Dr. Pratima Murthy, Director, NIMHANS, Bengaluru, talks exclusively to The Hindu about the short-term and long-term implications of the COVID-19 pandemic on mental health, and what needs to be done.
COVID-19, an unprecedented humanitarian crisis, has affected people in various ways — financially, physically, emotionally. What kind of myriad mental health issues has it led to?
Initially, people's fears were about contracting the infection. They feared going out. There were worries about what kind of mask and protection was adequate. There were fears of contamination and people started sanitising all grocery items. Subsequently, once it was clear that chances of surface transmission of the virus were uncommon this fear subsided. But then during the second wave, the virus affected a lot more people; entire families got infected. It created panic.
Then, generally, when a person is sick, family members rally around that person and provide a lot of care and support. Similarly, in case of death, family and friends come together to provide support to the aggrieved family. There are several rituals that take place, which in a way help deal with the loss. Lack of social support particularly during grief is very psychologically distressing.
So, a lot of people are finding it difficult to come out of the trauma, some are facing repeated panic attacks.
How has the pandemic affected the psycho-social health of children?
Children have perhaps shown the maximum amount of resilience as they are ones who had to make the maximum amount of change — they have not been able to go to school; they had to adjust to the new online medium of education; then there are a large number of children who have no or limited access to even online education.
We held a painting competition for children to explore how they managed the lockdown. Though the paintings of some children reflected the loneliness and isolation they experienced during the first lockdown, paintings of most children were positive and hopeful. They admired the frontline workers; created pictures on how they were playing indoor games and doing a lot many activities with family members. But when confinement became protracted, it became difficult for children to adjust to what we call the new normal. Older children faced uncertainty regarding their academic future. Lack of access to a lot of developmental activities, especially for children who were out of school, or those in vulnerable populations can certainly affect their mental well-being.
Another worry is too much exposure to consumer technology. During this prolonged confinement at home, children have started using technology for non-academic purposes, which can expose them to other influences such as gaming, gambling, pornography. Lack of physical activities, peer interaction, social gatherings can affect their physical development and cultural competency.
Does COVID-19 have a long-term impact on the mental health of people?
Yes, it can have long-term implications. We are seeing cases where people are suffering from Post-Traumatic Stress Disorder, which can persist for a long time. Then on people with pre-existing mental health problems, the stress, anxiety, and grief could have a compounding effect.
Third, we now know that the COVID-19 doesn’t affect just the lungs, it can affect multiple systems of the body, including the brain. It can cause inflammatory responses in the brain. There have been studies on the long-term sequelae of SARS and MERS, where people suffer sleep disturbances, depression, anxiety, and in some rare cases, psychosis. And then there is Long COVID, which is characterised by fatigue, tiredness, brain fog, memory loss, which can also affect the mental health of people.
Mental health seems to be emerging as a big concern. How can it be tackled knowing very well that not many people seek help for mental illness in the country?
There has always been a gap between the need and treatment for mental illness. Somehow, people never felt comfortable talking about their emotionality. And I think now that there is a greater awareness of more aspects of mental health among wider population, we too need to address it at an individual level, at the societal level, and at the policy level.
First, people need to realise that just like the way they seek medical help for their physical illness, they need to seek help when they feel mentally distressed. Then, they also have to learn the ways to de-stress their mind, to deal with stressful situations. They need to look for ways to engage in safe recreational and relaxing activities.
Then, mental healthcare must be integrated with physical healthcare. In fact, government’s District Mental Health Programme is a step in this direction. Asking people about how they are feeling, if they are sleeping well, if their mood is stable should become part of routine healthcare. Any healthcare provider should be able to identify and counsel a person in mental distress. Besides, there is an urgent need to strengthen online mental health services. At NIMHANS, we have set up a 24x7 helpline. Managed by mental health professional, the helpline provides health and psychological support to the affected population.
We need to understand that our mental health has a direct relation with our physical well-being. Stress, anxiety, fear, depression can lead to many physiological changes in the body and can manifest as any chronic illness such as diabetes, hypertension, obesity, etc.
Do you think a lot of exposure to tragedies can impact the psychological health of a person? How should frontline workers manage the strain?
Healthcare workers, frontline workers, media people are exposed to a lot of trauma and tragedies, and this can impact their mental and physical health. To cope up with the trauma, one needs to seek a balance between stories of tragedy and positive stories. For example, a doctor who has lost some patients to the pandemic, should also look at the patients he/she has saved; if there is a mortality toll, there are also those who have recovered. It is important to see things from a more balanced perspective during such a crisis, however frightening it sometimes is.
It is an unprecedented crisis, we need to stand stronger — both physically and mentally — to be able to face it and come out of it.
