The COVID-19 pandemic poses challenges to everyone’s mental health with the stress, uncertainty, and disruption of daily life that accompany it. Mostafa Hussein is a psychiatrist at The Behman Hospital. He previously worked with Medicins Sans Frontieres providing mental health care for refugees and the Al-Nadeem Center for Rehabilitation of Victims of Violence and Torture. Yasmin El-Rifae spoke with Hussein about his views on our vulnerabilities as a society at this moment, and how we can try to take care of both our own mental health and that of others around us.
Yasmin El-Rifae: What kinds of challenges does this pandemic bring up for people’s mental health, whether or not they already have mental health conditions?
Mostafa Hussein: Firstly, people with mental health problems also often have physical health problems. We see this especially with cases of severe mental health problems, which tend to have higher rates of diabetes and heart disease. They also tend to have higher rates of untreated or poorly managed physical health problems. Higher rates of smoking lead to worse lung health. This will translate to higher rates of serious complications from COVID-19 among this demographic.
We know also that older people feel threatened and scared by this pandemic, especially considering that the initial messaging from officials about the virus was that it will “only” affect the old and the frail. This is not very good for the old and the frail.
YR: We are used to coming closer together at times of crisis. With measures of social distancing and isolation, how can we support one another?
MH: People, in general, are actually very resilient in the face of overwhelming events. Most people will be able to cope and to manage as long as there is a line of communication, as long as they are in touch with other people. Isolation and distancing can be stressful for some, but it is already the reality for so many people: people with disabilities, the elderly, the imprisoned. Many people already have to stay at home and they manage.
The key is to call and text loved ones, and for people to feel supported through this limitation on contact.
YR: Are there specific problems or threats that flag up for you, as a practitioner?
MH: There could potentially be disruption to medication supply lines, and this will be a problem for people with all kinds of diseases, including mental health issues. A lot of people already rely on important medications that are either in short supply or imported.
If cases continue to spread, we also have to think about the experience of seeing loved ones go into hospital and be put on ventilators. These are traumatic experiences. We have to think about the possibility of more people dying, that this will mean a lot of grief in upcoming months. This will be more difficult with limits on funeral gatherings and services, which are important. They are a culture’s way of allowing for important coping mechanisms to help people through loss, at least initially.
There is a paper – published by the Lancet, I believe – assessing the mental health of people in Wuhan during and after the crisis had passed there. One of the interesting things it mentions is that, after the crisis, people felt guilty for having spread the virus to loved ones. These can be very difficult feelings to process.
The advice being sent by the WHO is very useful. It focuses on limiting news intake, staying in touch with people. We call it “social isolation,” but we should actually think of it as “physical” isolation only. We have to find ways to be social through physical separation.
YR: People have mentioned certain conditions as being particularly vulnerable, or having a harder time living through this pandemic. Like Obsessive Compulsive Disorder, hypochondria, and anxiety.
MH: Yes, these are very uncertain times. Focus on reasonable things. Follow up with therapists online, and try to find time for non-violent video games that you can play with other people, or other music and art. Basically, try to take time away from the anxiety-inducing reality.
We have to bear in mind, when thinking about mental health, that this is also a very difficult time for people who are daily laborers, whose livelihoods depend on every daily pay. It is very difficult for refugees around the world, and no less so for the refugee community in Egypt. It’s also very stressful for doctors, nurses and other healthcare workers, as they are on the frontlines.