Wounded bodies- Wounded Minds: Mental health challenges of COVID 19
Prof. R. Srinivasa Murthy
The emerging once in a life time COVID 19 pandemic has challenges in all aspects of life for all of humanity. The current discussion note specifically focusses ton the mental health needs of the population and how they can be addressed.
I have had the opportunity to work in a number of disasters/conflict situations and refugee situations. I know that mental health is a vital part of these situations. Mental health professionals have a key role to play.
Let me recall three experiences.
Following the Bhopal disaster in 1984, when in Feb 1985, Dr.Mohan Issac and myself visited to assess the health needs of the population. At that time the chief problem was the population looking for medical solutions to the symptoms of gas exposure. We at that time coined the phrase: Wounded bodies- Wounded Minds. Further, as there were no psychiatrists in the City of Bhopal, we organized mental health training for the general medical officers and prepared a Manual for their use.
Nearly 16 years later, 1989, following the Orissa Super Cyclone, the interventions were carried further by preparing mental health interventions or the general population(self-care), the community level workers (Snehakarmis).
A decade later in 2002, as part of the Gujarat riots relief, manuals for teachers and women were added.
The main lessons of the experiences is the recognition of the importance of mental health and the feasibility of innovative ways of addressing the mental health needs.
As a result of NIMHANS efforts and those of other professionals, today, mental health is recognized as an essential part of disaster care, at all levels.
Current COVID 19 Pandemic
The mental health is recognised as a vital part of the pandemic.
This is reflected both in the general press as well as in the professional literature.
WHO, Geneva was the first to bring out a 4 page information sheet(Mental health considerations during COVID outbreak) (1) along with a one page poster.(Coping with stress during the 2019-nCoV outbreak) (2)
The Lancet Psychiatry, published on February 26, 2020) a rapid review of evidence article titled, The psychological impact of quarantine and how to reduce (3). American Psychiatric Association put up COVID 19 resources (4). The Ministry of Health and Family welfare has a number of resources like posters in its website(5). Institutions like Harvard started offering online mindfulness courses (6). Google had a list of five things to do cope with COVID on its entry site (7).
Subsequently, there have been many publications. For example, in the latest issue of the Lancet Psychiatry, (March 21 2020) there is one COMMENT and three CORRESPONDENCES related to the Chinese experiences.
• Psychological interventions for people affected by the COVID-19 epidemic
• Patients with mental health disorders in the COVID-19 epidemic
• Mental health care for medical staff in China during the COVID-19 outbreak
• Online mental health services in China during the COVID-19 outbreak
In the lay press there is a surfeit of articles on self-care during the crisis and self-isolation, along with videos. (Appendix 1) (8-16)
Suggested Action Plan:
In the current situation of the COVID 19 , pandemic, the whole of the population will benefit from mental health care, at different levels- promotion, prevention and clinical care. This is also an opportunity to bring to the attention of the general population the importance of mental health in every day life.
What are the initiatives that can be taken at different levels.
Firstly, at the Institutional level, (Indian Psychiatric Society, Indian association of Social Psychiatry, Indian Psychological Association etc, National level Institutions like NIMHANS, Bangalore, CIP, Ranchi, IHBAS, Delhi and Departments of Psychiatry, ) can takes leadership to collate, disseminate and support the spread of high quality evidence based interventions for emotional health care. They could use the websites to make materials ( written, audio, video etc) in LOCAL LANGUAGES for the general public. They should be disseminating these resources of information among the general public. A step further would be to open Q&A sections, chat sessions for continuous interaction with the public.
Setting up a HELPLINE would be valuable.
Secondly, persons with mental disorders, new or on treatment, will need to receive care without travel and barriers of self-isolation/social distancing. We have to find ways to communicate to all persons with mental disorders- in our care and new persons that their needs will be met. Innovative ways will have to find ways to be CONNECTED with our clients.
Thirdly, social distancing and self-quarantine will be stressful to all people, especially for the children and elderly. Maintaining Mental health by SELF-CARE has to be developed that is PRACEABLE and communicated through wide stead dissemination. In addition to sharing of information/skills , there is need for SUPPORT to those who need help. This support is crucial. Luckily, the mobile phone, internet can be used to ‘decrease the feeling of isolation’ of people. Each of us can offer free online support to nearby school(s), the apartment complexes where we live and other groups of populations.
Fourthly, medical personnel working directly with the persons with COVID 19, need emotional support. This should be built into all health care settings. Again, we have to develop innovative ways of reaching this support to all people from the Asha workers to tertiary care facilities.
Fifthly, there is need for continuous communication with media, planners, health authorities so that they keep in mental health aspects in the list of interventions and while making choices of difficult nature.
Sixthly, DOCUMENTATION . There is much that we know but much more that we do not know. This is the time to organize our efforts to document all aspects of the PANDEMIC from the mental health perspective. This will be a great contribution to the field of mental health as well as for the similar situations.
I want to quote from a Guardian podcast of the USA Health Workforce on the pandemic:
“I feel like a soldier in the frontline of war.. this is what we are here for and we will take care of it”
Second, the pandemic could have a silver lining for humanity, similar to what is happening to the ecology of Venice: Nature is takin back Venice (birds, fishes returning to the area). \I honestly believe we should take the opportunity of this lockdown to reflect and see how we can be more organized in the future to find a balance between the city and tourism”
I see the current need is for ‘ALL HANDS ON DECK and DOING THE BEST AND GIVING THE BEST BY EACH OF US FOR ALL OF US’.
Appendix: Some of the articles on ‘self-care’ ‘emotional health’ in the press
• If coronavirus scares you, read this to take control over your health anxiety-the guardian, March 16,2020.(8)
• How not to panic during the coronavirus pandemic: welcome hard times like a Stoic-March 17 2020. (9)
• ‘Cabin fever’: Australia must prepare for the social and psychological impacts of a coronavirus lockdown, THE CONVERSATION, March 13, 2020(10)
• Coronavirus fears can take a toll on our mental health. Here are ways to cope, Angie Jackson, Detroit Free Press (11)
• Anxious due to coronavirus pandemic? Here’s how you can manage your mental health-Geetha Mantri, March 12 2020(12)
• What to read if … you’re feeling anxious: NYTimes, Mar 19,2020.(13)
• Guide to Staying Sane During a Pandemic: You can let anxiety consume you, or you can feel the fear and also find joy in ordinary life, even now. The Atlantic, May 19,2020. (14)
• The ability to regulate your attention may help protect against anxiety symptoms
CLAIRE OBEJAS MARCH 16, 2020, PSYCHOLOGICAL REPORTS(15)
• BBMC, Guidance to Resident Welfare associations. Bangalore.(16)
(all the quoted documents can be share on request. Do email me: firstname.lastname@example.org)
Looking forward to work together to make life better for all.
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