In this time of the pandemic, the mental health status of most people can be compared to a silent but ticking time bomb. As many as 264 million people in the world suffer from depression and about 85 per cent people in low and middle-income countries do not receive any treatment for their condition.
According to the Lancet Commission on global mental health and sustainable development, mental health problems exist as a continuum — from mild, time-bound distress to severe mental health conditions, the range can vary a lot. The pandemic can have an influence on the mental health of an individual based on where that individual is situated on that band. Many people who usually cope well with a distressed mental state may report a quicker reaction to a trigger due to the multiple stressors caused by the pandemic. Those who had sporadic episodes of anxiety and distress previously may experience an increased frequency and intensity of such occurrences, bordering on a serious mental health condition. Meanwhile, those who had a mental health condition previously may experience even worse — a gradual decline of their condition and lower functioning.
Identifying the vulnerable
While the onset of a mental health problem does not discriminate, certain populations are more vulnerable to it. Most important among them are elderly people and those with pre-existing and chronic health conditions. They may be people who have long-drawn illnesses such as hypertension and diabetes, while people with diseases like cancer and other degenerative illnesses are also known to have depressive tendencies. Besides, many elderly people live alone, especially in cities, while some may live in a commune, making them vulnerable to stressors such as loneliness. Some of them, particularly those with weaker or damaged cognitive capabilities, are at a higher risk of isolation as their access to advice on infection prevention may be limited due to impairment.
Children and adolescents are the next most vulnerable group. They may grapple with several problems including loneliness, nervousness, irritability, restlessness and difficulty in concentrating on tasks. The long exposure to screens due to online classes can aggravate these problems. Estimates show that suicide is the second leading cause of death among 15 to 29-yearolds and that nearly half of all mental health conditions start by the age of 14. They are also at a higher risk of abuse, particularly those living in crowded settings or who live and work on the streets.
Frontline workers and first responders in health and long-term care have also been stigmatised and faced assault during the pandemic, along with a growing amount of stress due to extreme workloads, witnessing the deaths of patients, taking difficult decisions, being at risk of becoming infected and becoming the carrier to their families and communities.
Women are also at risk during this time. The high incidence of violence against women even in the pre-pandemic era can be a marker of their vulnerability to genderbased violence and its impact on their mental health.
Elevate mental health services
The social and economic faultlines exposed by the pandemic may result in large-scale unemployment, shrinking of existing social safety nets, loan defaults, starvation and penury, and an increase in gender-based violence, providing a ground for an increase in chronic stress, depression, anxiety, substance abuse and selfharm, which is likely to increase morbidity, suicides and the number of disabilityadjusted life years (DALYs) linked to mental health. So much so that the next statelevel burden of disease may have mental health as a parameter for DALYs.
To make matters worse, the coping mechanisms for people in such difficult times may not necessarily entail dialling the mental health helplines launched by the government and NGOs, but taking refuge in alcohol, tobacco, or drugs, or spending more time on potentially addictive behaviours such as online gaming. According to the United Nations, Canada reported that 20 per cent of its people, between 15 and 49 years, increased their alcohol consumption during the pandemic.
Therefore, it is time to shun the disease-oriented approach to mental health and treat it as a part of general wellbeing, much like the focus on nutrition, and ensure there is no dearth of options for accessing support. All healthcare programmes should have a mental health aspect to it. Including mental health and psychosocial aspects in our Covid-19 national response is essential because, as the UN states, it will improve the quality of programming, enhance the coping skills of people during the crisis, and is likely to speed up the recovery and rebuilding of communities.
The campaigns for mental health should be penetrative and expansive like the ones for polio and HIV which helped to remove the stigma attached to these diseases to a large extent. The government and media have an extremely important role in ensuring the spread of the right message in the right intensity, and the pandemic is an opportunity to elevate, promote and protect mental health interventions at the level of the society so that the benefits trickle down to the affected individuals.
The writer is an expert and entrepreneur in mental health. Views expressed are personal.