Psychological aftermath of pandemic Preparing for a post covidera : A mental health perspective

Even as we talk of preparing for a post-covid era, there is a long way to go before we can have the satisfaction of watching Covid-19 grow smaller in our rearview mirrors. For now, all we see ahead is a road paved with increasing numbers of cases.A majority of the population is likely to contract the disease, albeit in milder forms. Do we dare to hope of a future where the world is no longer ravaged by Covid-19? 

In light of the heightened sensitivity to all things related to our physical being, we risk not taking into consideration something equally important - our mental health and well-being. 

How bad will be the Mental health scenario?
Mental health, despite being among the most crucial areas of human functioning, continues to be consistently neglected among the areas of health. The impact of such pandemics on mental health is well documented. From previous outbreaks the world has witnessed, we know that reports of psychiatric symptoms and exacerbation of existing mental health conditions is likely. Mental health services in previous outbreaks like the Ebola virus have been reported to be “overwhelmed” and indeed, findings from EVD showed that people can experience feelings of numbness, fear, detachment and anxiousness while entire communities can experience isolation and fear as well. 

Let’s not get so entangled in the biological, social, political and economic dimensions of Covid-19 that we fail to notice it wreaking havoc on the psychological front. A recent report by the United Nations has called attention to mental health needs of the world's population, showing thatpeople are taking cognizance of this fact. We have started strong and hopefully this momentum will propel us through these turbulent times. 

Covid-19 has not left any of us unscathed, giving us all battles to fight on the personal front. The scenario is identical in all the countries reeling with the deadly pandemic and Indian landscape has its own cultural and belief contexts.

Healthcare workers who are bearing the brunt of the pandemic, are struggling with stress, heightened levels of anxiety and depression as well as emotional trauma, anger and fear, in addition to moral injury which comes in the face of fighting the pandemic while teetering on the edge of a shaky healthcare system with sub-par resources. Doctors, who, on the one hand are being hailed as our heroes are also facing stigma from the community at large. Headlines like “Coronavirus: India doctors 'spat at and attacked” are regrettably, all too common these days. 

Looking deeper, we find people facing countless additional struggles - people stranded miles away from home and family, family members of frontline healthcare workers who are living in fear, couples who are expecting children amidst the pandemic, people who have lost or are on the verge of losing someone to Covid...the list can go on. Suicide is likely to become a concern with mounting financial stress, anxiety related to the infection itself, along with other problems like domestic violence and increased alcohol and substance use. 

Even Covid survivors will need psychological aid.Individuals who have survived a stint in intensive care might still have their mental health compromised by virtue of the traumatic experience they lived through. Post intensive-care syndrome is likely to follow them home for after the infection has left their systems and it is to this need that mental health professionals must be attuned. 

All these segments of our population, the myriad of emotions people are facing amidst the pandemic in addition to the concoction of socio-economic unrest is a call to action for mental health professionals. We clearly have our work cut out for us. Efficient planning and networking are prerequisites for hindrance-free delivery of mental health services.

What the Future Holds: The Post-Covid Era

To put things in perspective, consider this: in 2015, when we asked ourselves, “Where do I see myself in 5 years?”, could any of us have predicted this? Could we have imagined that many of those five-year plans would likely not have been achieved due to Covid-19?

Uncertainty and unpredictability. Uncertainty and unpredictability appear to go hand-in-hand with Covid-19.  Even a World Health Organisation official has said that the virus may never go away completely. When faced with uncertainty, we try to organise and make sense of it. In a case like this, that possibility may be remote and allowing ourselves to give in to the illusion of control may be a sure shot way of setting ourselves up for disappointment. It is important to prepare ourselves to deal with uncertainty. To be able to tolerate the discomfort that comes with not knowing is a necessary and useful skill, both during and after the pandemic. 

A new life: better or worse?  What we have in store for us, is it better or worse? Neither! It is simply different, and that is how we need to take it in our stride. It's true that tomorrow will be different from what we are accustomed to, but using a yardstick based on the life we knew to judge the life we might know will leave us stuck firmly in the past.
         Importance of adaptation. If evolution has taught us anything, it is that old dogs must, at times, learn new tricks, if they are to survive in an ever-evolving world. Effective adaptation can be the difference between surviving and thriving. Whether it means doing old things in new ways or learning to do totally new things altogether, change is necessary and the more we resist it, the more we jeopardise our mental health.

The importance of mindfulness and acceptance

Mindfulness. With new predictions emerging everyday, we can seldom stop ourselves from spiraling into a series of “what ifs”. We consider and begin to anticipate dismal prospects, and before we realise it, the worry and anxiety starts to set in, leaving us confused and helpless. The importance of a mindfulness-based approach cannot possibly be overstated in these times where people are expected to build, or rather, rebuild their lives on shifting sands. Taking the time to ground ourselves in the present moment can help us deal with this crisis, one day at a time. Taking a moment to halt, get in touch with our surroundings and our present experience can bring a sense of calmness of which we are in need more than ever. 

Acceptance. From a mental health perspective, professionals can help people reach acceptance of the present situation, while emphasising that acceptance does not have to include a liking of the situation. At this stage, we need to remind ourselves that we are in this for the long haul, and acceptance is what can help us channel our limited resources into doing the best we can.

Necessity is the mother of in(ter)vention:
           A well-timed approach at this point will be the basis for future intervention. A multifaceted and proactive strategy focused on screening, psycho-education, prevention and management of psychological problems is the need of the hour. The word ‘intervention’ now has a digital flavour to it. For mental health professionals, firstly, ensuring visibility on digital platforms is imperative since mental health and digital services presently show enormous scope for growth. Ensuring accessibility of mental health services across a variety of populations and socio-economic strata is also important. Many people may not realise that what they are facing is a legitimate concern and that they can seek help and expect to feel better.
            The way people are sensitised to signs and symptoms of Covid-19 is essential. Professionals can psycho-educate them about signs and symptoms of psychological distress to be on the lookout for. Spreading awareness and encouraging self-checks will be useful as prevention is surely better than cure. Screening for mental health problems is also crucial and we need to cast the net wide. Individuals at-risk once identified should be offered psychological help by collaborating with various organisations and professionals to undertake a collective effort with multidisciplinary teams.

Possibilities of intervention are endless

The possibilities for delivering virtual interventions are many. In addition to virtual individual and group counselling/therapy sessions, app-based and self-help techniques can also be helpful. Telephone based helplines are already in place. Helping people work through their worries and put them in perspective, weed out the distortions while coming to terms with and accepting uncertainty can be what makes all the difference in how they perceive the outbreak. Professionals also need to undertake research to the best of their abilities during this time because that will be the bedrock on which we will build further interventions.

The new ways of doing and being that we have learned due to Covid-19 are likely to be the norm for the foreseeable future. Another set of duties which take precedence include helping people gradually accept and get used to this new way of life. Be it working from home, or maintaining social contact while undergoing physical distancing, giving groups of  people a safe space to vent, perhaps offering solutions to problems being encountered may be beneficial. 

Even months from now, the scars on our psyche will likely remain. Understandably so,  everything we once knew has changed. Engaging in tasks to maintain a healthy mind and by extension, a healthy body is something we need to prioritise..  The onus for mental health is on the general public as much as anyone else.

Looking Forward
Let us not fall into the trap which positive psychology pioneers have worked so hard to get us out of : an overwhelming focus on the negatives. We need to highlight instances of strength and resilience so that we can draw strength and hope from them and pass it on to those who need it most.
We have had the privilege to witness some extraordinary acts of kindness which will not easily be forgotten. Be it local police officers queueing up to celebrate the birthday of an elderly resident or good samaritans feeding stray animals, these instances will remind us what we are capable of. The climate crisis which was, until very recently, looming precariously over our heads, has taken a turn for the better with reports of clearer water and cleaner air from around the globe.

As mental health professionals, how quickly we can prepare for the incoming onslaught will make all the difference. We have focused our years of study into making high-quality mental healthcare accessible to the masses. This new-found affinity for technology may help us do just that by strengthening the roads in our ever-expanding global village. Technology was always going to be the way of the future, and with Covid-19, it simply got fast-tracked. For all of us, then, the future is now. 

Posted by: Brain Behaviour Research Foundation of India

Written by: Sanjna Shukla

Edited by: Dr. Meena Mishra

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