COVID-19 outbreak has caused immense mental stress and anxiety among the people. While many in the world have died due to the virulence of the disease, the rest of us have been watching in panic and planning on their next steps. As many countries have imposed lockdown on the citizens, the social life of the people has been severely affected and different segments of the populations have been affected in different ways. Mental Health First Aid India looks at the current situation from a mental health perspective. 

Pandemics and mental health:

Pandemic outbreaks have an impact on the mental health of a person and the society as a whole. Though the physical effects of the pandemic can be controlled or countered with a vaccine or suitable drug therapy the impact of it on the mental health is far-reaching and can continue well beyond for a few years after it has ended. Well known epidemiologist Dr. Sandro Galea writes on his blog  that during his work in SARS control with his colleagues in 2004, he found "...quarantined persons a high prevalence of psychological distress, including symptoms of depression and post-traumatic stress disorder (PTSD). A key takeaway: Even if we can halt the physical spread of a disease through the expeditious use of quarantine and social distancing, we will still have to contend with its mental health effects in the long-term." The psychopathology experienced by communities during a pandemic has been compared to that of a post-disaster effect Most common mental health problems experienced during this time are: Post-traumatic stress disorder, major depressive disorder, substance use disorder and other psychological symptoms such as generalized anxiety disorder, panic disorder and phobias. Comorbidities among the mental health problems has also been observed commonly. 

Why do pandemics like COVID-19 cause anxiety?

Humankind has experienced pandemics throughout history. There have been various of them and the most recent pandemic that we faced in 2009 is the H1N1 flu pandemic or the swine flu. So, why are people so scared about COVID-19? 

• High number of deaths in a very short period of time. 
  • From a medical perspective, the virulence and spread of the virus is high and it has caused thousands of deaths worldwide in a short time. This is seen as a threat to the existence of the human race and many feel like the world is going to an end. 

• Easy contamination and passing of the virus to one another. 
  • Passing of the virus when you are not symptomatic is increasing the panic and fear of contamination. Persons with Obsessive-Compulsive Disorder (OCD) are less than 1% in India, but the constant advice of contamination can have a vast impact on their mental health condition.

• No medication which leads to a high level of uncertainty.
  • The virus has been identified as a new virus and no known treatment or vaccine exists for cure. This coupled with a large number of deaths in a short time has caused considerable anxiety and stress in the minds of the people. 
  • The affected governments have not disclosed till when the social distancing is expected to last. The uncertainty has led to high levels of confusion, stress and s. 

• Health System struggling to cope with the need for service
  • Even the most modern and developed Health systems are struggling to cope with the big wave of pandemic needs. In ability to access care and treatment is another stressor that may lead to hopelessness. 

• Spreading misinformation in a connected world
  • We are living in the age of information and everyone has access to data. Covid-19 has triggered enormous rumours and misinformation often spread on social media causing mass panic and distress. Very often we can see mob phenomenon such as panic buying setting in with the spread of such fake news. Even though government machinery warns the citizens about fake news it is quite difficult to completely control the spread of fake news. Fake news can have considerable impact on the mental health of individuals as well as a community leading to mob mentality, riots or similar acts. 

• Coping with the new situation 
  • Isolation and Social Distances are the extreme actions taken to interrupt the transmission and to curb the number of deaths. Unfortunately, this means that people who had been leading a productive, active life have been confined to their homes. As a result there has been a breakdown of the economy and a future of uncertainty hangs over some section of the population, such as daily wage labourers. This has resulted in vexation, frustration and anxiety among those who have been affected. This has largely affected those who work away from home. 

Protecting  Mental Health during Covid-19 

The government have mental wellbeing in consideration when taking measures  

Historically mental health across the world and India has been less invested creating a deep gap on the understanding and addressing of mental health problems as compared to physical illnesses. According to the NMHS 16 In India 1 in 10 people experience a mental illness in a lifetime, 1 in 10 are diagnosed with Depression and 6 % of the population is at high risk of suicide. Unfortunately, the gap in the treatment of mental illness is as high as 83 %. This results in a high number of people not accessing health services. 

In mental illness, social and psychological risk factors play a crucial role which contributes along with biological factors in triggering a mental illness or worsening it.  Covid -19 can be called a traumatic event and for many might not be easy to deal with and for the population living with mental illness, it can worsen the situation. 

Therefore, the government should have the mental well being of the population in their agenda when planning measures. The Covid -19 cure sure will come and hopefully heal us all, but the impact on the emotional and mental health of individuals will be there for long. 

Increasing Literacy of Public on Mental Health as well as first aid skills.  

Our mental health system suffers from a systemic approach and vision of tackling the mental health problems at the early stages with a huge focus and funds in service provision and very little in the prevention and early identification. With high stigma on mental health,  fear of being judged as weak, feeling ashamed of talking or reporting it, and a very poor literacy on mental health so as many do not realise that they are going through a mental illness, the Covid -19 is surely pushing the mental health of many towards poor mental health. 

Building Literacy on mental Health where the public gets the basic knowledge to pick up signs and symptoms of emerging mental health problems and be able to approach the one in need and carry a supportive conversation should be considered as the next step to avoid an increase of incidence of mental illness and death from suicide.  Prevention and early identification can be a share of responsibility that the public can handle very well.

For an analogy,  we learn to respond and support in case of heart attack through physical First aid how to do CPR. Similarly, people can learn how to provide support to the loved and near one like family members, colleagues, friends and guide them early to appropriate professional help. This is called Mental Health First Aid and anyone can learn it. 

What is Mental Health First Aid (MHFA)

MHFA is a standardized, evidence-based international training program to educate the public on mental health and develop the skills for early identification and recognition of common mental health issues. It builds practical skills and confidence to reach out and provide support to someone experiencing mental health problems or a crisis, helps in managing one’s own mental health in a better way and reduces stigma and increases positive attitude towards mental health.  

There are more than 3 million people trained around the world and MHFA programs are available in India and already public workplaces and colleges are receiving the training. All Mental health First aiders are able to give first aid support. In the time of Covid-19 MHFA skills are seen as very crucial to help each other and communities during isolation. Not far then the renown News channel BBC called all trained MHFAider in the UK to step in and support communities to preserve good mental health. 

From the Mental Health First Aid perspective during Covid-19

Who should we take care for?

There are certain high-risk individuals who need to take care of their mental health during times like this. 

1. Vulnerable groups such as children and young adults are at risk but they can recover more resiliently. Similarly, dependent populations such as elderly individuals, physically disabled persons are also at the risk of developing mental health problems. 
2. Persons with pre-existing mental health disorders can experience a relapse or worsen of their mental health. 
3. Individuals with poor coping capacity, habitual substance abusers and persons with long-standing chronic general medical conditions are also at high risk of developing mental health problems.
4. The health workers, allied health workers and support staff In case of COVID-19, are also at a high risk of mental health problems due to working conditions, anxiety, stress and pressure faced by them. 

What mental health problems can develop?

Usually, a range of mental health disorders can manifest during the time of a global disaster or a pandemic like COVID-19. 

1. Anxiety disorders 
2. Adjustment disorders
3. Non-specific physical symptoms
4. Mood disorders
5. Substance abuse 

are some of the disorders that can be experienced by the population in the time of a pandemic. 

1. Depression may also co-exist with these conditions. 

It is possible to go through a range of emotions like

1. overwhelming emotions and fear of losing control of the situation.
2. Crisis situation such as Suicidal thoughts, Non-Suicide Self Injury and sudden increase in substance use can emerge in case of tragic losses such as the loss of a person, money, possessions, etc.  

What to Look for? 

• Look for deteriorating signs of mental health like 
  • A sudden change of mood and behaviour
  • loss of interest in communication and keeping in touch 
  • Spending excess time on Social media
  • Worried all the time 
  • Easily agitated and restless or isolated 
  • Talking about ending life or sounding hopeless 
  • Poor hygiene and appetite 
  • Excess drinking or smoking 
• Monitor for any relapse or worsening of mental health in persons with a history of mental health problems or Illness

How to apply first aid in case of mental health problems?

1. Approach the person and express your concern 
2. Give space to the person to share on how they are feeling and what are their thoughts 
3. Look for keeping up with existing medication. In the case of dependent persons, stock up medicines for the next few weeks.
4. Check on any crisis like Suicidal thoughts or emerging Panic Attack
5. Provide emotional support by talking to persons who are unable to cope up with the situation.
6. Provide practical support on reaching professional help like GP, Psychiatrist, Therapist. 
7. Avoid Judgmental comments, blaming or ridiculing. 
8. Continued monitoring of high-risk persons. 
9. Involving family members or caretakers of elderly persons to give appropriate support to them.
10. Stay Positive and Hopeful 
11. Take care of yourself and stay safe