LEFT UNATTENDED, MENTAL HEALTH ISSUES THREATEN A SILENT PANDEMIC

The emotional ripples of the pandemic can linger long. This can eclipse recovery and efforts to rebuild societies

The human mind has to deal with a lot more when living through a pandemic, disease outbreaks, disasters, wars and conflicts.

Crisis settings implant bitter memories. Everyone gets affected; different people are affected in different ways. The emotional ripples of the pandemic can linger long. This can eclipse recovery and efforts to rebuild societies.

On a recent trip to Sendai in Japan, where I had worked soon after the massive 2011 tsunami which hit Sendai and Fukushima, relief workers, and mental health experts told me that some children survivors there refused to flush the toilet even years later because the sound and movement of the water brought a flashback of the deadly tsunami. Disasters leave lasting footprints on young minds.

During such adverse situations, the mind is like a balloon. The more air you try to pump into the balloon, it finally reaches its full capacity and gives way. Similar is the pressure that you accommodate in the mind. Finally, the mind just collapses, resulting in long-term psychological suffering.

This pandemic is an unprecedented crisis with health, economic, and humanitarian dimensions. Several factors are amplifying anxieties such as physical distancing, reduced interactions, and uncertainty over medicine, vaccine, lockdowns and loss of jobs. Frontline health and social care workers, people with pre-existing mental health conditions and those who have limited access to health services such as children in conflict zones, and refugees are more vulnerable.

Some health workers consider themselves as heroic and rarely ask for help until it is too late. Some are discriminated against because of stigma around mental health issues, cultural practices, or societal norms.

Why address emotional needs?

Currently for the right reasons, the priority is to save lives and strengthen public health, hygiene and sanitation measures. However, people’s minds require attention or else this can result in a silent epidemic, causing serious damage to individuals and the economy.

The Ebola outbreak in West Africa showed us how the minds of several children who lost their family and friends were impacted just as severely as it threatened their physical needs. COVID-19 Pandemic has some similarities. Many customary funeral rites and ceremonies cannot take place and hospital visits are prohibited. Here is where community leaders and religious leaders could play a critical role to support family members to mourn and grieve appropriately.

Firstly, we need to recognise the needs of people, their fears, hopes, and aspirations. Secondly, we need to mobilise social capital. In my own experience, while working in disaster zones worldwide, I have often found that the disaster itself can act as a catalyst to bring and bind people together, and draw out the best in people. Disasters can trigger solidarity and compassion and remind everyone that ‘we all are in this together’. It is important to galvanize such social capital.

Most importantly it requires an early start, long-term vision, community support, and sensitive psychological and social interventions. Act Early, Act Fast, Act long term.

Psychosocial support is life-saving

Actions to address the psychosocial needs early on during a crisis are critical to stop or delay simple symptoms and anxieties from turning into complex mental health problems.

Basic psychosocial services in the early stages of a crisis can go a long way to reduce the number of people who will need specialized, therapeutic, and expensive care at a later stage.

It is necessary for the policymakers, donors and aid agencies to recognize that taking care of the mind and Psychosocial support is life saving and life-sustaining.

The United Nations’ Central Emergency Response Fund, the Inter Agency Standing Committee’s guidelines on Mental Health and Psychosocial Support in Emergency Settings and universally accepted Sphere Humanitarian Standards (‘go-to guide’ including for disaster responders in India), all recommend the top priority actions needed in an emergency to save lives, including the provision of Psychological First Aid.

If access to treatment for mental health issues is tough to come by – and that goes for aid workers and disaster victims – family and community-based approaches must be put in place.

How do we change this story?

What can help to heal and turn victims to resilient survivors is access to early and culturally appropriate mental health and psychosocial services.

In 2018, the medical journal The Lancet reported that severe mental illness is projected to cost the global economy $16 trillion between 2010 and 2030. Most low-income and lower-middle-income countries spend less than US$2 on mental health per person annually.

In the long run, early action is cost-effective. Left unattended, some of the simple symptoms and anxieties may result in irreversible psychiatric diseases that will need specialised therapeutic and expensive treatments.

During a visit to the earthquake-impacted areas in Chengdu in People’s Republic of China, I met some industrialists who were concerned about the impact of the devastating earthquake there on factory workers.

In crisis settings, such as earthquakes, alcoholism and substance abuse can become irreversible ‘coping strategies’ resulting in absenteeism, and low productivity. Investing in emotional care helps to heal broken minds; also aids recovery and bolstering economy. The UN has added the promotion of mental health and well-being in the Sustainable Development Goals.

The overall objective of psychosocial services to people impacted by the crisis is to bolster their dignity, hope, and confidence; protect their rights; and provide them basic services.

“Our approach is an adaptation to keep humanitarian Mental Health and Psychosocial Services running and to ensure staff and volunteer care and support by encouraging employers to take the duty of care seriously,” said Sarah Harrison, Chair of the Inter Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in emergency settings, a network of UN agencies, aid agencies and mental health professionals.

With lost jobs and new political and social consequences, lives will never be the same again. We are witnessing the best and the worst and this pandemic is leading humanity to ‘new reality’. Aid agencies are adapting fast. For example, children’s organisations such as War Child’s ongoing specialized services on education, child protection and mental health and psychosocial services in conflict and war zones are now complemented by public health and hygiene practices.

Often jobs and food to keep their families from hunger or cash payments as social security are preconditions to help mend broken minds. Psychiatric counseling sessions alone may not make much difference if children are hungry, sick, dehydrated or forced into child labour with their parents losing their jobs. Personal hygiene is a very good tonic for instilling dignity, self-efficacy, and confidence. The point is to make mental health and psychosocial support as a complementary ingredient and not as a substitute. It is necessary to strengthen education activities since they can help children bounce back on their feet quickly.

To make emotional care and healing a reality, family, and community-based approaches are necessary. Academics and experts must move beyond the walls of their labs, consulting rooms, and lecture halls. Dealing with the mind is complex and it can’t be left only to mental health experts alone. You can’t stop trauma only with psychiatrists.

Let people connect with matters of the mind. Media can play a critical role. Demystify matters of the mind; make it part of popular science – something that is fun to deal with.

Creativity and collaboration are key. For example, Clowns Without Borders, a volunteer organization, deploy clowns to entertain and offer laughter in humanitarian crisis settings. We need to work with artists, musicians, influencers, and entertainers.

Mental health and psychosocial needs in humanitarian settings is not a priority for policymakers, governments and donors. Strong political commitment, clear policy directions, and improved investments are needed to address the emotional impacts of the pandemic. If left unattended, they will linger for long while eclipsing other efforts to rebuild societies. This pandemic is a wake-up call to invest in public health and to build robust mental health and psychosocial services.

(Dr Unni Krishnan is Humanitarian Director, War Child, a humanitarian agency that works with children in wars and conflict settings. War Child believes that no child should be part of war. Ever.)

An edited version of this blog also appeared on The Federal: https://thefederal.com/opinion/left-unattended-mental-health-issues-threaten-a-silent-pandemic/