Stigma, Pandemic and Mental Health Issues in 2020

Dr. Narmada Hidangmayum *

COVID Care Centre (CCC) at UNACCO School at Meitram on 1st September 2020 :: Pix - Shankar Khangembam

Globally the year 2020 has been declared as public health emergency period by the World Health Organization (WHO) on March 11, 2020. Although the epicenter of the COVID-19 outbreak in December of 2019 was in Wuhan City of China, this disease has spread to more than 150 countries with over 3,69,45,310 confirmed cases and over 10,69,513 deaths worldwide as of October 8, 2020 (Coronavirus Outbreak, 2020).

The Director-General of the WHO, said that the ongoing global Covid-19 pandemic has affected the mental health of millions of people. He noted that “For many people, the lack of social interaction caused by the pandemic has had a profound effect on their mental health”.

He also recalled that mental health was already “a neglected health issue” globally before the pandemic, with close to one billion people living with a mental disorder. It also informed that in low and middle income countries, more than 75 per cent of people with mental, neurological and substance use disorders received no treatment at all for their condition.

In present situation many persons diagnosed with COVID-19, quarantined, or admitted for treatment are stigmatised. Many frontline workers also face stigmatising experiences. There are many families who had started to hide their COVID-19 status as they feel anxious to talk about it and to face the social attitude and social acceptance. The help-seeking behaviour has been affected by the fear of the stigma.

It is also seen that many people hide the death of relatives’ especially elderly persons at present pandemic situation in fear of how the society will react. Since this will also affect their socialization as well as their work participation which may directly or indirectly affect their economy.

In rural area many people are engaged in harvesting and there is a fear that if tested positive, that need to spend time in Covid care or home isolation may also affect their harvesting of paddy which is the main source of income for farmers. Many feel isolated, socially rejected, experience constant anxiety and mild depression.

This stigma present in COVID 19 does have an impact on the mental health of people. It makes people more vulnerable to distress, anxiety and insomnia. Before COVID 19 pandemic the mental health problems accounts for about 13 per cent of the global burden of disease.

And now this neglected health issue is increasing tremendously which call for an urgent intervention. At individual level or personal level it will cause insecurity, confusion, emotional isolation, and stigma and in community level it affects owing to economic loss, work and school closures, inadequate resources for medical response, and deficient distribution of necessities.

These conditions may translate into a range of emotional reactions, psychiatric conditions, excessive substance use and noncompliance with public health directives like running away from Covid Care Centre or Quarantine centre.

Many studies also have revealed numerous emotional outcomes, including stress, depression, irritability, insomnia, fear, confusion, anger, frustration, boredom, and stigma associated with quarantine, some of which persisted after the quarantine was lifted. Specific stressors included greater duration of confinement, having inadequate supplies, difficulty securing medical care and medications, and resulting financial losses.

Some groups may be more vulnerable than others to the psychosocial effects of pandemics. In particular, people who contract the disease, those at heightened risk for it which includes the elderly, people with compromised immune function and people with preexisting medical, psychiatric, or substance use problems are at increased risk for adverse psychosocial outcomes.

The greatest risk in COVID-19 is transmission to health-care workers has been reported throughout the globe. Health worker are also particularly vulnerable to emotional distress in the current pandemic, given their risk of exposure to the virus, concern about infecting and caring for their loved ones, shortages of personal protective equipment (PPE), longer work hours etc.

Frontline workers are experiencing increased workload and trauma, making them susceptible to stress, burnout, depression, and post-traumatic stress disorder (PTSD). There is also a need to acknowledge that even our policy maker also experience stress and needs public support.

Prevention efforts such as screening for mental health problems, psycho education or awareness programme, and psychosocial support are the need of the hour. There is need for psychosocial assessment and monitoring which include queries about Covid-19–related stressors such as exposures to infected sources, infected family members, loss of loved ones, and physical or social distancing, secondary adversities like economic loss , psychosocial effects such as depression, anxiety, psychosomatic preoccupations, insomnia, increased substance use, and domestic violence, and indicators of vulnerability such as preexisting physical or psychological conditions.

People should know that this is a viral infection and there is nothing to feel ashamed of and nothing to be afraid of. Once any symptoms of COVID-19 infection are displayed, it needs to be immediately reported for medical attention. Home isolation is recommended to suspected cases with mild illness with proper ventilation for fresh air and light is advised by doctors.

In addition, wearing a simple mask, appropriate coughing etiquette, and hand hygiene is advised. Persons with close contacts and possible exposure to COVID-19 infected patients should be advised for self-isolation, starting from the last day of contact.

Events such as a pandemic can have the detrimental impact on the mental health of affected populations as historical examples shows. For example, research from communities affected by outbreaks of Ebola virus disease (EVD) revealed widespread panic and anxiety, depression resulting from the sudden deaths of friends, relatives, and colleagues, and stigmatisation and social exclusion of survivors.

Therefore when informing the above mentioned information to the public there is a need for mental health professionals to craft messages in such a way that it does not create anxiety or stigma and it should be delivered or conveyed by trusted leaders.