The ‘new normal’ can get you down
Life under lockdown was tough enough. It affected the mental health of millions all over the world; the South African Depression and Anxiety Group (SADAG) reported that daily calls to their helpline had doubled.
SADAG board chairperson, Dr Frans Korb, said the initial focus was on the medical aspects of Covid-19, but a lot of work has been done subsequently on the mental health side. “Many things have been written about the psychological effect. Depression, anxiety and suicide have had a dramatic increase in some of the surveys. At one stage researchers were writing that we were expecting a tsunami of psychiatric disorders coming out,” he says.
Dr Elke van Hoof, a professor in health psychology and primary psychology at the Vrije Universiteit in Brussels, said in an article on the World Economic Forum’s website in April that with an estimated 2.6 billion people, or a third of the world’s population, in lockdown at the time, “we could be conducting arguably the world’s largest psychological experiment ever”.
The World Health Organisation (WHO) in a statement early in October 2020, said: “Bereavement, isolation, loss of income and fear are triggering mental health conditions and exacerbating existing ones.” More people are experiencing higher levels of alcohol and drug use, insomnia and anxiety.
Many who have had Covid-19 have reported neurological and mental complications such as delirium, agitation and stroke, while people with pre-existing mental, neurological and substance use disorders are more vulnerable to infection and severe illness.
“Good mental health is absolutely fundamental to overall health and wellbeing,” said WHO director-general, Dr Tedros Adhanom Ghebreyesus. “Covid-19 has interrupted essential mental health services around the world just when they’re needed most. World leaders must move fast and decisively to invest more in life-saving mental health programmes, during the pandemic and beyond.”
Hunger and the worry about where food will come from can also drive mental health problems. With an estimated 6.5 million South Africans suffering from hunger, this is a concern. However, an online survey conducted by the University of Johannesburg’s Centre for Social Change in April and May found that, although the strongest predictor of composite psychological stress was hunger, there was not a direct correlation between hunger and psychological distress — perhaps because family bonds are stronger and resilience higher among people who have less money.
As South Africa is emerging from its winter flu season to a softer lockdown, some have reported guilt feelings. Johannes de Villiers, a yoga instructor whose latest self-help book, Blydskap, deals with how to be happy, writes on his blog with the same name that post-lockdown guilt is about “suddenly realising that you are missing lockdown”.
He says for those who had a relatively comfortable lockdown, and who didn’t face hunger, it might be difficult to face the world again after using the lockdown isolation “to hide from the tough world and to care for yourself”.
Some are now feeling guilty about missing the lockdown, even if it was something “that was so terrible”. He suggests listing the things about lockdown that made you happy when there was “no alcohol or cigarettes or holidays or dances”, and incorporating those things into your life under the new normal.
Stepping out to anxiety
Stepping out of the house again after a long time inside can be difficult for someone who lives with anxiety, and who might have felt anxious about going outside even before lockdown. Dr Steven Taylor from the psychiatry department at the University of British Columbia told BBC News in May that people, whether at home or working on the frontlines of the pandemic, have gone through a lot of change in a very short space of time — and that is stressful.
“People are trying to cope by loving being in lockdown, by creating a cocoon of safety, a haven, to make the whole experience more tolerable. Ironically that can create problems later on, because people can love their lockdown too much and become anxious about going outside.”
Taylor wrote The Psychology of Pandemic, which was published a few weeks before Covid-19 first became known in China in late 2019. He says the spread of contagion in a pandemic is “very much a psychological phenomenon” because the spread of the virus is determined by how people behave.
Money for mental health
The WHO found in a study from June to August in 130 countries that the Covid-19 lockdowns disrupted mental, neurological and substance abuse services, but says those who invest in mental health will reap rewards. “Pre-Covid-19 estimates reveal that nearly $1-trillion in economic productivity is lost annually from depression and anxiety alone. However, studies show that every dollar spent on evidence-based care for depression and anxiety returns five dollars,” the organisation says.
South African experts have warned that local funding fell far short of ideal. According to the WHO South Africa has the sixth highest rate of suicide in Africa, and the majority of suicides or attempted suicides are individuals who suffer from undiagnosed and untreated depression. Worldwide, 300 million people suffer from depression.
Underinvestment in SA
Less than 5% of South Africa’s national health budget goes towards mental health, Dr Mvuyiso Talatala, chairperson of the SA Mental Health Alliance, said on World Mental Health Day, on October 10. This figure should be at least 10%, he told a press conference hosted by SADAG, but some provinces spend even less than the 5% national average. Most of this spend goes towards psychiatric hospitals.
Medical aids also fall short. Regulations should be reviewed every two years, but there have only been two reviews in the past two decades with no implementation, he said. This means people can only access treatment with the help of their medical schemes if their mental illness is severe.
“We have three problems: underinvestment, lack of implementation of policies as highlighted by many authorities, but also inefficient models of care,” he said.
Don’t forget the carers
SADAG has partnered with Cipla to drive awareness. Paul Miller, CEO of Cipla Medpro, said people should look out for each other during the Covid-19 pandemic, but stressed that “caring for our carers” is more important than ever. “Healthcare professionals are at the frontline of tackling this pandemic, and in a country where there’s a shortage of medical professionals and a massive disease burden, they can also become overwhelmed and stressed, or experience burnout.”
Another pharmaceutical company, Adcock Ingram, is behind a campaign entitled Sponsors of Brave in which they and News24 profile and honour healthcare professionals and their initiatives.
Mental health at work
Suffering from depression and anxiety isn’t only bad, and possibly even life-threatening, for individuals: it also harms the bottom line. Increased absenteeism, reduced productivity and higher costs are all part of the impact that mental illness can have on the workplace, according to a Mental Health Awareness Month statement by the Department of Health.
“Mental health problems are the result of a complex interplay between biological, psychological, social and environmental factors,” the statement reads, adding that the “content and context of work” can also play a role.
Key factors include:
∙ too much or too little work;
∙ lack of participation and control in the workplace;
∙ monotonous or unpleasant tasks;
∙ ambiguity or conflict about what your role is;
∙ poor interpersonal relationships;
∙ poor working conditions;
∙ poor leadership and communication; and
∙ a lack of work-home balance.
Employers can help to create a healthy work environment by putting in place mental health programmes for their workers.
Mental health disorders can be transient, such as an acute stress disorder; periodic, such as a bipolar disorder, or long-lasting and progressive, such as Alzheimer’s disease. Other conditions include schizophrenia, dementia, depressive disorder, obsessive compulsive disorder, panic disorder, and post-traumatic stress disorder.
The uncertainty about the future of work often adds to the strain — and Covid-19, which has changed workplaces and work habits dramatically, hasn’t made things simpler. Work has become faster and more intrusive, with digitisation and devices that are always on. Those who are now working from home report that they find the lines between work and down time blurred by what is called the Silicon Valley business model. With cutbacks in a depressed economic climate, some face an ever-growing workload and even more strain.
The National Sleep Foundation in the United States recommends between seven and nine hours of sleep for adults under the age of 65, but has found that about a third of employees get less than six hours.
Some companies in the US believe prevention is better than cure. The Huffington Post has two rooms designed for napping in its New York City offices, as does Uber and ice-cream maker Ben & Jerry’s. Other companies have acquired napping chairs, or pods, which can help employees if they want to take a restorative catnap.
Covid-19 could, however, turn out to be a blessing in disguise. “Unhealthy” offices with sick and polluted buildings; open-plan designs which lead to a lack of concentration; and the use of headphones, which cuts out communication — all have been blamed for workplace stress.
Should more employers follow the example of Microsoft, which has recently given their workers the option of working from home permanently in a new “hybrid workplace” model? This may eliminate some stressors but may introduce others, such as having to deal with power outages and unpredictable WiFi, annoying fellow housemates and pets — and that one colleague who can never find the Zoom mute button.
Ask yourself if you need help with your mental health
1. Have you lost interest in things you once enjoyed?
2. Do you feel hopeless and pessimistic?
3. Do you feel guilty, worthless and helpless?
4. Are you struggling to sleep or to wake up?
5. Has your appetite changed?
6. Do you feel tired and run down?
7. Are you using more drugs and/or alcohol?
8. Are you thinking about death and/or suicide?
9. Do you feel restless, irritable or hostile?
10. Do you struggle to concentrate, remember or make decisions?
11. Do you have headaches, stomach problems or chronic pain that won’t go away, even with treatment?
12. Are your relationships suffering?
Based on SADAG’s list of 12 symptoms
1. Make the connection. Talk to someone who will listen and make you feel cared for. And while it’s good to keep in touch by phone or social media, meeting someone face-to-face (safely) can help to relieve depression. Find ways to support others by volunteering. Caring for a pet can also bring you joy.
2. Do things you love. Push yourself to do some activities that you used to love, such as a hobby, sport, music, art or writing. Go out with a friend for a hike. Even if you don’t feel better immediately, you may see a gradual improvement.
3. Get enough sleep. Aim for eight hours. Depression can disrupt your sleep, but try to learn some healthy sleep habits.
4. Check your stress. Stress can trigger or prolong depression. Try to figure out what stresses you — work overload, money problems, relationships — and learn ways to deal with them.
5. Practise relaxation techniques. Try yoga, deep breathing or meditation, and get into a daily relaxation routine.
6. Get moving. Regular exercise — about 30 minutes a day — can be as effective as medicine for depression symptoms. Start with a 10-minute walk, and build on that. Find an exercise partner or a dog if you need motivation.
7. Eat yourself well. Cut down on caffeine, alcohol, unhealthy fats and preservatives and hormones (in certain meats), as well as sugar and refined carbs such as pasta and white bread. Don’t skip meals. Get more B-vitamins by eating more citrus, leafy greens, beans, chicken and eggs, and eat foods rich in omega-3 oils, such as salmon, herring, mackerel, anchovies, sardines, tuna and seeds.
8. Let the sunshine in. Sunlight helps to boost serotonin levels and improve your mood. Get at least 15 minutes a day — in South Africa and in summer this shouldn’t be too difficult.
9. Challenge negative thinking. Depression puts a negative spin on everything, but try to remember that this isn’t objective. Try to identify the type of negative thoughts fuelling your depression and replace them with a more balanced way of thinking. Negative thoughts include all-or-nothing thinking, over-generalisations, filtering out and diminishing the positive, jumping to conclusions, emotional reasoning, beating yourself up over small things, and labelling yourself a loser.
10. Commit a random act of kindness. Some ideas are: smile at someone, hold a door open for them, give an honest compliment, express gratitude to someone, truly listen to people, offer to help someone, ask people you interact with how their day is going, treat someone to coffee or tea or let someone pass you in the supermarket queue.
Sources: www.helpguide.org and happyologist.co.uk
Mental health first aid: what to do if you still feel down
Get hold of the South African Depression and Anxiety Group on 011 234 4837, 0800205026 or on social media, and speak to a trained counsellor. More emergency numbers can be found on www.sadag.org
Cipla has a WhatsApp chatline on 0768822775
Adcock Ingram has a Depression and Anxiety
Helpline on 0800708090