Cerebral Cabin Fever: Returning From Isolation With Our Mental Health In-Check
Lately there has been growing discussion around when and how we can re-open society, taking down barriers created for and by physical distancing, and returning public spaces, parks and playgrounds to the people.
When is the right time to re-open, what is the right approach and what are the risks?
Re-opening Ontario, the other provinces and the country is being met with a drastic difference of opinion similar to the polarizing attitudes towards COVID-19 which, if you can believe it, is considered a hoax or conspiracy in some dark corners of our piece of flat earth.
Some Canadians, albeit a vast minority, are calling and protesting for an immediate full scale re-opening. Others, including provincial and federal leaders, are being more cautious, basing decisions on the recommendations of health and science experts, the ones they have been listening to all along. That has others, including a few politicians on the right, in the wrong to suggest our scientists and medical experts are working for China or big pharma.
No matter when and how we move forward, and whether or not novel coronavirus was a hoax or bleach a cure, one thing many experts agree on is the cost to mental health will long outlive the financial impact of the pandemic.
COVID-19 has people scared and scarred.
JAMA, published since 1883, is an international peer-reviewed general medical journal. The JAMA Network recently reported that unprecedented efforts to institute the practice of physical distancing has resulted in changes in behavioural patterns and shutdowns of usual day-to-day functioning. "While these steps may be critical to mitigate the spread of this disease, they will undoubtedly have consequences for mental health and well-being in both the short and long term.”
The SARS epidemic, JAMA states, was "associated with increases in PTSD, stress, and psychological distress in patients and clinicians. The impact on mental health can occur in the immediate aftermath and then persist over long time periods."
In the context of the COVID-19 pandemic, there will be substantial increases in anxiety and depression, substance use, loneliness, and domestic violence. This concern is so significant that the UK has issued psychological first aid guidance from Mental Health UK which recommends taking three steps to pro- actively prepare for the inevitable increase in mental health conditions.
First, it is necessary to plan for the inevitability of loneliness as populations physically and socially isolate and to develop ways to intervene. Digital technologies can bridge social distance, even while physical distancing measures are in place. Normal structures where people congregate can conduct online activities on a schedule similar to what was in place prior to social distancing. Employers should ensure that each employee receives regular outreach during the work week.
Second, it is critical to have in place mechanisms for surveillance, reporting, and intervention, particularly when it comes to domestic violence and child abuse.
Third, the mental health system must properly prepare for the inevitable challenges precipitated by the pandemic.
By Sandro Galea, MD, Raina M. Merchant, MD
and Nicole Lurie, MD