Throughout the coronavirus (Covid-19) crisis much emphasis has been placed on factors that might make individuals physically ‘high risk’ should they contract the virus. NHS UK has published guidelines to help identify and advise people within this category - including, for example, cancer patients, transplant recipients, and those with heart, lung, or kidney conditions – on how to ‘shield’ and prevent themselves from coming into contact with the virus. The reason is that their compromised physical health means a heightened level of vulnerability and the likelihood of becoming gravely ill. What we may have heard less about over recent weeks are factors that might lead those with mental health difficulties to be at higher risk during this crisis. Whilst an individual’s mental health history may not necessarily heighten or reduce their risk of physically contracting coronavirus (Covid-19), or directly influence how seriously they would be affected if they were to fall ill, it can have a profound impact on how they cope with the current situation. It seems universally recognised that the coronavirus (Covid-19) pandemic, and all the measures that have been put in place to halt its spread, are affecting people’s mental health[1]. Who might warrant additional care and consideration from a psychological perspective, though? Here, I present several different categories of mental health difficulty and explore how people living with them may be affected at the current time. Anxiety, Panic Attacks & OCD It’s an anxious and worrying time for most people right now as we wonder, without clear-cut answers, how long the virus will be prevalent for, whether we and the people we love will remain safe, when restrictions to our daily lives will lift, and how our individual and collective livelihoods will be affected longer term. For anyone with anxiety, for whom intense levels of worry and fear are a general and restrictive feature of everyday life, such concerns are likely to be amplified at present. This may lead to feelings of being overwhelmed. Some sufferers of anxiety may also be noticing an increase in panic attacks (intense periods of fear, sometimes accompanied by shortness of breath and shaking), and those with obsessive compulsive disorder (OCD) may find themselves drawn towards compulsive behaviours such as handwashing and cleaning – particularly now these behaviours are being promoted as ways of protecting against the virus. Finding a trusted person to talk to is likely to help anyone experiencing these types of conditions, as struggling with worries and compulsions alone can feel isolating and also lead to anxiety spiralling as it goes unchecked. Limiting one’s exposure to the news and social media can also be a helpful strategy for dealing with anxiety at this time, as is sticking to reputable sources of news that can be relied upon to be factual rather than sensationalist. Whilst there is a lot about the current situation that none of us can control, anyone with anxiety may benefit from reminding themselves of the things they still can control at the present time – for example, planning how they spend their day and creating a routine that promotes self-care and overall well-being. Bereavement & Loss Anyone who experiences the death of someone close to them during this period, be it due to coronavirus (Covid-19) or any other reason, is likely to have a particularly challenging bereavement. It may be that they were unable to see the person in their life who died due to social distancing, and that they can’t reach out to friends and family after the loss in the way that they usually would. Funerals currently have to be much smaller, scaled-down events than families might wish for, and this can also feel very upsetting. Similarly, anyone who has experienced a bereavement in the past may find that difficult memories of this are stirred up through the constant reminders of death and suffering that we are encountering in the news right now. It is important to remember that grief (the progression and range of emotions we go through as we adjust to losing someone close to us), is a natural process and not something to necessarily be pathologized or viewed as a mental health ‘problem’ – even though it can feel very difficult at the time. If anyone you know is bereaved at this time, then gently acknowledging their loss and offering what support you can over the phone or through video-chat will likely be helpful. Do not push a bereaved person to ‘open up’ or share deeper feelings right now, though. They will be in the early stages of their loss and, given the uncertain and unusual circumstances we’re currently all experiencing, they may not feel safe to connect with more complex emotions for a little while. Depression In its mildest form depression can mean feeling low in mood and finding it hard to muster up the energy to engage in day to day life and the things you once enjoyed. More serious depression can manifest in feeling unable to perform the most basic aspects of self-care, such as eating, bathing and dressing, and can result in sufferers feeling hopeless and sometimes suicidal. Many aspects of the current coronavirus situation might compound the difficulties of a person suffering with depression. Social distancing, for example, might draw a depressed person living alone further into isolation, and working from home might reduce a depressed person’s motivation to get up each day and maintain a reasonable routine. Worries about the future and bleak news stories may particularly impact on someone who is already depressed. Therefore, if someone you know may be experiencing depression at this time, do check in on them to provide social and practical support. If their depression seems more severe (particularly if they have spoken of feeling suicidal or at risk of harming themselves), encourage them to speak to a mental health professional – who should still be able to offer them a consultation remotely. Telephone helplines such as the Samaritans (and other national helplines listed through Befrienders International) can also offer valuable support to anyone in crisis. Trauma Anyone who has directly experienced or witnessed trauma in their past may have a nervous system that’s particularly sensitive to stress. In worrying or uncertain situations, trauma survivors may experience strong physical and psychological reactions such as shaking, sweating and unwanted ‘flashbacks’. They may also feel very ‘activated’ and easily launched back into the ‘fight or flight’ mode we associate with responding to danger. It’s easy to see how the current coronavirus crisis might feel very ‘triggering’ for someone with a history of psychological trauma, and how some of their responses might feel distressing or overwhelming. However, such responses are usually very normal – what we might call a ‘normal reaction to an abnormal situation’. Trauma-informed counselling (which can be delivered remotely) can help individuals in this situation to make sense of their reactions and to learn how to manage them – for example, through learning relaxation and grounding techniques. Summary Those with current or historic mental health difficulties are likely to be at a higher risk of struggling during the coronavirus outbreak - even if their physical health remains unchanged - due to increased levels of worry and a heightening of certain symptoms, as detailed above. ‘Shielding’ and supporting these individuals may not be as straightforward as is the case for those with physical vulnerabilities. Employers, colleagues, friends and family members of those living with mental health difficulties will do well right now to sensitively check in with them and encourage them to seek further professional support if this seems necessary. Below are details of some relevant sources of online information. However, it is worth remembering that GP surgeries and community mental health teams (CMHTs) are still available and able to offer support and guidance at this time in the UK, albeit remotely. The same should be applicable for emergency mental health services overseas. Therefore, if managing staff abroad, now may be the time to check relevant details and make your team aware of how such services can be accessed if needed.
Author: Felicity Runchman, Associate, FD Consultants Date: May 2020 References [1] Roxby, P. Coronavirus: ‘Profound’ Mental Health Impact Prompts Calls For Urgent Research. BBC News [Internet]. 2020 April 16 [cited 2020 May 1]. Available from https://www.bbc.co.uk/news/health-52295894.
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