Pandemic & Mental Health

One of the biggest challenges we all are facing right now is how to manage enormous disruption to our normal lives. Our work, home, and social life have been turned upside down, and we are finding new ways to continue to do what we had been doing. We are getting our daily essentials online, taking virtual classes, and getting used to the new normal. And, as much as we are getting used to the normalcy, we are facing uncertainty at the same time. Living in the heart of the country has its own advantages and disadvantage. Lately, Kathmandu has been one of the hotspots, along with the Tarai, for COVID-19. It is not unknown that we have limited healthcare facilities, and by now, the government has designated all government hospitals as COVID-19-dedicated hospitals. All the hospitals in Kathmandu are running at full capacity, including their ICUs, and in this case, it is equally challenging for the government to increase capacity and mobilize available resources. Using modern technology and apps will help the system to track the disease, as containment has been tough even for developed nations with advanced healthcare systems.

Having said all this, people dying due to stress related to COVID-19 is surpassing the actual number of deaths from COVID-19. At the time of writing, 1200 suicide cases have been reported, as against 700 COVID-19 deaths. The pandemic is taking a toll on the mental health of Nepalis as per major findings of the ‘COVID-19 Second Social Media Survey 2020’, conducted by Transcultural Psychosocial Organization (TPO) Nepal. Introducing habitual changes to the mundane will give us strength to deal with the difficulties. Establishing structure to our days will also provide some stability. Let’s hear it from our expert on how to deal with a crisis situation and keep ourselves busy as we wait for this pandemic to get over.

Interview with Rishav Koirala, M.D. Psych, Ph.D. scholar, Faculty of Medicine, University of Oslo

While getting used to the new normal, taking care of yourself and family comes first. Here are other things to get engaged with, according to Dr. Rishav Koirala.

Plan your daily routine as how you would like to spend the day

Currently, people do not have many options in their hand to indulge themselves while they are staying indoors. Change of the old schedule has created an imbalance in most people’s biological rhythm. So, the first thing to do is to maintain a routine of daily activities. This routine should include the exact time to wake up, sleep, exercise, take meals, and if

possible, work from home. As many of us are staying home with our family members, we can separate some time for our family. It may be either to play with kids or have chats with parents and so on. This is the first time that most of us have got some time to spend on ourselves. We can make a list of things that we wished to do, but were not able due to lack of time. We can make use of the current free time to indulge in those wishes, whether it may be reading books, playing music, watching movies, gardening, etc. Exercise and meditation are very important things that help us fight stress.

 Think positively, be creative

These are hard times, for sure, and it has been difficult for everyone, especially those who are hard hit in other parts of the world. In Nepal, we are going through the first wave of the pandemic. We should make a habit of seeing different aspects of the event. For example, if we think that the pandemic stopped our daily routine, it has brought our work/ studies to a halt, we can also see it as an opportunity that we had never got in our lifetime: a completely free time many of us have been wishing for, free time to spend with our families, or for the many things that we wished to do.

Take help when required

It is normal for everyone to feel anxious or a bit out of good mood at times like these. But, we should start seeking help when we feel that our emotions are overwhelming us. Some of the common symptoms to look out for are: insomnia, nightmares, irritability, excessive thoughts and worries about being infected, and excessive lethargy and inactivity. People may also start having physical symptoms like headaches, increased heart rate, and tingling sensation of hand and feet that may be of psychological origin. It is good trying to fight these symptoms with exercise, meditation, and other methods of distraction as mentioned above. If these methods fail, then do seek help from local mental health experts. Help in the right time may help you avoid long term treatments.

 Meditate and join interesting groups

Some other suggestions: Download a free app called “What’s up”. It is a good source of information, as well as has techniques to fight anxiety and depression. Try free guided meditation following links like: https://www.youtube.com/watch?v=64ZU2UCQdmQ

 Keep your children engaged

Along with the adults, children, too, are suffering from the pandemic. Schools are closed, and it is becoming challenging for the children, as well. Right now, a few schools and colleges have started taking online classes, which also comes with limitation when it comes to practical lessons. And it is challenging for parents, as well, to keep the children engaged. We can see a lot of online platforms to engage children during this time.

Nepal faced a major earthquake of 7.8 magnitude in 2015, where people were forced to stay out, whereas this pandemic has forced us all to stay inside our houses, safe and sound. On the one hand, we can worry about the situation, whereas on the other, we can make the most out of this and have a positive attitude towards life. With obstacles come the opportunity, and this uncertain scenario has definitely added positives; it has created global accessibility, where people around the world can connect with each other virtually. Online education has started where there is accessibility.

We can understand the importance of staying home during the pandemic, but we have delivery services to fulfill our necessities. So, I believe this is an opportunity to learn new things and fulfill those things in our bucket list that we never had time to do, and spending time with your family is the most important part of your life. Watch movies, cook, do gardening and some organizing stuff, and learn a new language. Somebody has said it right, “Instead of worrying about what you cannot control, shift your energy to what you can create.” And, let us live in the moment and expect things to get better soon.

 Mina (name changed) is a 17 year old girl living with her parents. She has always been a diligent child and a friendly person. Since the lockdown started, she had to stay with family members all day long, which started making her more irritable. She started to argue and fight with everyone, and even her neighbor started complaining about her being rude and aggressive. Mina started becoming more socially isolated, her anger and irritability also started rising, and she started feeling lonely. She began staying alone in her room for hours and spoke to no one. She began feeling hopeless and thinking that she was good for nothing, and that it would be better to die instead. She cried all night but couldn’t tell her family about it. This feeling continued and she started showing symptoms of stomach ache and headache. After these complaints, her family became more concerned about her and sought help from the counselor, where she received counseling that helped her to bounce back.

Interview with Alisha Adhikari, a professionally trained counselor with a master’s degree in Clinical Psychology

When we talked to her, she told us that the pandemic had a huge impact on mental health.

Mental health impact due to COVID-19

We surely have faced a lot since the pandemic broke out ten months ago. Due to the uncertainty about the virus, the world had to face an extended period of lockdown that caused a lot of problems around the globe, be it physical, social, or mental.

Due to the outbreak, many people went through fear, worry, and stress, which could be considered as normal responses to the threat we face during this uncertain pandemic situation. The fear that people are experiencing in the context of the pandemic is understandable, especially in the cases of older adults, healthcare providers, and people with underlying health conditions. But, the new way of life that we had to adapt to has definitely restricted our movement, impacted social life, and affected mental health in many ways.

The lockdown and restrictions imposed by the government forced the shutting down of small businesses, closed schools and colleges, restricted mobility of people, etc. Many people have become unemployed; they had to struggle with loans, arranging even a daily meal, and similar issues, which has been a struggle for many, leading to rise in anxiety, stress, and depression. The increased rate of suicide can be seen as one of the visible impacts of COVID-19 in Nepal, as well as around the world.

The World Health Organization (WHO) recently published the results of a survey of the impact of COVID-19 on mental, neurological, and substance use services in 130 member states, which revealed that most countries are experiencing some disruption to these services, with the greatest impact on community- based and prevention and promotion services. WHO showed an insufficient number or redeployment of health workers to the COVID-19 response, use of mental health facilities as COVID-19 quarantine or treatment facilities, and insufficient supply of personal protective equipment (in 28% of the countries). This study is based on mounting evidence that the pandemic has a huge impact on the mental health and well-being of people around the world. WHO also reports that misuse of substances, particularly alcohol, has been rising, and different people are showing different responses to this situation. People with mental health issues are also being affected by it. People with salaried jobs are far less likely to be affected than those with informal, daily wage jobs, which include a substantial proportion of the workforce in lower-income countries. Frontline workers are experiencing increased workload and trauma, making them susceptible to stress, burnout, depression, and post-traumatic stress disorder (PTSD).

Stress is a natural psychological and physical response to life’s demands. Everyone has their unique response to stressful circumstances, and during a crisis, it’s natural to feel stress and worry. But, many regular challenges will drive you beyond your capacity to cope, such as the impact of the COVID-19 pandemic. During this time, many

individuals may have mental health problems, such as anxiety and depression, and these feelings may shift over time.

You may find yourself feeling helpless, powerless, sad, frustrated, irritable, hopeless, anxious, or afraid, despite your best efforts. You may have difficulty fo

cusing on the usual tasks, appetite changes, body aches and pains, or sleeping problems, and you might feel out of sync with your family members and may fail to face regular chores. When the signs and symptoms last for several days in a row, make you miserable, and cause problems in your daily life so that you find it hard to carry out normal responsibilities, it’s time to ask for help.
How to cope with the pandemic

1. Understand that you can feel sad, stressed, confused, scared, or angry during a crisis.
2. Talking to people around you whom you trust can help us, as well.
3. Engage in creative activities and spend time on your skills.
4. Engage in recreational activities.
5. Be in contact with family and friends, even if it’s virtual.
6. Do not smoke, drink, or do drugs to deal with stress.
7. If you are having trouble managing stress on your own, seek a professional counselor.
8. Take a break from stressful social media and TV news.
9. Take care of your body with proper diet, exercise, and rest.
10. Only trust fact-based news and information.

There are organizations working in the field of mental health that can be contacted for psychological/ psychosocial/ psychiatric help. This pandemic situation isn’t something that we were prepared for, and thus, it has brought a lot of stress and anxiety to all. In this time of uncertainty of the future, we should take good care of ourselves both physically and mentally. Mental health issues are as important as physical health issues and needs proper management and treatment. So, let’s talk about mental health and work on promoting it

Some help lines that provide counseling

• Child helpline (psychosocial support for children below 18 years of age) – 1098
• Kanti Children Hospital (psychiatric services for children below 18) – 9808522410
• National Women Commission (for women and girl child) – 1145
• TPO Nepal – (for any type of psychological support) – 16600102005

The overall health and well-being of a person are dependent on good nutrition, physical exercise, and healthy body weight, along with good thoughts. Therefore, feed your brain with positives. Structure your daily routine. We know we are going through a bad phase of our lifetime, but the recovery rate gives us some hope, and with time, hopefully, we get to hear about the vaccines too. Although our situation might not be great at the moment, we should still be thankful that we are surviving the pandemic.

References:

1. https://www.thejakartapost.com/news/2020/06/15/over-1200-people-killed-themselves-during-74-days-of-lockdown-in-nepal.html
2. https://www.who.int/publications/i/item/978924012455
3. https://www.who.int/teams/mental-health-and-substance-use/covid-19
4. https://www.narayanhealth.org