COVID-19 Mental Health Tool Kit

The initial step is usually recognizing that uncertainty and anxiety during this period is perfectly normal, understandable and common. Anxiety is a natural human reaction to feeling in danger. It can be experienced through our thoughts and feelings. Our thoughts are interlinked with how we feel emotionally and physically. Worrying constructively is useful to a degree as it helps the person to take necessary actions.

Anxiety is a normal, healthy experience except when the symptoms are significant, causing distress or impacting the person’s daily activities.

Dealing with the reactions resulting from stress, anxiety and depression can improve health, quality of life and wellbeing.

Anxiety and depression are commonly associated together, and there is an overlap in some of their symptoms.

Symptoms of anxiety may include sleep difficulty, constant worry, feeling tense, lack of concentration, sleep and appetite difficulty, restlessness, shallow breathing, tremors, sensitivity towards information or constantly checking social media, and thinking a lot about everything.

Symptoms of depression include loss of interest, feeling sad, angry, crying a lot, becoming withdrawn, changes in sleep and appetite, poor memory and concentration, hopelessness, losing confidence, thoughts of death and self-neglect.

The coronavirus can present a trigger for depression and anxiety; for example, as a consequence of isolation, quarantine, bereavement or physical illness. Factors that can increase the risk of depression are a previous history of depression, social isolation, pain, physical illness and other ongoing life stresses.

Recognition: Recognize your own emotions when you are worrying or are in a low mood. Be aware that a high degree of certainty is just not possible, however much we would like it. Manage your thoughts of uncertainty by trying to separate what is in your control and what is not in your control. Attend to things that you have control over.

Challenging bad thoughts: Identify and challenge any worrying thoughts or negative thoughts of helplessness. These are central to anxiety and depression. Examine the evidence that does not support your negative thoughts. Shift your negative self-statements to positive self-statements that allow you to function with less distress. For example, rather than saying, “This is a terrible time,” you can say, “I am sure that I will overcome this terrible time.” This will normally convert your emotions into positive emotions and positive actions.

Promoting a sense of safety: Improve your sense of safety by educating yourself about mental health and the coronavirus using information from reliable sources. Following good hygiene habits and measures to limit the risk of infection, as published by the infection control authorities, will promote a sense of safety.

Connectedness: Try alternative ways of making contact with others if you cannot go out, such as phoning, texting, video calling and emailing friends and family. Contact others on a daily or regular basis and let them know how you feel.

Maintaining a routine: Maintain a healthy routine as far as it is practical. For example, make sure you have enough sleep and do some physical activity if appropriate. Modify your daily activities and increase activities that you enjoy doing.

Practical measures: Avoid excessive checking of social media and consider turning off notifications from unreliable or anxiety-provoking sites. Focus on information that provides practical steps for yourself and your loved ones. Amplify positive and hopeful stories, such as stories about people who have recovered from the virus. Use technology positively to promote community safety and a sense of control.

Reliable sources of information: Identify reliable sources and allow yourself to check one source once a day, such as the World Health Organization, National Centers for Disease and Control, and your local Ministry of Health or National Health Services.

Practice calmness: This is done through relaxation techniques and anger management. Practice slow, steady breathing and muscle relaxation at the same time. Alternatively, do yoga or another form of exercise, listen to music or practice any distraction technique that has worked for you previously.

Be positive about others: Someone who has a cough or fever does not necessarily have the coronavirus, and someone who has the coronavirus will likely recover well. Self-awareness is important in not stigmatizing others in the community. Recognize that people who are affected and are in isolation have done nothing wrong and they deserve your support, compassion and kindness. And avoid attaching the virus to any ethnicity or nationality.

Worry time: Rather than worrying all the time, try to set aside a specific time each day and call it “worry time”, but do not do this close to your bedtime.

Consult with your primary care physician or your local mental health services if you continue to suffer from mental health symptoms for a period of several months after the outbreak, and the symptoms are at such a level that they are affecting your daily activities or causing severe distress. Long-term effects may include the continuation of the symptoms of depression and anxiety, or developing symptoms of post-traumatic stress disorder, such as flashbacks, nightmares, hyperarousal and avoidance around the traumatic events. There is treatment and help available for any prolonged consequences, including prescribing medication and psychological therapy.

For the elderly and people with chronic health conditions, mental health symptoms can be worse compared with other healthy people. This is particularly true if they are in isolation, which is in itself an independent risk factor for depression in older people. Also, older people may be suffering from dementia and can become more confused and distressed, especially by the news. Practical and emotional support is usually provided through their families. Giving simple, non-distressing and honest information to the elderly is very important. Information may have to be repeated for elderly people, particularly if they are suffering from Alzheimer’s disease or another form of dementia.

Children and teenagers react to what they see and observe from the adults around them. When parents and care givers deal with COVID-19 calmly and confidently, they can provide better support for their children.

Children can be frightened about something they do not understand, and parents can be reassuring if they are well prepared. Children can also think they have caused the events around them by being naughty.

Not all children will respond in the same way, but some common reactions will include crying, excessive worry, sadness, unexplained headaches, petulance and irritability, avoidance of activities enjoyed in the past, and difficulty concentrating. Other symptoms include nightmares, and babyish talk and behaviors.

Children also react differently to grief and can go through the grief stages more rapidly. Remember, children can understand the concept of death when they are as young as five years old.

Make time to talk with your children and share the facts in a simple way that they can understand. Reassure them and make them feel safe. Children should know that it is ok to feel upset. If the child is in isolation, connect regularly with them such as through online platforms and phone calls. Try to devise a regular routine for them, and if schools are closed, create a schedule for both learning activities and fun activities.