COVID-19’s mental health fatigue – An expert’s view

Dr. Alinaitwe Racheal (PHOTO /Courtesy)

By Dr. Alinaitwe Racheal (MBChB. MMed (Psych))

Mental ill-health is a global concern with depression being the second leading cause of years lived with disability. It is estimated that at least 1 in every 4 Ugandans has some form of mental disorder.

Mental illness can begin at any age, from childhood through later adult years, though most cases begin earlier in life.

Mental disorders affect one’s productivity and functionality hence making it difficult for affected persons to fulfill their different responsibilities in society.

The increased morbidity caused by mental disorders greatly affects the quality of life of the sufferer. Mental disorders are defined as disorders that affect one’s mood, emotions, thinking and behaviors. The commonest of these include depression, anxiety, alcohol and substance use disorders, bipolar affective disorder and psychoses.

There are no distinct causes of mental health disorders but it is believed that mental illness can be due to genetic or environmental causes or a combination of these.

A mental illness develops as a result of interaction of biological, psychological and social factors as illustrated in fig.1 below. Common environmental factors include; adverse events such as loss of dear ones, physical illnesses, trauma of all kinds, work related stress, marital discord and broken families and alcohol and substance use.

 Figure 1: psychological, biological and social interactions for mental health

Figure 1: Psychological, biological and social interactions for mental health

Other risk factors that increase ones’ chances of developing a mental illness include: Stressful life situations, such as financial problems, a loved one’s death or a divorce; use of alcohol or substances; a childhood history of abuse or neglect; traumatic experiences, such as military combat or assault, sexual assault; lack of social support and a chronic medical condition, such as diabetes or stroke.

Children and mental health

Children are not immune to mental illnesses as many people assume. The commonest disorders in children include neurodevelopmental disorders such as autism spectrum disorders, attention deficit hyperactivity disorder and Intellectual disability; learning disorders, behavioral disorders such as conduct disorder and oppositional defiant disorder; anxieties and attachment disorders.

Predisposing risk factors stretch from intrauterine life to early childhood including pregnancy complications, maternal mental health, parental conflicts and child abuse among others. Some of these disorders are carried on into adolescence. Hence, adolescents have a share of both childhood disorders and adulthood disorders such as depression, anxiety, psychoses and substance abuse.

COVID-19 related mental health burdens
Difficult times like epidemics and pandemics also are risk factors for mental illness.

There has been a spike in mental disorders in this Covid-19 era because of increased uncertainty as a result of the pandemic. There is uncertainty pertaining almost all spheres of life including schooling and job situations. Ironically, the measures put in place to control the disease’s spread are recipe for mental illness.

Stress during this pandemic is related to: fear of being infected by a deadly disease or infecting loved ones with the disease; limited access to services (health, religious, entertainment, etc); Restricted/limited physical movement; lack of basic needs due to lock down measures; job losses, contradicting information and rumors regarding the pandemic and broken social networks hence limited social support.

Also, due to the control measures imposed, many mental health patients are unable to access care in a timely fashion hence relapse and worsening of their illness.

The worsening of their symptoms puts them in harm’s way with the enforcers of the Covid-19 protective guidelines as the patients are most times mistaken for criminals and wrong doers in society.

There have been multiple cases reported of suicide, self-harm and homicide due to inability to cope with the tough social and economic times in this pandemic.

The most vulnerable populations for mental illness during this pandemic are the health workers who not only work long hours but are exposed to traumatic experiences of Covid-19 victims, children who may be separated from families and care takers.
As a result of Covid-19, many mental health units in Government facilities have been converted into Covid treatment centers leaving the mentally ill with either sub-optimal care or no care at all. Most mental health units are now providing only outpatient care services due to lack of space and capacity to admit the severely ill.

The severely ill are advised to seek for care from the National referral mental hospital which is also operating beyond its capacity given the increased number of mental complications as a result of Covid-19.

Most of these patients and their families cannot afford transport to the national referral because the transport fares have more than doubled hence patients are physically restrained with ropes within their homes.

Symptoms of mental illness

Signs and symptoms of mental illness vary depending on the disorder one has.

However, common symptoms include: feeling sad, difficulties with concentration, excessive fears or worries, extreme feelings of guilt, extreme mood changes, isolation from friends and activities, significant tiredness, low energy or problems sleeping, detachment from reality (delusions) and paranoia or hallucinations.

Others are: inability to cope with daily problems or stress, major changes in eating habits, sex drive changes, feeling suicidal or homicidal, trouble understanding and relating to situations and to people, problems with alcohol or drug use, excessive anger and hostility or violence

However, sometimes, especially in children and adolescents, symptoms of a mental health disorder appear as physical problems such as on and off stomach pain, back pain, headaches, or other unexplained aches and pains.

Nonetheless, despite the high burden of mental disorders in the country in light of the current pandemic, little attention or priority has been given to mental health.

The challenges of mental health services are enormous ranging from inadequate funding (mental health receives only 5% of the already meagre health budget), to low staffing with overwhelming number of patients.

The country has about 55 psychiatrists which translates into a psychiatrist- patient ratio of 1:1,000,000 for the country. There is need for more funding towards mental health so that there is better service provision, enhanced training of mental health professional and more research in mental health.

Nipping Mental Illness in the bud

Did you know that mental illness is a leading cause of disability?

Suffice to note is that untreated mental illness can cause severe emotional, behavioral and physical health problems. Complications sometimes linked to mental illness include: poor quality of life, family conflicts and other relationship difficulties, social isolation, problems with alcohol and substances, reduced productivity at work, school and in the community, legal and financial problems, poverty and homelessness, self-harm, harm to others and a weakened immune system hence predisposing one to other physical illnesses.
To prevent the above complications, it is necessary for people to pay attention to their mental health and that of their loved ones.

Seek for help early when you see changes in your (or loved ones’) behavior and functioning. One needs to seek help from the nearest health facilities which can provide the mental health care to refer to mental health experts.

There’s no singular way to prevent mental illness. However, people have to control stress; balance work and leisure; learn positive coping skills; talk to someone about one’s stressors; pay attention to warning signs such as changes in sleep, appetite and motivation; seek early medical care and take good care of yourself (sufficient sleep, healthy eating and regular physical activity are important).
Mental health issues affect everyone and are a health concern in this country, more especially during the Covid-19 pandemic. There is great need to prioritize mental health and increase funding to this vital health sector.

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