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Mental Health considerations in response to the COVID-19 outbreak

 

 

The outbreak of coronavirus disease 2019 (COVID-19) has been stressful and nerve-racking for people.  Fear and anxiety about disease can be overwhelming and cause strong emotions in adults and children.  Coping with stress proactively will make you, the people you care about, and your community stronger.

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In any epidemic, it is common for individuals to feel stressed and worried. Common responses of people affected (both directly and indirectly) might include:

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  • Fear of falling ill and dying

  • Avoiding 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

  • Feelings of helplessness, boredom, loneliness and depression due to being isolated

  • Changes in sleep or eating patterns

  • Difficulty concentrating

  • Worsening of chronic health problems

  • Increased use of alcohol, tobacco, or other drugs

 

Specific stressors particular to COVID-19 outbreak include:

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  • Risk of being infected and infecting others, especially if the transmission mode of COVID-19 is not 100% clear

  • Common symptoms of other health problems (e.g. a fever) can be mistaken for COVID-19 and lead to fear of being infected

  • Caregivers may feel increasingly worried for their children being at home alone (due to school closures) without appropriate care and support

  • Risk of deterioration of physical and mental health of vulnerable individuals, for example older adults and people with disabilities, if caregivers are placed in quarantine if other care and support is not in place

 

The constant fear, worry and stressors in the population during the COVID-19 outbreak can lead to long-term consequences within communities and families:

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  • Deterioration of social networks, local dynamics and economies

  • Stigma towards surviving patients resulting in rejection by communities

  • Possible anger and aggression against government and frontline workers

  • 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 unable to access their care providers

 

On a more positive note, some people may have positive experiences, such as pride about finding ways of coping and resilience. Faced with disaster, community members often show great altruism and cooperation, and people may experience great satisfaction from helping others. Examples of MHPSS community activities during a COVID-19 outbreak might include:

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  • Maintaining social contact with people who might be isolated using phone calls or text messages

  • Sharing key factual messages within the community, especially with individuals who don’t use social media

  • Providing care and support to people who have been separated from their families and caregivers:

 

Messages & activities for helping children deal with stress during the COVID-19 outbreak

Not all children and teens respond to stress in the same way.  Some common changes to watch for include:

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  • Excessive crying or irritation in younger children

  • Returning to behaviors they have outgrown (for example, toileting accident or bedwetting)

  • Excessive worry or sadness

  • Unhealthy eating or sleeping habits

  • Irritability and “acting out” behaviors

  • Poor school performance or avoiding school

  • Difficulty with attention and concentration

  • Avoidance of activities enjoyed in the past

  • Unexplained headaches or body pain

 

Encourage active listening and an understanding attitude with children.

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  • Children usually feel relieved if they are able to express and communicate their disturbing feelings in a safe and supportive environment. Every child has his/her own way to express emotions. Sometimes engaging in a creative activity, such as playing and drawing can facilitate this process. Help children find positive ways to express disturbing feelings such as anger, fear and sadness.

  • Encourage an increased sensitive and caring environment around children. Children need adults’ love and often more dedicated attention during difficult times.

  • Remember that children often take their emotional cues from the important adults in their lives, so how adults respond to the crisis is very important. It’s important that adults manage their own emotions well and remain calm, listen to children’s concerns and speak kindly to them and reassure them. If appropriate and depending on the age, encourage parents/caregivers to hug their children and repeat that they love them and are proud of them. This will make them feel better and safer.

  • If possible, make opportunities for children to play and relax.

  • Keep children close to their parents and family, if considered safe for the child, and avoid separating children and their caregivers as much as possible. If a child needs to be separated from his/her primary caregiver, ensure that appropriate alternative care is provided and that a social worker, or equivalent, will regularly follow up on the child.

  • If children are separated from their caregivers, ensure regular and frequent contact (e.g. via phone, video calls) and re-assurance. Ensure all child protection and safeguarding measures are addressed.

  • Keep regular routines and schedules as much as possible or help create new ones in a new environment, including learning, playing and relaxing. If possible, maintain schoolwork, study or other routine activities that do not endanger children or go against health authorities.

  • Provide facts about what is going on and give clear child-friendly information about how to reduce risk of infection and stay safe in words they can understand. Demonstrate to children how they can keep themselves safe (e.g., show them effective handwashing)

  • Avoid speculating about rumors or unverified information in front of children.

  • Provide information about what has happened or could happen in a reassuring, honest and age-appropriate way.

  • Support adults/caregivers with activities for children during home isolation/ quarantine. Activities should explain the virus but also keep children active when they are not at school, for example: hand washing games with rhymes, make cleaning and disinfecting the house into a fun game, explain person protective equipment (PPE) to children so that they are not scared

(Source: WHO. Helping children cope with stress during the 2019-nCOV outbreak)

 

Activities that will support adults’ wellbeing during home isolation/quarantine

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  • Physical exercise (e.g. yoga, tai chi, stretching, workout programs)

  • Cognitive exercises (games, puzzles, journaling)

  • Relaxation exercises (e.g. breathing, meditation, mindfulness)

  • Reading books and magazines

  • Reduce the time spent looking at fearful images on TV/online

  • Reduce time listening to rumors

  • Rely on social support networks through use of technology to maintain social distancing

  • Search information only from reliable sources

  • Reduce time looking for information (1-2 times per day, rather than every hour)

  • It can be difficult to be isolated for an extended period of time with the same few people, even if they are loved ones.  It is healthy to take some time alone.  Engage in an activity by yourself such as going on a walk, playing with a pet, taking a hot bath, praying or meditating.  

 

Additional links and resources:

 

https://mcusercontent.com/c2523f4cbed5f394e2158b43f/files/d92de91b-bf7f-4cf8-86fb-44957ab46970/MHPSS_COVID19_Briefing_Note_FINAL_26_February_2020.pdfMental health and the psychosocial aspects of COVID19.  This link contains specific information on how to support different groups including older adults, those with disabilities, children and teens, and people working with the COVID19 response. 

 

https://store.samhsa.gov/system/files/sma14-4894.pdf

Taking Care of Your Behavioral Health: Tips for social distancing, quarantine, and isolation during an infectious disease outbreak.

 

https://www.nctsn.org/sites/default/files/resources/fact-sheet/outbreak_factsheet_1.pdf

Parent/Caregiver Guide to Helping Families Cope With the Coronavirus Disease 2019 (COVID-19)

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