COVID-19 and Mental Health: Working together in India

COVID-19 is re-writing human history. Two thirds of the world is under “lock-down”, trillions of dollars in global savings and revenues have been wiped out, world GDP is contracting, and millions will be losing their jobs. It is shaking the entire health establishment of the world. The number of infected people is nearing two million and more than 113,000 people have lost their lives, including 100 doctors and many other health professionals. The world is looking at a calamity, worse than a world war and with no end in sight.

India, with a huge population of 1.38 billion, is facing a daunting task. There is a nation-wide “lock-down” from March 24 to April 14, 2020 which is likely to be extended. The Union and State Governments are doing tremendous and co-ordinated work. The number of infected is nearing 9,000 with nearly 300 deaths. But we fear the worst is not over, and hence there is constant vigil. The enormity of the country’s size and population is making the task of the planners and health professionals much harder.

Last week, in an effort to address the mental health impacts of COVID-19, the Dept. of Psychiatry at the Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India together with the National Alliance for Mental Health India, organised a lecture titled: COVID-19 and its impact on Mental Health.


Prof Roy Kallivayalil delivers a lecture on COVID-19 and Mental Health at the Pushpagiri Institute, Kerala, India.

Enforced isolation, social rejection, and financial crisis can contribute to depression

"Quarantine can cause negative psychological impacts, including post-traumatic stress symptoms, confusion, anger and depression" said WPA Secretary General, Prof. Roy Abraham Kallivayalil as he delivered his lecture. Noting that "officials should quarantine individuals for no longer than is required, chalk out clear rationale for quarantine, provide information about protocols, and ensure sufficient supplies for them." Prof Kallivayalil also added that the government decision to quarantine those returning home from COVID-19-affected countries was a step in the right direction.


"Many people feel distressed at the prospect of being quarantined" he said, citing examples of one person who ran away from the isolation ward at a General Hospital and was found hiding in his home; as well as two American citizens who fled from Medical College Hospital, Alappuzha, but were tracked down at the Cochin international airport. In addition, a post-viral fatigue (a consequence of the virus infection on brain function) and intense bereavement could cause severe depression among the quarantined people. "On April 10, one such ‘guest worker’ from Orissa committed suicide", he said.

World Health Organization (WHO) guidelines

Enforced isolation in a quarantined environment (often in strange places), social rejection by people who are afraid of dealing with the cured or suspected patients, and unexpected financial crises are just some of the other contributing factors to depression and suicidal thinking in the quarantined people, said Dr. Kallivayalil. Referencing the World Health Organization (WHO) guidelines to minimise the psychological stress in quarantined and affected people, he noted that those who are home quarantined should maintain a healthy lifestyle, which includes proper diet, sleep, exercise, and social contacts over phone.

Only credible information

It is important that quarantined and affected people are encouraged to gather credible information to help them assess their risk and take precautions, said Prof Kallivayalil; for example, a trustworthy source like the WHO website or a State public health agency would be most reliable. He also recommended that quarantined and affected people should avoid anu upsetting media coverage and seek help from mental health professionals when needed.


"Our medical, public health, political, economic, and educational institutions have to work together to face this global threat," said Prof Kallivayalil. "Initially, there were attempts to trivialise this viral disease, treating it as a ‘flu-like illness’ that was likely to disappear soon, but COVID-19 has proved more devastating to humanity as a whole."

Emotional needs

"The healthcare systems are overworked and we have to prevent it from crumbling down", said the Prof. "The mental health and emotional needs of all those who suffer from COVID-19, those who are quarantined, their families, and also of the health providers should be addressed. Persons with psychiatric disorders are especially at risk in these challenging times."

Author: Professor Roy Abraham Kallivayalil, WPA Secretary General and Professor and Head, Department of Psychiatry at the Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala- 689101, India

References:

1. Chaturvedi, S.K. COVID-19, Coronavirus and Mental Health Rehabilitation at Times of Crisis. J. Psychosoc. Rehabil. Ment. Health 7, 1–2 (2020). https://doi.org/10.1007/s40737-020-00162-z

2. Looking after our mental health. https://www.who.int/news-room/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health

3. Coronavirus (COVID-19) Mental Health Resources https://www.wpanet.org/COVID-19-resources

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The WPA is the global association representing 140 psychiatric societies in 120 countries, and bringing together more than 250,000 psychiatrists.  It promotes collaborative work in psychiatry through its 70+ scientific sections, education programs, publications and events. 
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