to visit relatives and friends.”

“I couldn’t see my mother for 4 months; I could not go to the computer shops to buy essential equipment for my computer. I had to rely on my family to buy me things in town that I needed.”

“My disabled child and I were both so delighted as the food parcel [provided by PMBMH] has helped us greatly and we were able to manage the grant better. PMB Mental Health has assisted us immensely during these difficult times.”

“Wearing a mask took a while to adjust to and I found breathing difficult. It was a problem for some of us that are not able to afford more than one mask.”

“2020 has been a challenge due to COVID-19. This year I had not seen my Psychiatric doctor as we were told he only attends to emergency cases. My doctor’s appointment is very important to me because that is where I get to tell him about the usefulness of the medication and check my progress.”

Port Elizabeth Mental Health also engaged with their service beneficiaries and shared the following:

“I am still scared and fearful of what COVID-19 might do to me and am worried about the safety of my dear family where they are.”

“I was sad I could not do my domestic duties anymore. I felt stuck in one place and nowhere to go”

“I am just not comfortable at all. If I cough even though I am vaccinated I still worry I have COVID-19.”

“I feel depressed and frustrated because I can’t go out. My family can’t visit me and I can’t visit them. I feel like I am in prison in my own environment. Nothing is the same. COVID-19 taught me patience with getting in touch with family and waiting long ques to access health care and medication.”

To support these individuals, PE Mental Health assists service beneficiaries on an ongoing basis with accessing health care and education related to COVID-19 symptoms and safety regulation. This helps these individuals develop a greater awareness of COVID-19 and its impact.

Naseema Parker and Sasha Lee Brown from Cape Mental Health shared their COVID-19 experiences with us.

After a few months of lockdown, the Deputy Director of SAFMH noted the following reflection on how the pandemic had affected him personally and professionally:

“Over a hundred days of lockdown… Sitting at my little workstation at home, day and night, trying my best to stay on top of work, study, personal and all other priorities. Missing friends and family, missing being able to go to the shops without the suffocating confines of a mask. Missing seeing other people’s faces and smiles and not needing to rely on eye-to-eye contact only. Missing being able to go about my daily business without the stinging, ever-present stench of hand sanitiser. Perpetual worry about the health and wellbeing of my children, my partner, my parents, my family, my colleagues, and myself. Who of us will get it first, and how bad will we get it? This is my daily question. I feel the need to be strong for those around me who depend on me, while not showing the cracks that occasionally appear in my own resilience.”

Here are some other reflections from persons working in the mental health sector:

“These have been difficult times. Increased levels of stress, anxiety and depression are no longer just cold, hard and conveniently distant facts and figures, even for us working in the mental health field. They are part of everyday life now, in our homes, in our own lives, in our jobs. Everywhere. Affecting everyone”

“Experiencing all the media surrounding China and Italy, who peaked first, gave us a very grim view of what we could expect and it was frightening. Being an older mom with an underlying condition and considered more high risk made me fearful – not for myself, but for my nine-year-old daughter who still needs her mom so much. This was a really good point of departure to be extremely careful to adhere to the safety protocols and we actually felt at peace, safely cocooned in our home during lockdown – for the most part working from home.

As lockdown lengthened and conditions in our communities deteriorated, our work – providing psycho-social support – became imperative, but also quite mentally draining for the team of social workers. Just so much suffering – from the effects of isolation, to fear of the virus, to impacted livelihoods, to absolutely devastating hunger.

Where working from home was initially a salvation, lines began to blur and work seemed to take over – leaving little time for loved ones at a time when they should be our priority. As a single mother, having to juggle this and home-schooling – workdays only finished around 22h30 / 23h00 – burnout is a possibility.

However, put in perspective of the devastation in the disadvantaged areas, we remain positive and rejoice in all the resilience we see around us.”

With You All the Way No matter the darkness Creeping behind Or the darkness lying ahead With your hand in mine Dear sister, The darkness has no hold For our dresses are white And our souls are pure Our sisterly love, set to endure So cast off your worries And come dance with me Through darkness to golden fields Where sunflowers laugh And bid us to play in the sun - Rose Boswell

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You Are Not Alone We have been living in the grips of the pandemic for 20 months now. This is a really long time to be in constant distress. The most important thing to note however, is that help is available.

At SAFMH, we run a mental health information desk. Through this we facilitate referrals to mental health and legal resources for persons with mental disabilities and their families, and we also assist these individuals with information on residential facilities, how to access treatment and support, and with information on mental health processes and procedures.

You can reach out to us via our enquiries Help Desk at 011 718 1852 or send an email to info@safmh.org and we can then refer you to the necessary mental health services you need.

As much as the pandemic has been overwhelming, it has in some ways normalised the idea of openly expressing fear, stress and anxiety, and for us in working in the mental health space it has helped with tackling the stigma so often associated with mental health. We are encouraging everyone, at all levels of society, to continue speaking out, to raise awareness, and to fight to make more resources and services available for those who are living with or struggling with mental health illness.

It is really important for us to reiterate that safeguarding mental health is essential, not just for persons with existing mental health conditions, but for EVERYONE… Because the truth is,

there can be no health without mental health.

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Happy 100th Birthday to Us! As we already know, 2020 was quite a year but did we mention that SAFMH celebrated its centennial birthday on 21 September 2020?

This milestone was commemorated with video messages from key stakeholders and members who have been part of the growth and success of SAFMH.

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Resilience

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