COVID-19: Stigma, inequality, and mental health impact

IN January 2020, the World Health Organisation (WHO) declared the outbreak of a new coronavirus disease, COVID-19, a public health emergency of international concern. As at June 10, 2020, the world had recorded 7,04 million confirmed cases and 404 000 deaths. Of these, Zimbabwe had 314 confirmed cases and four deaths

In the backdrop of the extensive physical health coverage about the pandemic, we need to be reminded that the world was already seized with a major mental health crisis before the COVID-19 pandemic. About one in every four, already experiencing some form of mental health condition.

However, it remained unjustly ignored, partly because of faulty understanding of the matter and lack of resources to properly mitigate it. In some parts of the world, governments are starting to act after realising the economic cost of ignoring the mental health crisis, something we cannot afford to do in these COVID-19 trying times. Even more with the knowledge that without COVID-19, depression and anxiety alone were projected to cost the global economy an estimated $1 trillion each year in lost productivity. As the COVID-19 pandemic continues to complicate, so will the mental health crisis. Unfortunately the latter will be with us for much longer with some cases only becoming apparent in months and even years to come.

So, as we plot our ways in the unchartered territories of COVID-19 response, all players need to be reminded of the chronic nature of the mental health crisis and that there will be “no health without mental health”. Even more when the pandemic is, like in our case, complicated by poverty, stigma, and inequality, and set to have a more devastating impact on mental health that will be long lasting.

Evidence on the actual mental health impact of the COVID-19 pandemic in Zimbabwe is still emerging, and we need to be proactive about seeking and applying it. It is interesting to note that responsible players are already working on it with some organisations providing telehealth where it is feasible. The early picture developing from our setting and other severely affected regions like China, America and Europe is showing increased moderate-to-severe post-traumatic stress symptoms, stress, depression, anxiety, and substance use disorders. This is largely because the COVID-19 pandemic is coming with exposure to some known risk factors for stress, depression and anxiety including high mortality rate, resource and food insecurity, discrimination, and experience with infected and sick individuals, which can lead to more adverse mental health outcomes. These mental health challenges have been reported among healthcare workers, persons with COVID-19, their caregivers, and the generality of those exposed or at increased risk.

In addition to the human toll, these mental health challenges also have implications on work, resulting in decreased productivity. People will have difficulty concentrating, take longer to accomplish tasks, have difficulty thinking and problem-solving, procrastinate on challenging work assignments and have difficulty multitasking and fulfilling responsibilities.

Part of the management strategies to contain the spread of the coronavirus including lockdown, quarantine and isolation measures will have adverse psychosocial impacts on us. People will respond to these in different ways depending on their life circumstances. However, what is constant is that our lives will be disrupted and we need to adjust. Unfortunately, many do not have the mental and economic resources to cope in adaptive ways. Some negative mental health impacts will kick in and these are signs to look for:

 Drastic changes in sleeping patterns — mostly insomnia  Changes in appetite  Extreme mood changes — easily getting angry, agitated, or irritable or feeling extremely sad  Severe tiredness and feeling easily fatigued  Losing interest in the things you loved to do  Withdrawal from family members and friends  Difficulty in focusing or concentrating  Desire to increase alcohol or tobacco use

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NB: The mental health services remain available, and people are encouraged to seek help early for optimum results. The Health and Child Care ministry has constituted a psychosocial treatment working group to respond on the psychosocial impacts of COVID-19.

Mental health impact on professionals The mental health of the general population also depends on that of people who serve them in crisis times like these. For the mental health of our frontline workers, WHO advises that responsible authorities be proactive on meeting their basic needs. By protecting our health and social care staff from chronic stress and poor mental health, we protect our own health and promote societal wellbeing. This will boost their ability to perform their duties. Responsive and ethical leadership that delivers quality communication and accurate information updates to all staff can also help avert mental health challenges among frontline workers.

COVID-19 will also definitely have its mental health toll on our national leadership and line managers. Most of them will be forced to make difficult decisions as they operate on a survival mentality mode. This will increase the risk for work-related stress, burnout, compassion fatigue and other occupational disorders. If this is not addressed, mental health challenges will rise in this group and manifest as absenteeism, presentism, and poor performance. It is, therefore, crucial that our COVID-19 response incorporate preventative mental health strategies for all key groups. The levels of stress they encounter can be significantly lowered by applying coaching, mentorship and basing their decisions on sound scientific evidence.

The inequality dimensions

While we understand that COVID-19 does not discriminate, so is the mental health impact, inequalities are quite evident in the way we are affected. In our situation of a predominantly informal economy, people with the most precarious livelihoods, those with pre-existing mental health conditions, the elderly, persons with disabilities and those in abusive relationships have a greater risk and should have special consideration. Most people in informal trades fear for their financial future which was already strained by prevailing economic hardships.

They have few or no resources to fall back on, and they foresee worse health outcomes for people like them. The mental health impact will intersect with all these and other injustices resulting in increased risk among the already marginalised.

Attending to stigma

We must deal decisively with stigma. Stigma towards persons with COVID-19 and those with already existing mental health conditions will derail our progress in fighting this virus. There is no use in stereotyping, discriminating, harassing and or bullying those affected or at risk. Stigma can lead people to hide symptoms of illness, abscond from quarantine centres and falsify information to avoid discrimination. It can also result in people not seeking healthcare even when needed or they may further self-isolate. In Zimbabwe, stigma could be propelled by misinformation, denialism and lack of a comprehensive plan that considers the everyday realities of the common man. We are, however, all called upon to be “empathetic to all those who are affected, in and from any country”. This is WHO’s warning against stigmatising anyone who has or had the virus. We, therefore, need to invest in sound community and public engagement to fight the stigma scourge.

Conclusion