While the primary threat posed by COVID-19 is to people’s physical health, the pandemic is also taking its toll on economies, social and cultural activities, and people’s mental health. Spotlight spoke to mental health experts in the public, private and NGO sectors to hear how the COVID-19 pandemic is affecting the mental health of people in South Africa.
Suntosh Pillay, a clinical psychologist working in the public sector in KwaZulu-Natal, says that South Africa could see a massive rise in depression following the pandemic. “I think there’s going to be intense feelings of depression after this, especially as we’re dealing with the aftereffects of the economic meltdown.”
“We must never talk about keeping people physically healthy without a parallel conversation about keeping people emotionally well. We need to keep [the] conversation around mental health alive on all levels,” he emphasises.
An emotional tsunami
Pillay says that the pandemic has caused what he calls an emotional tsunami. “People’s feelings are exacerbated to the extremes at the moment, especially because of the uncertainty of what’s going to happen,” he says.
“We don’t want to pathologise people’s feelings, because [they] are normal and acceptable, but it takes a toll on mental health even if it doesn’t lead to serious mental illness. It definitely leaves people in a perpetual state of stress,” he says.
However, Pillay adds that the lockdown came with some positive mental health benefits, such as added time at home with family. “I think on the one hand there are potential benefits to mental health, but on the other hand, more so, there are negative implications. Only the future will be able to tell us if these weeks in lockdown have created a rise in mental illness or not.”
What people worry about
A recent survey conducted by the South African Depression and Anxiety Group (SADAG) found that nearly half of the 1 214 respondents felt that financial stress and pressure were one of the main challenges during the lockdown.
Adding to this, over half of respondents cited anxiety and panic as a major challenge.
Masutane Modjadji, South African Federation for Mental Health’s (SAFMH), Information and Awareness Project Leader, says that people are worried about different things at the same time.
“For those who struggle to put food on the table, providing food for their families is a priority while sacrificing their safety. Those who were homeless, needed some kind of shelter whilst still practicing physical distancing, [and] those who are better off felt responsible for providing food for the poverty stricken,” says Modjadji.
Adding to this, Pillay says that there is a direct relationship between socio-economic wellbeing and mental health. In his experience, Pillay says, most patients face stress and anxiety as a result of issues like food, money or employment.
“COVID-19 has forced humanity to adjust to a different way of life which has caused much stress which has a major impact not only for those with pre-existing mental health conditions but also for the broader population,” says Modjadji.
The hidden epidemic of gender-based violence
Pillay emphasises that gender-based violence was another major concern. “There’s a whole hidden epidemic that’s happening around gender-based violence,” he says. “People don’t have the room to leave the spaces that they’re trapped in.”
“I think there’s a double-edged sword about the alcohol ban,” he says. “On the one hand, people are becoming abusive because of not being able to drink alcohol or smoke cigarettes, and on the other hand, where people are getting access, it’s exacerbating the effects of alcohol-induced gender based violence.”
Pillay adds that as a result of the lockdown, other vulnerable groups, like the LGBTQI+ community, could be forced to be in emotionally violent spaces for long periods of time.
Mental healthcare on the front lines
While shortages of essential psychiatric medicines and personal protective equipment (PPE) continue to plague facilities across the country, mental health professionals are hard at work making sure some of society’s most vulnerable people still receive the highest quality of care.
Professor Bonga Chiliza, President of the South African Society of Psychiatrists (SASOP), tells Spotlight that a lot of the trauma from the pandemic comes from its size as case numbers increase every day. He emphasised that if we can flatten the curve and reduce the impact on hospitals, this trauma might be reduced.
“I think a lot of psychiatrists are worried about if or when their patients develop COVID-19,” he says.
Chiliza says that he and his colleagues were trying to gain access to foreign medical journals to better understand the possible reactions that mental healthcare users could have to the virus, and how to treat them.
“One of the things that has come out to us [in the research] which was surprising, is that a lot of frontline workers really felt traumatised by [the pandemic], and they described symptoms which sounded like Post-Traumatic Stress Disorder (PTSD),” says Chiliza. “I presume that that’s likely to happen here.”
SASOP, along with SADAG, the South African Medical Association (SAMA) and other health professionals have set up a network of mental health professionals to help the country’s frontline healthcare workers. So far, Chiliza says, the project has assisted workers in Johannesburg and Durban, and there are plans to launch in Cape Town as soon as possible.
“There’s quite a few people that are coming through requiring crisis counselling to try and help them at this time. It’s mostly young doctors and nurses [who] are worried about getting the virus but also taking it home to their families,” says Chiliza.
Patient care during lockdown
“The first few weeks [of the lockdown] were quite quiet in our psychiatric wards and clinics but towards the end of the month a lot of people were being admitted and a lot of that was due to the fact that they were too scared to get more meds,” says Chiliza.
Chiliza says that patients who were stable were given two months’ worth of psychiatric medicines, but concerns and stress from the pandemic were resulting in some patients not taking their medications.
“Most people are anxious, and our psychiatric patients who have depression [and] anxiety, some of them are even more anxious than usual. [The pandemic] can destabilise people who have mental illnesses from the increased stress and make things more difficult for them.”
“The difficulty is that some of the things we ask people to do who are depressed or anxious, is often around chatting to families, going outside for walks and now all of those things have been stopped.”
As a result, Chiliza says, people are struggling to find ways to remain connected and supported by their families.
Bracing for chaos
In April, the Department of Health issued guidelines for psychiatric hospitals and facilities during the pandemic, but Chiliza says that these are not enough.
“The one major anxiety is that we feel that we don’t have good protocols in place that we can rely on to say this is how we should do things,” he says.
“The regular social distancing rules that everyone abides by becomes tricky in psychiatric wards. The way our psychiatric wards are designed are for people to get together rather than be apart.”
Similarly, a staff member from a prominent Eastern Cape psychiatric hospital says that they are preparing for the inevitable “viral tsunami” that could soon hit the facility.
The hospital has created their own comprehensive guidelines for COVID-19.
“It is evidence-based and referenced, and a good working document,” the staff member says. “But even with the best plans, I suspect that the local health system is due to be overwhelmed very quickly following the onset of the peak of the pandemic.”
Despite this hospital’s plan, the staff member says that they face drastic shortages of personal protective equipment (PPE), and some staff members are threatening to strike should the situation worsen.
“We’ve placed orders over a month ago and still [wait for] even one single delivery,” the source says. “We are supplying frontline healthcare workers with just one surgical mask per week. Even at this rate, we will run out in about a month from now.”
Spokesperson for the Eastern Cape Department of Health, Sizwe Kupelo, says that hospitals are expected to place their own orders with the depot, and that the province was continuing to procure and distribute PPE.
Another issue facilities are facing are stock-outs of essential psychiatric medicines.
“We had a huge problem last year,” says Chiliza.
“There are still stock-outs in both sectors. Basic medications like Lithium which we use for the management of bi-polar has been difficult to get stock of, [and] other medications that we use for sedation have been in short supply for a while now.”
Besides the guidelines issued for psychiatric facilities, government says it has stepped up to improve psycho-social support services to families in need during this time.
In a briefing last week, Social Development Minister Lindiwe Zulu announced that 276 psycho-social support teams would be dispatched at district level. The purpose of the teams, she said, was to assist with trauma, briefing and debriefing families affected by the COVID-19 pandemic.
Deputy Director General of Welfare Services, Connie Nxumalo said at the same briefing that the teams comprised social workers who were trained in trauma counselling. “The support they provide is counselling and reunification with those who have been in quarantine [and/or isolation] sites. One example is the South Africans who have come back from Wuhan, who had been in Limpopo, the social workers were able to reunify them with their families.”
Nxumalo said that the psycho-social teams worked alongside the Department of Health to receive information about which families needed assistance and intervention. However, these teams are not part of the contact tracing or rapid response teams.
She added that individuals were also consulting with social workers, and that the Department had conducted almost 10 000 individual counselling sessions so far.
Include mental health in COVID-19 screening
Modjadji and Pillay both agreed mental health screening should be factored into the screening process for COVID-19.
Pillay says that frontline healthcare workers, specifically, should be conscious of mental health conditions. “Even if it’s not part of the formal screening process, they need to pick up on people who might have pre-existing mental health conditions or might be at risk for developing a mental health problem.”
Modjadji says that government also need to prioritise resources and support for community mental healthcare facilities run by the NGO sector.
“These facilities are in need of face masks, gloves and sanitisers to ensure that residents practice safe hygiene and physical distancing,” she says.
The SAFMH called for primary health care clinics to ensure persons with mental illness has access to at least a three months’ supply of medication.
Spotlight asked the National Department of Health: how DSD’s psycho-support teams work with the DOH to assist families, how the DOH is working to support mental healthcare workers during this time, what the DOH’s greatest mental health concerns are and how and what was being done to address them, if any mental health screening was coinciding with the COVID-19 screening, if community healthcare workers are adequately trained in mental healthcare, if essential psychiatric medicines are widely available across the country and how many months of medication mental healthcare users have been provided with during this time. Read the department’s response in full here.
Free help is available.
For those who are struggling during this time, Pillay says that the Psychological Society of South Africa (PsySSA) has created an extensive database of psychologists offering free services for anyone in need. To connect with one of these professionals, you can email Fatima@psyssa.com
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