Is the Mental Health Iceberg our next Titanic event amidst the current COVID-19 crisis?

by Ken Smith

After the first reported case of the novel coronavirus, COVID-19, in Wuhan, China, at the end of 2019, modern quarantine practices have been implemented worldwide to try to stop the virus from spreading. These have included a variety of measures such as lockdowns (ranging in length from short to prolonged), voluntary self-quarantine at home, rules and laws restricting public and private gatherings, social and public events being canceled, the shutdown of mass transit, and numerous other limitations on movement, particularly regarding travel. Some schools never opened since closing in March of 2020. Changes that happened fast, but not fast enough to stop the virus spread.

And here we are now, now nearing the one-year anniversary of the outbreak, one anniversary I believe we’d rather not commemorate.

I attended my first campfire sometime around the end of summer 2020, listening to a knowledgeable and informed group of global attendees from many different professional backgrounds – sharing local/national assessments of COVID19 at ground level. Here, I have learned to listen and come to appreciate and recognize that I am not the only one witnessing a second crisis in the unfolding, as mental health begins to be echoed upon by many others attending the campfires.

It is safe to say that many of us have waited with anticipation for 2020 to be gone and January 1st, 2021 to arrive, expecting a calendar reset to bring with it a New COVIDLESS Year and the prospect of possibly exiting the pandemic before too long. However, this wish did not materialize, and my faith in magic dust and fairies shattered for eternity. It appears 2020 never left, and some days, it feels like we are fixed in time, awaiting a miracle to transpire, or to wake from this dreaded nightmare we find ourselves enmeshed in.

The attempts to curtail the outbreak have caused widespread repercussions for everyday life on an international, national, community, family (Seeing it), and individual level. The vast majority of the world’s population has been affected somehow, with significant impacts on many aspects of day-to-day life that are typically routine and go unseen. This massive shift in how daily life is conducted has seen what is considered “normal” change radically in a short time and for the immediate future, with no end date in sight. Well, at least not in 2021.

Being separated from family and friends due to regulated quarantine or isolation is an unusual and challenging experience that signals a drastic change from typical daily activities for most people. As we well know, such measures are used in particular contexts such as in corrections or custodial settings as a punishment. However, here we are, irrespective of the country or region we live in, finding ourselves in a similar situation. And yes, some days, it does feel like punishment!

Nevertheless, this Isolation poses a psychological risk to all humans living on this little planet we call earth, with some demographics – I would argue – being affected more significant than others—such as children (personally experiencing some affects) and teenagers, the elderly, minorities, people from lower socio-economic backgrounds, women, and those already suffering from mental health problems— already vulnerable without a pandemic, who now find themselves disconnected from the social lifelines that helped and supported them through weekly lows.

Recent campfire conversations have highlighted that depression and suicide help hotlines are busier than average, with a considerable increase in calls for help. Needs that are more than likely – my opinion here – from people faced with significant changes to their everyday life, who feel unsettled, worried, and perhaps jobless, trying to cope and get through life on a daily, maybe hourly basis.

These feelings may include feeling unsafe and can be possibly tied to the disease-fear contagion nexus, which arise due to experiences such as a lack of knowledge about the cause or likely outcome of a disease, and the spread of ill-informed or deliberately misleading information, that can cause people from a specific background being marginalized or discriminated against. The COVID-19 pandemic, like all crises, requires a heightened need for social and mental support.

Unfortunately, the nature of the pandemic and the physical Isolation required to stop its spread can often pose problems for people’s sense of community and social well-being, potentially impacting mental health, short and long-term. Quarantining large numbers of society can have significant and severe outcomes for those subjected to it; as such, its use is generally a last resort. Even people who were previously mentally well can potentially experience mental health issues due to long-term quarantines. Some of these may include acute stress disorders, insomnia, emotional distress, mood disorders, and general irritability. These may be driven by fear, anxiety, panic, and stress due to financial problems, annoyance at the situation, boredom, feelings of social Isolation (Yup, I’m here), lack of access to necessities, and inadequate communication from government to grass root level organizations having to deal with the crisis. Topics we have discussed at one point or another during weekly ISRM campfires, and which are linked to our own personal struggles faced these past 12-months.

The incidence and severity of mental health outcomes may worsen in alignment with the COVID-19 quarantine confinement length. For example, lengthy quarantine is more likely to result in post-traumatic stress disorder (PTSD), avoidance behavior, and generalized anger. This suggests that the quarantine may be traumatic in and of itself. A lack of control over the timing and quantity of food supplies, medication and significant disruption to typical day-to-day activities may contribute to this trauma. I fear that our younger teens under the age of 18 will bear the brunt of the current pandemic and will experience lasting effects mentally for years to come. My belief is, and I am not a psycologist, is that we are only now seeing the tip of the Iceberg and about to enter a Titanic-type scenario.

When and if quarantine is over, it does not mean that its effects also end. People returning to everyday life after the SARS (severe acute respiratory syndrome) health emergency exhibited a range of post-quarantine behaviors that can be considered atypical and a direct response to quarantine. These included: restricted social contact, avoidance of crowded and small places, not engaging in normal levels of contact with others and crowds, and not returning to work; as well as changes to behavior on a longer timeframe such as undue frequency of handwashing. Similar adverse effects were experienced by health workers who had been in quarantine. They reported adverse mental health outcomes, including PTSD and a sense of helplessness, loneliness, fear, depression, and lack of connection with others. This, I fear, will be our children in the not-too-distant future if we do not reintroduce them to in-school, in-person learning over the next twelve months. Certain personality types may lose the cognitive ability to interact socially with their peers. They may rely further on social media and electronic devices as safe platforms to communicate and socialize for personal and educational purposes. Again, I worry teens will come out the other end of this pandemic, unable and unskilled to blend as human beings, in person, with friends and colleagues.

Health workers have also been faced with disease and death on a large scale. They have had to cope within stretched and pressured work environments, often with shortages of the necessary equipment to protect themselves and their patients. During the current crisis, one can assume from media reports that they have experienced significant exposure to grief and morally confronting scenarios involving care rationing. The pandemic’s emotional impact has been immense for such workers, as they have undertaken their jobs in highly uncertain, hazardous, and distressing situations. A lack of guidance regarding clinical practice, uncertainty about just how long the crisis will last, and fears about the pandemic’s impacts in the near and longer- term future all compound this.

People facing Isolation who have pre-existing mental health problems will likely experience a more severe response, including heightened anger and anxiety. Such people are more likely to have encountered social Isolation in the past and other social problems due to their susceptibility to homelessness, social disconnection, and physical health issues. In particular, homelessness makes people more vulnerable to worse health outcomes, all of which the pandemic is predicted to have intensified.

Catastrophic freak weather events, such as the recent arctic storm that the State of Texas experienced, can trigger a heightened response or exacerbation of symptoms associated with a pre-existing mental health condition. Further, people with serious mental illness are at a greater risk of experiencing PTSD caused by a crisis or traumatic incident. Existing problems, such as alcoholism and other conditions, may also be exacerbated by social isolation conditions, heightening the risk of setbacks and added complications – yet to be evaluated – as the COVID- 19 pandemic continues to rule daily life globally.

The restrictions implemented to curtail COVID-19 have led to the temporary or permanent shutdown of many support services and programs usually relied on by groups in need. Their primary focus is to assist people in distress during the pandemic. I believe this focus will shift toward undertaking a mammoth effort to provide the needed initiatives and services to help people return to their everyday lives as best possible. This makes it a matter of absolute urgency to continue to support community members who are at particular risk of adverse outcomes due to the global pandemic. Mental health and its related social challenges were already a prominent issue in great need of focus before the pandemic; COVID-19 has only emphasized the need to assist those already vulnerable, facing significant stress and distress due to the current situation.

Campaigners for improvements in addressing mental health during the current pandemic must continue to advocate for those who do not have a platform to do so themselves, due to a lack of resources, or overcome by the current situation at many levels – Loss of Income; illness; anxiety; depression, etc. Awareness of mental health issues that have yet to surface, and the effects COVID -19 has had on specific mental triggers, is more important than ever before. As a global society, we must continue to work together conscientiously and help shield our communities as best we can while dealing with the limits posed by the pandemic we currently live in.

My plan A in Houston is to start locally with my neighbors and friends, ask if they need a little help, and work my way outwards. You do not need to be a member of a major nonprofit organization to make a difference in your immediate community of family, friends, and neighbors. The first step starts with you, one person, on a mission to help the vulnerable and affected one individual at a time. Saying that, don’t forget to allow yourself time for introspection and self-reflection. Your well-being and mental health will help you and others through 2021 and into 2022.