The importance of nurturing one’s mental health during Covid-19

As we all know, the Covid-19 pandemic has taken a huge toll on the physical health of people, with many dying and others becoming very ill. It has also caused immense economic and social disruptions. But what about the mental wellbeing of people during this pandemic? How is Covid-19 affecting people mentally and what should they do? To find out more, we asked a panel of psychologists, psychiatrists and other healthcare professionals. Here’s what they told us.

Humanity is facing an extraordinary challenge. COVID-19 has demonstrated how interconnected, fragile and dependent we are, and how easily we can succumb to fear and hopelessness. At the same time, it has forced us to introspect, to summon our recourses collectively and to restore hope.  We need to understand the nature of the challenges facing us (including the physical and psycho-social-spiritual questions that arise), as well as possible ways of responding to them. We categorize the questions for convenience only and offer a few general, practical guidelines.

PHYSICAL-PSYCHOLOGICAL- SOCIAL-SPIRITUAL ASPECTS

Symptoms of Covid-19

Our first concern is naturally the symptoms of COVID-19 with the common ones being: fever, dry cough and tiredness. Less common is the loss of taste or smell, diarrhoea, headaches, rash, discoloration of fingers or toes, aches and pains, and sore throat. Severe symptoms include difficulty breathing, chest pain or pressure, and loss of speech. Most people who fall ill tend to have mild to moderate symptoms, and often recover without specific treatment. Many who test positive are free of symptoms.

Daily Self-help Activities

Sleep, regular exercise, maintaining a healthy balanced diet, together with good personal hygiene habits and the use of natural sunlight – all help to enhance our immune systems. These activities are part of the knowledge base of our culture, but negligence and the need to maintain healthy bodies have now forced us to refocus with greater urgency.

 

Restful sleep requires a regular sleep-wake cycle. When we find it difficult to initiate sleep, we may need to devise strategies such as getting up at a particular time each morning regardless of how we slept the night before and continue with that pattern for several days. Over time, our sleep will become regular. Some activities that impinge on restful sleep are: using the bed for other activities like watching TV; taking excessive fluids or caffeinated beverages late afternoon; and also rigorous exercises late at night. Let’s rather read a book instead of fiddling on social media. Try to sleep in a quiet dark room.

 

Exercise is particularly important especially when in lockdown. The releasing of neurotransmitters has the effect of lifting the mood.  Start with simple stretching and exercise at a level of tolerance. If need be, it is always wise to get advice from a health practitioner.

 

A balanced diet provides the nutrients to bolster our immunity. There is a real risk of weight gain when in lockdown and we need to be particularly cautious of that.

 

Good hygiene habits help us avoid infection. It is useful to practise these habits with children. This can be fun. Using an elbow bump instead of a handshake; opening doors with a closed fist, or with the hips if possible; learn to sanitize; practise physical and social distancing; wear appropriate protection, especially when coughing or sneezing, etc.

 

Sunlight is a gift of nature we need to exploit to enable our bodies to create vitamin D needed for our immune system.

Psycho-Social

It is normal to be anxious and fearful in these times. The key is to balance fear with hope. If symptoms of depression and anxiety persist, and if they interfere with personal functioning, then it may be necessary to seek help from a healthcare professional.

Children

Children might find the changes in the adult world confusing or fearsome and need to be informed on the reasons for a lockdown, for social and physical distancing, and for meticulous hand washing, in a manner they understand. They must be encouraged to ask questions and express their feelings, instilling hope and to be viewed as proactive and protective. Without communication children might sense danger to internalize. Clear communication, comfort and support are crucial for our children’s security and wellbeing.

Daily Routine

Routine provides a sense of order and support in situations of crisis. Prepare a routine for all, particularly when in lockdown:  times for work, for fun and prayer. The key is to have a balanced life, and this shared activity also offers a semblance of comfort and stability. Remember, nerves might become frayed and we need to adjust our routines. There are activities that we can do that are constant and can be performed at more or less the same time, like waking up, dressing, meals and sleeping. After that, let us add the other important or significant things that help reduce anxiety in between.

Pessimism

We must guard against pessimism. Just as we consciously cleanse our hands with soap and water, so must we consciously cleanse nihilistic, gloomy thoughts from our minds.

Self-monitoring

Healthcare practitioners monitor our personal, occupational, or social functioning, but rely on us to observe and self-monitor changes if we are under care for a particular disorder and that we be vigilant in keeping up with our management plans. We know our conditions best – a clue for deterioration is a worsening of our symptoms which might be accompanied by sustained changes in our normal sleep, appetite, and energy patterns.

Control exposure to social and other media

Maintaining important relationships help in strengthening our support structure. It also serves as a way to reduce our sense of isolation at this time. Ways to engage with others may include having meals together as a family, face to face chats with family and/or friends, telephone or video calls, watching movies or current affairs programs together. This must be balanced: determine how long and how often we connect with others and avoid fake media. There have been many instances of people who denied the existence of the virus and failed to protect themselves with tragic consequences.

Meditation, breathing exercises or relaxation

These are best done early in the morning or as a means of preparing to sleep. Meditation helps reduce anxiety as well as improve self-awareness. During this time, we could keep a gratitude diary to remind us of the progress of all our management plans.

Help is at hand

As a community, we feel secure knowing that help is at hand. In the same vein it is our collective responsibility to be of help to family, friends, neighbours and strangers, regardless of race, colour or creed. Above all, let us be safe.

Some health issues affecting people during a pandemic

In South Africa we have all been in lockdown for the greater part of five months, and the stress can feel relentless. Lives are being lost, disrupted and restricted. We can’t wait until this is all over, or when we start to feel better to live our best lives. We have to action function and balance in this moment. 

 

Of course, those who have to work for a living, for example, in the informal settlements, have a very different take on lockdown to those who are seen to be chilling at home. It is about “how is it affecting our survival right now”.  Being unable to earn a living immediately, being retrenched or being fired and with no opportunity to earn money, generates massive stress – fearful of retrenchment.

 

The ban on cigarettes and liquor added to the complications for people who smoke daily, maybe 20 to 30 cigarettes a day and those people who drink alcohol substantially. For these people, it felt like they were in rehab:   being irritable, their anger was released onto someone who had nothing to do with the pandemic. Usually it would be a family member close by – hence the increase in family violence by people who are frustrated by some of these restrictions.

 

But the most common experience during Covid, is fear – fear of many things: lack of knowledge of the virus, not seeing family members, fear for parents’ wellbeing if they were living alone. In private practice we have seen an increase in anxiety and panic attacks about contracting the illness, but more importantly, people are panicking that they might infect other people and then feel responsible for their deaths.

How do we cope?   

While there are many things you may not be able to control, like whether your job is safe, whether you’re going to get an income or whether you’re going to be able to see your family, you can learn to manage your stress caused by these uncertainties.

 

Some of these solutions are mentioned above: exercising, sleep hygiene, watching the diet and practicing relaxation daily (You Tube has a variety of excellent and free programmes).

 

Sleep hygiene is really important in managing Covid anxiety. While this may be difficult, learn to stop using cell phones and computers at least 2 hours before bedtime, and no action-packed, adrenaline-producing thrillers either! Watch happy movies if you must.

 

Let us maintain the rule: keep the social distancing but stay socially connected …with everyone we hold dear. It’s good for your soul!

 

Stay informed but don’t overdose on Covid news. It’s hard to tell truth from fake news and it just creates more anxiety anyway.

Function and Balance (The Occupational Therapist):

work, self-care, leisure, relationships

Function and balance include our ability to perform optimally in the areas of work, self-care, leisure and relationships. If we focus too much on one area to the neglect of the other, then we are out of balance. Use these four areas – work, self-care, leisure and relationships – as check points for yourself.

 

Ask yourself weekly: “Have I given my work enough attention and energy?  How did I self-care and self-nurture this week?”  In the busyness of life, we may get so involved in the needs of others that we forget about ourselves. We need opportunities to let our hair down and do something fun. This is a fundamental stress relieving mechanism.

 

Ask yourself: “Have I spent time and energy investing in my relationships?”  Use this time to evaluate the quality and quantity of your relationships.

 

Function and balance can’t wait. We can’t wait until this is all over, or when we start to feel better to live our best lives. We have to action function and balance in this moment. 

Function and Balance (The Occupational Therapist):

work, self-care, leisure, relationships

Function and balance include our ability to perform optimally in the areas of work, self-care, leisure and relationships. If we focus too much on one area to the neglect of the other, then we are out of balance. Use these four areas – work, self-care, leisure and relationships – as check points for yourself.

 

Ask yourself weekly: “Have I given my work enough attention and energy?  How did I self-care and self-nurture this week?”  In the busyness of life, we may get so involved in the needs of others that we forget about ourselves. We need opportunities to let our hair down and do something fun. This is a fundamental stress relieving mechanism.

 

Ask yourself: “Have I spent time and energy investing in my relationships?”  Use this time to evaluate the quality and quantity of your relationships.

 

Function and balance can’t wait. We can’t wait until this is all over, or when we start to feel better to live our best lives. We have to action function and balance in this moment. 

Basic skills to improve daily life and management of difficulties.

 

  • Have open communication with family and children regarding COVID-19 and precautions e.g. handwashing, social distancing, wearing a mask and good coughing and sneezing hygiene.
  • Children easily fall into pattern of no schoolwork. Formulate a routine for their day with daily activities schoolwork and other activities.
  • Working from home, do time management, as work can easily influence family time.
  • Many families are complying with social distancing from important loved ones – keep in touch via social media, Skype or video calling.
  • Monitor physical symptoms of Covid-19 to seek medical help timeously.
  • Speak to someone you trust about your difficulties

 

Should you feel that you are unable to cope emotionally and that despite all that is discussed above, your anxiety or depression is worsening, you can contact your nearest mental health provider. You can also call helplines such as SADAG and get assistance or obtain a referral to an appropriate professional. If it still feels too much, then consult a mental health professional.

 

A Mental health state assessment will be made after which the necessary referrals will be made to either a private institute or clinic, or a government hospital if finance is a problem.

The contributors to this article are:

    Dr Ashraf Jedaar, Psychiatrist

    Dr Keneilwe Lehloenya, Psychiatrist

    Rafiq Lockhat, Clinical Psychologist

    Jillian Domingo, Occupational Therapist

    Wendy Lackay, Senior Professional Nurse

They can all be contacted at Summit Clinic Tel 021 659 1100.

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