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jueves, 6 de agosto 2020
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Mental health during the coronavirus outbreak

By Jenny García, Psychiatrist
Translation by José López

It is common for people to feel stressed by fear of illness and death of themselves or loved ones, and being worried about work and the possible decrease in income. Fear of being excluded, feeling unable to protect loved ones, as well as boredom, loneliness and helplessness, can also emerge when isolation is a measure to be taken.

Previous epidemics have shown that these factors could lead to an increase in anxiety, depression and stress-related disorders in vulnerable population, as well as relapses in people with a history of addiction to psychoactive substances. In this regard, some countries have developed mental health interventions during the COVID-19 outbreak in order to reduce the psychological impact on the population. Therefore, the following recommendations have been determined for different population groups:

For the general community:

  •  It is important to access information from reliable sources such as universities, the Ministries of Health and the World Health Organization. Although coronavirus is a real threat, rumors and misinformation can result in an unnecessary increase in stress.
  •  Keep in touch via telephone, text messages and social network with relatives and friends who are self-isolating or quarantining because of COVID-19.
  • If you live with older adults with memory loss, you should provide them with clear, understandable information, as many times as necessary, about how to reduce risk of infection.
  • Don't use tobacco, alcohol, and other drugs to cope with stress.
  • Limit the time you and your family spend gathering information about the epidemic to one or two hours a day. Be careful not to read too much about COVID-19 outbreak as this can increase anxiety.
  • You may have to stay at home. This measure is necessary so that everyone is safer and actions can be taken to make the situation more bearable.  For example, buying food in advance, implementing new activities with your children and family, working from home, maintaining a healthy lifestyle (proper diet, exercise, enough sleep), and maintaining social contact via telephone and social networks, are measures that can help to cope with this situation.
  • It is normal to feel sad, nervous, worried or irritable. Try to talk to people you trust, and if you feel you are losing control, seek help from mental health professionals like a psychologist or a psychiatrist.

For those self-isolating or quarantining:

A quarantine is when someone who has been potentially exposed to a contagious disease is separated from healthy people to lower the risk of spreading the disease to others. On the other hand, isolation is when someone who is already sick with a communicable disease is separated from healthy individuals until they are no longer contagious. However, quarantine is quite stressful due to an increased risk of illness and death, and the stigmatization of patients.
It has been recommended that health practitioners who are in contact with isolated or quarantined patients, are provided with solid psychological first aid training so that they know when to seek help from mental health professionals, preferably via telehealth services.

Recommendations for this population group include:

  • Understand that your collaboration is very important to prevent the epidemic from spreading. Isolation prevents the spread of the disease to other people, since it can be transmitted even without the presence of symptoms. Actually, you are saving lives.
  • Stay informed about the epidemic by accessing reliable sources only. However, you should limit the time you and your family spend getting information to a maximum of one or two hours a day. Be careful not to read too much about COVID-19 outbreak as this can increase anxiety.
  • If you have children and you are with them, it is recommended to implement daily routines regarding sleep, feeding and study hours, as well as playing with them. Teach them how to wash their hands and reduce the risk of infection through games and rhymes. In difficult times children need more love and dedication. Depending on their age, show them your love, listen to their concerns, and speak kindly to them. Try to stay calm in front of them and give them clear, age-appropriate information about what is going on.
  • Keep in touch with your family and friends via telephone, WhatsApp and social networks.
  • Being locked up for a long time can cause discomfort, therefore, carry out activities such as reading, playing tabletop games, exercising, etc. It is good to plan the day so that you feel autonomous and calm.
  • If you have questions about your health and the chances of recovery, ask your doctor or a health practitioner about it.
  • If you had to be separated from your children, understand that this measure has been taken to keep you and your family safe. Stay in touch with them by phone or social media.
  • It is normal to feel stressed. If you feel very anxious, nervous, or depressed, seek help from someone you trust or from mental health professionals like a psychologist or a psychiatrist. You should also seek help for children and older adults if you notice that they are very depressed, nervous, or have changes in their behavior.

For health practitioners who have direct contact with patients:

It is normal to feel stressed because in addition to the aforementioned factors, health care personnel are more exposed to issues such as stigmatization; security measures that require physical effort and make it difficult to comfort patients; long working hours; the need to keep updated as new information emerges; as well as the fear of transmitting the virus to family and friends. Mental health monitoring of healthcare staff and funeral workers during and after the epidemic has been also recommended.

Recommendations for healthcare personnel include:

  • It is normal to feel stressed in a situation like this. Some healthcare professionals think that they are not doing their job well enough since the procedures they must follow are very strict, and this increases stress. Feeling stressed does not mean that you are unable to do your job well or you are weak.
  • If you are very stressed, you can draw on strategies that you have previously used in similar situations. However, avoid drinking alcohol, smoking, or using other drugs, as this can deteriorate your physical and mental health in the long term.
  • Do not feel guilty or weak if you are overwhelmed by stress since it is common during circumstances like this. If you feel that you have become more irritable, depressed or anxious, or if you feel tired or have unexplained physical symptoms, it is advisable to seek help from mental health professionals like a psychologist or a psychiatrist.
  • Effectively managing stress and maintaining psychological well-being is very important at this time. Therefore, you must take self-care actions by getting adequate rest, taking breaks during your work, and eating healthy.  When you are not working, try to be physically active and keep in touch with your family and friends.
  • Feeling marginalized and stigmatized because you are in contact with COVID-19 patients, can make the situation even worse. Therefore, you should keep in touch with your loved ones by phone and social media.  Also, talk to your colleagues or your boss, as they may be going through the same situation, so they will give you support.

For people with mental disorders:

People with mental disorders can have exacerbations of symptoms as well as recurrences due to the stress caused by the COVID-19 epidemic and alterations in the provision of health care services. Therefore, they will be more vulnerable than mentally healthy people. The following recommendations are addressed to health care personnel and health service providers responsible for treating patients with mental disorders.

  • Precautions must be taken to ensure that people with mental disorders continue to receive mental healthcare services. Also, if they have tested positive for COVID-19, they should be treated in the same way as other people.
  • Existing health care services must be tailored to the conditions posed by the current situation. For example, by using mobile health units, and as far as possible, avoiding group therapies. If services are not available in your area, they should be provided via telehealth services such as video calls and phone calls.
  • Mental health institutions and facilities for the chronically ill and individuals with drug dependence should implement procedures aimed at lowering the risk of infection, as well as care protocols for those at potential risk of infection.
  • Draw on organizations that can help provide mental health support, such as religious and social groups.

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