‘Everyone Is Essential to Victory Over This Virus and Over Its Consequences’.
To slow the spread of the new coronavirus that has sickened half a million people and killed over 24,700 globally, everyone now knows the five things to do: hand washing, coughing and sneezing into elbows or tissues, avoiding touching one’s face, staying at least six feet from others, and staying home when feeling unwell.
“We need a similar ‘five’ for mental health,” Karestan Koenen suggested at the second event of the School of Public Health’s Coronavirus Seminar Series, “Mental Health in a Time of Crisis,” on March 26. The online event drew an audience of 3,200 people, maxing out the Zoom conference capacity and spilling over onto Facebook Live.
The COVID-19 pandemic is unprecedented, said Koenen, professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health, but its mental health consequences are becoming clear.
In China, where COVID-19 now appears under control and in decline, Koenen said that research published this week found depression and anxiety in about half of the entire population.
Recent epidemics also show the heavy mental health toll of such events, she said, noting that the majority of people in parts of Sierra Leone affected by Ebola had depression and/or anxiety symptoms one year after the outbreak.
The current pandemic has “multiple qualities that are toxic to mental health,” Koenen said. There are constant visual reminders, she said, from news showing overwhelmed hospitals in New York City and coffins in Italy, to her own empty-shelved local supermarket. The newness of this coronavirus brings tremendous uncertainty, and population-wide isolation measures to prevent spread of the disease cuts people off from their friends and families, or traps them in difficult, and even dangerous, home environments. Xenophobia has reached every level of society, from verbal and physical abuse of Asian Americans in public spaces to the President’s references to the “Chinese virus.” And the loss of loved ones, as well as opportunities and economic stability, Koenen said, is bringing widespread grief.
“We need a concerted public health effort to address mental health in the COVID-19 pandemic,” she said. “We know it’s going to be a problem, and it’s something we need to address proactively.”
Her “five” for taking on the mental health consequences of COVID-19 begin with identifying that there is a problem. Next, Koenen recommended broadening the safety net, based on overwhelming evidence that “by buffering people from the economic consequences and the other social consequences of the pandemic, we are also protecting people’s mental health.”
Her third recommendation was to support those most at risk for trauma, including people with existing mental health problems, families in conflict and/or with histories of domestic violence, families with kids with special needs, people who were already isolated before the pandemic, and people working in health care. “There are a lot of at-risk populations, which again argues for a population mental health approach,” she said.
Koenen also recommended building up resilience strategies for individuals and communities. And for the fifth recommendation, Koenen said, “one thing we can all do to help our own mental health and others’ is to be kind to ourselves and to each other, to our families, and to our neighbors, because we are all under so much stress.
“All of us, everyone is essential to victory over the virus, and over all of its consequences,” she said.
Sarah Lowe, assistant professor of social and behavioral sciences at the Yale School of Public Health, described some of the ways that individuals and communities can reduce the mental health harms of the pandemic.
Lowe warned that more exposure to the traumatic event is harmful—meaning it is a good idea for individuals and families to limit news and social media consumption. Communities can also reduce exposure by protecting each other from COVID-19 and its social and economic harms through community organizing.
She also stressed the importance of what a person does with the feelings that arise from this pandemic. “Research has shown that people who have very intense fear, worry, anger, and grief during mass trauma tend to fare worse—but on the other hand, these are all normal reactions to an abnormal situation,” she said. “The strategies that we use to cope really shape responses, whether a person uses more adaptive strategies like mindfulness and acceptance, cognitive reappraisal, social support-seeking, and exercise, or less adaptive strategies such as rumination [dwelling on it], co-rumination, binge eating, or substance use.”
Asked by an audience member how leaders can help model healthy responses to the pandemic, Lowe stressed the importance of validation while simultaneously instilling hope for the future. “Doing those things in parallel is really important—Not telling people that they shouldn’t be afraid or that this isn’t something to be scared of, because it is scary and people are rightly worried, but at the same time we as a community are strong, and that we will get through this and support each other.”
In fact, Lowe said, getting through this difficult time will make many people more resilient: “Most trauma survivors report at least some degree of what’s called post-traumatic growth, including perceived stronger relationships with others, a greater appreciation of one’s life, a sense that new things are possible, that people are stronger than they thought they were, and a stronger sense of faith.”
Patricia Watson, assistant professor of psychiatry at the Dartmouth Geisel School of Medicine and senior educational specialist at the Department of Veterans Affairs National Center for PTSD, said that, while resiliency and recovery is the norm, 10 to 30 percent of the population will likely need some form of mental health treatment for the longer-term mental health effects of the pandemic.
That will mean unprecedented demand, she said, so she and her colleagues are “scrambling” to develop strategies and resources to help individuals develop skills to better handle their own experiences of the pandemic, and support their families, friends, communities, and colleagues.
Some of these resources are already available from the National Center for PTSD, including tips for anyone to manage their own stress from the outbreak, for providers and community leaders to help others manage this stress, and for health care workers to manage their own stress.
Watson and colleagues at the National Center for PTSD are also working on creating a “psychological first aid” factsheet for the COVID-19 pandemic and similar situations, pulling from the Skills for Psychological Recovery Manual (the manual should ideally be used by a mental health provider or with the help of one). Watson also noted that manual’s section for for helping children at different ages during and after traumatic events as a useful tool in this time.
The overwhelming theme for all of the speakers was the importance of social support, “which is of course particularly difficult in a time of physical distancing,” said Sandro Galea, Dean and Robert A. Knox Professor at SPH, who moderated the seminar and is himself an expert in the mental health effects of mass traumatic events. “Separating physical distancing from social distancing is critical,” he said.
The other speakers agreed, emphasizing the importance of finding ways to stay connected with friends, loved ones, and colleagues—a sentiment that, in a seminar conducted over Zoom with thousands of people, hit home.
Watch the full recorded Health in a Time of Crisis here. Sign up for next week’s event in the Coronavirus Seminar Series, titled “Politics, Health, and Coronavirus,” here.