The COVID-19 pandemic has tested the capabilities and limits of health-care systems and societies around the world. The priority focus has been on the physical and biological impact of the virus on the human body. However, a major aspect of the pandemic that is not as easily seen or measured, and risks being ignored, is mental health, which was addressed in the recent Policy Brief of the Secretary General: "COVID-19 and the Need for Action on Mental Health". Not only would failing to address the mental health impact of the pandemic potentially undo years of work and effort to improve access to and the quality of mental health services, it also creates the possibility of a mental health epidemic that could impact generations to come. Governments, communities and even individuals are responsible for taking serious and sincere steps to avoid such a grim outcome. Below are some suggested steps.
Applying a societal approach to promote, protect and care for mental health. Protecting people from pandemic-related adversities that are known to harm mental health ?
Social and financial safety nets should be expanded and strengthened, utilizing local, community-based non-governmental organizations to provide food, basic necessities and essential health services in remote and deprived areas. The potential for the exacerbation of risk factors or triggers caused by the pandemic should be reduced. Helplines should be established to better provide immediate response to calls related to domestic violence, child abuse or neglect, and suicide. New helplines should be able to provide opportunities for safe relocation, and in cases of active stress, helpful guidance by telephone.
Engaging alternative learning opportunities should be established and made available through public access television channels to ensure the continuation of education for students in remote areas where internet access and other technologies may be limited. The infrastructure for social connectedness and networking should be improved to avoid isolation during lockdowns. Healthy lifestyles that include daily sun exposure, exercise and a healthy diet should be promoted. Open spaces in urban areas should be adapted for use by children and teenagers for safe recreation.
Ensure widespread availability of emergency mental health and psychosocial support
Technical support for clinics and organizations addressing mental health should be strengthened to allow them to continue providing patient services during lockdowns. Mental health training opportunities for health-care workers in primary health-care settings should be expanded. A more localized response would reduce the need for large, overcrowded mental institutions in both the short and long term. Health-care providers must be aware of the mental health institutions to which they can refer their patients and have easy, convenient access to that network.
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The media should highlight personal narratives and sacrifices by frontline workers for the benefit of society, not only to motivate and uplift but also to counteract the discrimination and stigma they face. COVID-19 experiences should be incorporated into the plots and storylines of television shows, allowing audiences to better appreciate the plight of individuals diagnosed with the virus. Media outlets could share stories of people from varied backgrounds¡ªcelebrities, manual labourers, professionals and retirees¡ªand their experiences as COVID-19 patients, demonstrating that all people are at risk of contracting the virus. Showing that the burden is not equal for all who are infected can reduce stigma while simultaneously increasing solidarity. Financial or material support should be pledged to frontline efforts and social safety nets encouraging solidarity.
The media should also lead by example, ensuring and explicitly stating that they follow safety precautions. For example, presenters could be shown practising social distancing, separated by plexiglass and always having hand sanitizer in view and being used. Media outlets should embrace the reality of increased anxiety and validate the state of feeling anxious as a survival instinct instead of a mental illness.
Actions frontline workers can take to cope with stress during COVID-19
To avoid burnout, frontline workers dealing with the pandemic on a regular basis should practise coping relaxation techniques, including breathing exercises, progressive muscle relaxation, meditation, grounding and mindfulness. They should ensure that they are aware of their physical and mental stress limitations. If they have any condition, whether mental or physical, they should engage in selfcare, following recommendations from professionals and adhering to their prescribed treatments and medications.
Frontline workers should reduce unnecessary exposure to traditional and social media and utilize the time they have to themselves to unwind and regenerate. They should build and use support networks. Colleagues, family or friends dealing with similar pressure could meet to share their experiences and discuss possible solutions. Those working on the front lines should be vigilant in recognizing if they are beginning to rely on unhealthy coping mechanisms such as substance abuse or are experiencing burnout, and be ready to reach out to advisors and support networks. ?
Though suggestions for implementation strategies and policies can kick-start the movement, the real challenge lies in reaching consensus and then passionately ¡°walking the talk¡±. Only then will we begin to create the positive mental health impact we hope to see.
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