Psychosocial Impact and Psychosocial Care During Global Pandemic Covid-19

Coronavirus brings us tough times, you switch on the news or look at your favorite website, and it’s not a pretty picture. More dead every day, infections on the rise, health care systems reaching their limits. Whole countries in lockdown, families and friends cutting off contact with each other. And it doesn’t end there-businesses facing bankruptcy, workers losing their jobs in droves. It is all pretty scary stuff. What coronavirus does to the body is quite well known by now, and more research is under way, but what does it do to our soul. Fear of infection, the isolation, worries about loved ones who are at risk. Now our questions, how can we be not overwhelmed by this Pandemic when the world is combating against Covid-19?

The country lockdown due to Covid-19 is hitting young and old alike and this left people restless and isolated in some point or the other. There has been a case of suicide due to pandemic and this has changed every aspect of the society; people grappling with emotional and economic uncertainty. And everyone is having a tough time; some sort of stress and anxiety. This is a very serious matter of concern and it is important for us to look into mental health and psychosocial aspect of the people during this pandemic. According to NDTV, “This is a difficult time for everyone-some are especially hard hit-like the poor, the migrants, the labourers, whose worlds have been completely disrupted some are not as bad off, but nobody is unaffected- whether it is a 5-year-old who can’t understand why he’s not having a birthday party this year, or a class 12 student who worked hard all year to get into the college of his or her dreams but may not get to go there after all”. Each person is combating against the virus in one form or the other. This is a situation where the students feel their future looks blurry because of the uncertainty and this has negative consequences as well and need to be addressed. Above all people are facing an invisible crisis or suffering mental health issues because of the outbreak of Covid-19.

Coronaviruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes coronavirus disease Covid-19. Covid-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. This has been named which everybody can use both for scientific purposes to compare and to avoid stigmatising. While Covid-19 which was originated in December 2019 in China Wuhan, it has become cross cutting issues which affects and shattered the physical, economy, psychology and social aspects of the word. As during the 2003 SARS and 2014 Ebola virus disease outbreaks, generalised fear and fear-induced overreactive behavior were common among the public; both can impede infection control. In addition, psychiatric disorders, such as depression, anxiety, and posttraumatic stress disorder, developed in high-risk persons, especially survivors and frontline healthcare workers. On the basis of these recent experiences, due recognition are utmost importance meeting emergency psychological crisis interventions to reduce the psychosocial effects of the Covid-19 outbreak.

In one form or the other the general population is facing a mental and psychosocial issues and which needs to be addressed at the common platform to reduce the risk of mental disorders through psychosocial interventions. A psychosocial intervention is like a pint of salt in the food. The flavors and aroma of the curry becomes tasteless without adding salt to the curry. In the same way, it is essential for other professionals to work along with the frontline workers to curb the spread of the disease. Psychosocial interventions refer to different therapeutic techniques, usually classed as nonpharmacological (not involving medication), that address the psychological aspects of an individual or group and consider the person’s or group’s situation from a societal, familial perspective. Interventions can be evolved for a single person in treatment for a variety of diseases, best models of treatment may be suggested for groups that share a common illness like schizophrenia, or psychologists and others develop interventions for groups that are undergoing great stressors, like being in the midst of a war or recovering from a natural disaster or presently Covid-19 Pandemic. In the midst of this outbreak general population might face stress, anxiety, fear, stigma, helpless, boredom, and loneliness, powerless and socially excluded from the mainstream of the society.

Other major psychosocial problems related to Covid-19: Ever since the outbreak of the Pandemic everyone is facing a lot of anxiety and a lot of surviving mechanism kicking into place to go out and get stuff that we need in order to stay and to be in isolation. We have actually seen a lot development where there’s a lot more emotion and there’s grief that people are not able to be with their loved ones. In addition to that, quarantine and self-isolation are separating families. This kind of experienced people haven’t experience before and can cause a lot of anxiety and a lot of mixed emotion.

• Quarantine: Quarantine is often an unpleasant experience for those who undergo it. Separation from loved ones, the loss of freedom, uncertainty over disease status, and boredom can, on occasion, create dramatic effects. Suicide cases had been reported. Most of the studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss and stigma.

• Home Isolation: Dealing with isolation is hard. Humans are social creatures and need contact with others. Being deprived of that gives rise to a wide range of feelings, including fear, anger, sadness, loneliness, irritability, guilt, confusion. This time can be especially difficult for those with a pre-existing mental illness. In addition it can be a burden on relationships because of being in a confined space for a long time. Isolation can be damaging to both our minds and physical health. In fact there are countless negative effects that can have on our minds and bodies. It can be contended that lack of social support, limitations in executing daily routines and chores, and poor family support would have an immense cause for elevated stress, depressions and sleep problems.

• Movement Restriction: There has been loss of life, rapid changes to our way of life (e.g. study, work, social gatherings), and disrupted plans due to travel restrictions and social (physical) distancing measures in our efforts to slow the spread of transmission. People are naturally concerned their own and their loved ones’ health and safety. There is much uncertainty. Loss of interest in usual enjoyable activities, frustration, irritability, or anger, restlessness, feeling helplessness, apprehension about going to public spaces and trouble relaxing and these are experiences all understandable in the face of this significant challenge. Movement restriction could prove fatal in the long run though it is essential to contain the virus.

• Stigma: Public health emergencies, such as the outbreak of coronavirus disease 2019 (Covid-19), are stressful times for people and communities. Fear and anxiety about a disease can lead to social stigma toward people, places, or things. Stigma hurts everyone by creating fear or anger towards other people. In an outbreak, stigma may mean people are labeled, stereotyped, discriminated against, treated separately, and/or experience loss of status because of a perceived link with a disease. Such treatment can negatively affect those with the disease, as well as their caregivers, family, friends and communities. People who don’t have the disease but share other characteristics with this group may also suffer from stigma. The current Covid-19 outbreak has provoked social stigma and discriminatory behaviours against people of certain ethnic backgrounds as well as anyone perceived to have been in contract with the virus. The level of stigma associated with Covid-19 is based on three main factors: first it is a disease that’s new and for which there still many unknowns; secondly we are often afraid of the unknown; and it is easy to associate that fear with ‘others’. Stigma can undermine cohesion and prompt possible social isolation of groups, which might contribute to a situation where the virus is more, not less, likely to spread. This can result in more severe health problems and difficulties controlling a disease outbreak. Stigma can drive people to hide the illness to avoid discrimination; preventing people from seeking health care immediately; and discourage them from adopting health behaviours.

• Lack of Medicines and treatment facilities for chronic illness: When the world is combating and lockdown is in force, all governmental institutions are focused on the prevention and elimination of the pandemic, there could be a situation where a person with chronic illness such as diabetic patients, cardiovascular, inflammatory arthritis etc feel that they are not being taken care of. They may feel isolated, depressed, fear of the virus contact, hopelessness and could even have suicidal ideation. It is important to instill hope. Although the coronavirus can certainly cause added stress for patients with chronic illness, keeping their immune system healthy, practicing regular infection, and having an emergency plan in place can go a long way toward helping them stay calm and healthy.

• Mental disorders and substance use related treatment: Many people may use alcohol and other drugs as a negative mechanism to avoid or overcome certain emotions such as anxiety, fear, depression, hopelessness, and boredom at this Pandemic. There are two substance related disorders that may be encountered in the people affected by the pandemic and lockdown: substance abuse and substance dependence, both involve psychoactive substances, including alcohol, illicit drugs etc. psychoactive substances bring about physiological, emotional and behavioral changes. If the substance changes the way the individual acts, feels or thinks, it could lead to a pattern of substance abuse that results in at least one of four consequences: failure to fulfill role obligations, substance use placing the person in danger, legal consequences or interpersonal or social problems. In a way individuals with substance abuse disorders often have co-occuring mental illness that may be exacerbated by a disaster/pandemic Covid-19. They are running at the risk for withdrawals symptoms. In such case help of mental health or de-addiction professionals must be sought immediately to manage this group of people and or initiate withdrawal therapy.

• Infodemic: Last, a unique “infodemic”-an overabundance of (mis)information on social media and elsewhere-poses a major risk to public mental health during this health crisis.

Psychosocial impact of Covid 19: In any epidemic, it is common for individuals to feel stressed and worried. Common responses of people affected (both directly and indirectly) which might include: fear of falling ill and dying; avoiding approach health facilities due to fear of becoming infected while in care; fear of losing livelihoods, not being able to work during isolation, and of being dismissed from work; fear of being socially excluded/placed in quarantine because of being associated with the disease (e.g. racism against persons who are from, or perceived to be from, affected areas); feeling powerless in protecting loved ones and fear of losing loved ones because of the virus; fear of being separated from loved ones and caregivers due to quarantine regime; refusal to care for unaccompanied or separated minors, people with disabilities or the elderly due to fear of infection, because parents or caregivers have been taken into quarantine; Feelings of helplessness, boredom, loneliness and depression due to being isolated and fear of reliving the experience of a previous epidemic. Those are the psychosocial impacts in which the human of all races and beliefs will experience and this might exacerbate further if not their mental issues are not addressed.

Long-term Psychosocial Impact: The constant worry, fear and stressors in the population during the covid-19 outbreak can lead to long-term consequences within communities and families. There are number of factors which could lead a person to a long-term lasting psychosocial impact especially the recovered or infected Covid patients and these are: tackling the impact of Covid-19 outcome-rush, weight gain, laziness to get back to work, keeping up the schedule; deterioration of social networks, local dynamics and economies; Stigma towards surviving patients resulting in rejection by communities; possible higher emotional state, anger and aggression against government and frontline workers; possible anger and aggression against children, spouses, partners and family members (increase of family and intimate partner violence); possible mistrust of information provided by government and other authorities; people with developing or existing mental health and substance use disorders experiencing relapses and other negative outcomes because they are avoiding health facilities or unstable to access their care providers.

Psychosocial Support and Mental Health Services: The term is used to describe ‘any type of local or outside support that aims to protect or promote psychosocial well-being and/ or prevent or treat mental health condition’. The global humanitarian system uses the term MHPSS to unite a broad range of actors responding to emergencies such as the Covid-19 outbreak, including those working with biological approaches and sociocultural approaches in health, social, education and community settings, as well as to ‘underscore the need for diverse, complementary approaches in providing appropriate support. These calls for multiple levels of interventions are integrated within outbreak response activities. The spectrum of mental health and psychosocial needs range from embedding social and cultural considerations in basic services, to providing specialised services for individuals with more severe conditions. Core principles include: do no harm, promote human rights and equality, use participatory approaches, build on existing resources and capacities, adopt multi-layered interventions and work with integrated support systems. Providing psychosocial and mental health support/intervention begins with social considerations in basic services and security which includes advocacy for basic services that are safe, socially appropriate and protect dignity. Secondly to strengthen community and family support examples are activating social networks, supportive child-friendly spaces and communal traditional supports. Thirdly focused (person-to-person) non-specialised supports such as basic mental health care by primary health care doctor, basic emotional and practical support by community workers. Fourthly specialised services provided in Mental health care by mental health specialists (psychiatric nurse, psychologist, psychiatrist, medical and psychiatric social worker, mental health social worker etc).

Basic psychosocial care techniques: The basic techniques which the social workers working in Governments and Non-government Sector and other professionals and students of social work and engaged in other professions could render these valuable services for the people especially the most vulnerable during Covid-19. During this crisis it is almost impossible to render this psychosocial care to the people in person/face to face counselling due to social distancing, movement restrictions, and where the traditional method of providing psychosocial intervention is not possible, but we can do give this services through various means of technology applications. What people need now is not therapy but a crisis psychosocial care.

• Being physically and mentally active- daily routine: Pandemic restrict access to social support structures, such as schools, workplaces, places of worship, or even spending time with friends and family therefore keeping oneself busy with various activities is essential. Keeping regular routines and schedules as much as possible or help create new ones in a new environment, including regular exercising, cleaning, learning new skills, daily chores, singing, painting or other activities. Help others, through peer support, neighbor checking, and childcare for medical personnel restricted in hospitals fighting against Covid-19 when safe to do so. Keep regular contact with loved ones (e.g. via phone or other accesses).

• Keeping in touch family members, neighbours etc. through mobile phones: Stay connected with friends and family by Skype, Facetime, email, messenger and text, especially those who may be isolated. Be ready to listen to their concerns and share yours. Learn effective listening skills to help your friends and loved ones. Reflective listening is an excellent communication technique, where you listen to what a person is saying and repeat it back to them. You may help validate their concerns, and show them you understand their concerns, which can help put them at ease. Talking to another person about worries and fears can help, and just knowing that others share them can validate their own feelings.

• Getting crisis and helpline support: The general population can get access to the helplines available such as World Health Organisation, UNICEF, Ministry of Health & Family Welfare, NDMA and state helplines. A person who is in need of help can get access to apps such as CBT-I Coach, Mindfulness Coach, and PTSD Coach Etc.
• Limiting the viewing of news channels regarding Covid-19: Minimise watching, reading or listening to news that causes people to feel anxious or distressed; seek information only from trusted sources and mainly to take practical steps to prepare your plans and protect yourself and loved ones. Seek information updates at specific times during the day, once or twice. The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried. Get the facts; not the rumors and misinformation. Gather information at regular intervals, from WHO website and local health authorities’ platforms, in order to help you distinguish facts from rumors. Facts can help to minimise fears. Besides social media is creating a lot anxieties for the people

• Being helpful in this difficult situation by volunteering at minor or major level.

• Do not refer to people with the disease as “Covid-19 cases”, “victims” “Covid-19 families” or the “diseased”. They are “people who have Covid-19”, “people who are being treated for Covid19”, “people who are recovering from Covid-19” and after recovering from Covid-19 their life will go on with their jobs, families and loved ones. It is important to separate a person from having an identity defined by Covid-19, to reduce stigma.

• Protect yourself and be supportive to others. Assisting others in their time of need can benefit the person receiving support as well as the helper. For example, check-in by phone on neighbors or people in your community who may need some extra assistance. Working together as one community can help to create solidarity in addressing Covid-19 together.

• It’s essential to make your health a priority during this time. The critical self-care activities are sleep, physical exercise and a healthy diet. Find ways to address forms of stress, such as journaling, going for walks or calling a loved one. Maintaining a sense of normality and routine can also reduce stress.

• Social distancing is very important in the sense coronavirus is spread by person to person contact. Essentially droplets. That’s why social distancing is very important. The aim is actually to not transmit. We have to teach the general population about the importance of social distancing.

In such public health crisis, it is important to make general population productive and make them rely on their potentialities. Besides emphasis should be given to people that this fight is not about Covid that we are worried about but it’s about cognition and people need to develop positive cognition. So we need to change the dynamic process of thinking because it is very easy to get locked up and thinking about anxiety and depression. We need to validate those emotions because they are very real and something unprecedented. We haven’t seen this in our modern history where a global pandemic has really caused such a change in everybody’s life and they are real things. There is every possibility where isolation and financial stress could fuel spike in suicides. What people can do in such difficulty times is to be very mindful of their emotion, and make a beneficial use of the technology to be in closed with loved ones.

Everyone of us can adopt this motto, “Each One, Teach One” during pandemic. The above mentioned psychosocial technique is easily practicable and could adopt any literate man or woman to teach and spread as far as possible to curb the Pandemic outbreak.

Meijianthaipou Ruangmei (Francis),
Assistant Professor,
Department of Social Work,
St Joseph University- DMU