Mental Health and Psychosocial Support during COVID-19 Outbreak

National action, specifically the expanded community quarantine to contain the spread of COVID-19 dramatizes the need for every citizen to be part of the solution. What happens to the individual affects his community and what happens to the community affects the individual.. This interconnectedness is at the core of the pursuit and promotion of physical health and psychosocial well-being, and the prevention and treatment of ill-health. Needless to say, the COVID-19 pandemic poses a strain and stresses the individual’s health Including their mental health. Hence, the Philippine Council for Mental Health, (PCMH) calls attention to the vital need to address the mental health and psychosocial consequences of this crisis along with the quest for treatment strategies and intervention for the physical and material consequences of this extreme life experience on individuals and their communities. The suddenness of the impact of this experience and their psychosocial consequences on the Daily lives of individuals in their respective communities cannot be ignored. Though expected these consequences can be overwhelming putting individuals to be at risk for mental health conditions. Such strategies recently imposed on every individual in the country such as physical distance, self or community quarantine, school suspensions, working from home, etc. can have short-term and long-term effects on the mental and psychosocial wellbeing of individuals ,families and communities . Community quarantine, magnifies the deficits in opportunities and material deprivation of those who have less in life. In the extreme case, safety from the virus could come face to face with the reality of starvation. in the case of starvation with families with limited wherewithal to bring bread to the table. Through all these, the PCMH is in agreement with the guidelines set forth by the United Nations Interagency Steering Committee (UN- IASC) for Mental Health and Psychosocial Support Services (MHPSS) in Emergencies. The PCMH aims at providing support programs, to protect and promote psychosocial well-being and to prevent and treat mental health conditions. In this regard, the PCMH recommends the following during this time of crisis due to the COVID-19 pandemic: I. Promote Psychosocial Wellbeing in Everyone 1. Recognize that crisis occurs when sudden and/or adverse circumstances affect a person’s ordinary life. In epidemics and disasters these events put people in extreme stress and physical and psychosocial reactions are expected from them. These reactions include being sad, afraid, worried, angry, or confused, and although they are generally unpleasant they can be expected and generally therefore considered “normal.” 2. It is okay not to feel okay. In situations of extreme stress, one can expect not to feel okay. Talking or venting feelings to somebody you trust is helpful in overcoming negative feelings due to stress. Talking with a mental health professional is also okay. People should not be afraid of feeling judged and stigmatized for doing so. 3. Engage in healthy activities that you enjoy and find relaxing. If one must stay home or in isolation, maintaining a healthy lifestyle, which includes a daily routine, exercise, eating healthy food, getting enough rest and good sleep, praying or finding quiet time for yourself, and enjoying moments with family and loved ones, can help maintain positive mental health during this time. 4. Facts minimize fear. Gathering facts and accurate information from reliable sources will help in determining risks and planning appropriate precautions. However, people should also limit their daily exposure to various forms of media. Overexposure to negative and alarming news can be very upsetting. 5. Draw on the skills that have helped in the past to manage previous crisis/ adversities, and use these skills to manage this present one. One looks at his/her life in perspective as one considers the options one needs to take to overcome the crisis. 6. Shift perspectives away from number of deaths toward number of recoveries. A change of perspective is necessary. In fact, a sense of hope instead of fear could allow leaders and every citizen to better cooperate with one another – a vital element in defeating this outbreak. 7. Words do matter. When talking about coronavirus disease, certain words (i.e. Suspect, case, isolation...) and language may have a negative meaning for people and fuel stigmatizing attitudes. They can perpetuate existing negative stereotypes or assumptions, create widespread fear, or dehumanize those who have the disease. Do talk about “people who have COVID-19”, “people who are being treated for COVID-19”, “people who are recovering from COVID-19” or “people who died after contracting COVID-19”. DON’T refer to people with the disease as “COVID-19 cases” or “victims”. II. Promote Psychosocial Wellbeing among the Team of Frontline Workers and their Agencies and Supervisors 1. Frontliners should be allowed to express their fears and apprehensions. Their work is tough and highly stressful and much is expected of them at this time. The demands on frontline health workers can stretch the limits of human endurance. They blame themselves for not doing enough and push themselves to work harder. In helping them recognize these, they should be guided to see that these psychosocial reactions of frustrations, sadness, disillusionment, anger, etc. are expected and can be considered “normal”. 2. Recognizing their hard work during this crisis is important. This includes, at the very least, ensuring they have all they need to carry -out their work properly and efficiently – including providing them with personal protective equipment and ensuring that appropriate protocols are in place to keep them safe. Leaders and supervisors are encouraged to recognize the vital contributions of frontline health workers to the positive resolution of this crisis. They should listen to their concerns; give them credit for their diligence, commitment, initiative, innovativeness and personal sacrifices in the conduct of their duties. Providing appropriate incentives will help make these expressions of support more tangible. 3. Frontliners need to be given time to take care of their own basic needs too. They must be able to rest and recover from work through regular shift schedules, and encouraged to engage in physical activity, spend quality time with loved ones, pray or find quiet time with themselves, eat healthy food, and sleep well during breaks from work. 4. Frontliners may be subjected to stigma due to the nature of their work at this time, notwithstanding their possible exposure to the virus itself. They may experience stigma from different sectors of society – even among their own families, close friends, co-workers and law enforcers. This will make an already challenging and stressful situation worse and can interfere with their ability to serve. We must care for them as we would any member of our society. 5. Finding time to reflect is important to maintaining positive mental health. Drawing on skills and resources that have helped during past crises can help in managing the current crisis and minimizing the negative impact of stress on psychosocial wellbeing. 6. Frontliners are encouraged to be open to accept help from a friend whom he/she trust or seek A mental health professional and not be afraid that he’she will be judges a failure or a mental patient. Feelings of guilt arising from thoughts that one has not done enough can worsen the stress. This can feel very overwhelming. Changes in mood, such as feeling anxious, irritable or low and tired all the time, may make it difficult to relax even outside work. Confiding with someone being trusted or talking to a mental health professional will help process these feelings. 7. Policies and protocols of hospitals and other agencies involved in the frontlines should recognize and prevent burnout. This is a common consequence of extreme stress. Work schedules and assignments and appropriate referral systems should be in place to ensure the provision of mental health and psychosocial support. III Promoting Psychosocial Well-being in Children 1. In times of crises, it is common for children to seek more attention and be demanding on parents. Children also often observe parent’s behaviours and emotions and derive from this for ways to manage their own emotions. Keep them close and share simple facts about what is going on. Discuss COVID 19 with them using honest language to ease up their fear and anxiety. 2. Maintain familiar daily routines at home, since they must now stay at home away from school. Encourage them to continue to have physically activities like playing, even if only with family members because of restricted social contacts. 3. Create new routines by providing regular time for learning activities such as doing the work they would have had if they were in school. Encourage contact with friends/classmates, through phone calls or texts. 4. At all times, parents should respond to their child’s reaction in a supportive gentle way, by listening to them, and showing them affection, not being judgemental and being aware that children respond to stress in various ways like being a clinger, anxious, fearful, or showing behavioural changes, being agitated or bedwetting. Be open to seek help from a mental health professional if these child’s behaviour is overwhelming. IV. Psychosocial Well-being of Older adults, the elderly: 1. They may find it difficult to keep in touch with their loved ones and other supports during the quarantine. This can make them feel lonely and cause mental distress. Prepare a personal safety pack, which includes personal information and available contacts like family members, list and supply of regular medicines, storable food and snacks and bottles of water, for at least two weeks. 2. Provide emotional support through informal networks of families, neighbors, and health personnel. Encourage family members to call their older relatives as often as possible. 3. Encourage older people to take care of their own needs, to engage in physical activities, age appropriate exercises and their usual ways of relaxing and enjoying themselves with family members at home, to keep regular routines of eating, and sleeping, and to ask or call for help if necessary. 4. A constant stream of news reports can cause anyone to feel distressed and anxious. This can be more intense for older people. When sharing information use words that will help older people understand without much stress. Instructions need to be communicated in a clear, concise, respectful and patient way. Share facts about what has happened, explain what is going on now and give them clear information about how to cooperate. For older people, patience is necessary because this information may need to be repeated whenever necessary. It may also be helpful for information to be displayed in writing or pictures. This may be especially necessary if there are memory lapses observed in an older person. _____________________________________________________________ IMPORTANT REMINDERS FOR EVERYONE: There is no health without mental health. THE WHO states that health is the state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity. The pursuit of Health for All necessarily involves the pursuit of the physical and psychosocial wellbeing of the human community during ordinary or extraordinary times. Mental health and psychosocial support is therefore integral to a complete public health response to any crisis or emergency. This crisis has only highlighted what we have known to be true all along – we are all connected as one human community. The Virus will only be contained if we ALL act as ONE. By being responsible and taking good care of ourselves, we are also taking care of each other. Strength, determination, cooperation, kindness and prayers will see us through this extraordinary episode in our lifetime. Our connectedness with each other, not our differences is what matters NOW more than ever.

National action, specifically the expanded community quarantine to contain the spread of COVID-19 dramatizes the need for every citizen to be part of the solution. What happens to the individual affects his community and what happens to the community affects the individual.. This interconnectedness is at the core of the pursuit and promotion of physical health and psychosocial well-being, and the prevention and treatment of ill-health.

Needless to say, the COVID-19 pandemic poses a strain and stresses the individual’s health Including their mental health. Hence, the Philippine Council for Mental Health, (PCMH) calls attention to the vital need to address the mental health and psychosocial consequences of this crisis along with the quest for treatment strategies and intervention for the physical and material consequences of this extreme life experience on individuals and their communities. The suddenness of the impact of this experience and their psychosocial consequences on the Daily lives of individuals in their respective communities cannot be ignored. Though expected these consequences can be overwhelming putting individuals to be at risk for mental health conditions. Such strategies recently imposed on every individual in the country such as physical distance, self or community quarantine, school suspensions, working from home, etc. can

have short-term and long-term effects on the mental and psychosocial wellbeing of individuals ,families and communities . Community quarantine, magnifies the deficits in opportunities and material deprivation of those who have less in life. In the extreme case, safety from the virus could come face to face with the reality of starvation. in the case of starvation with families with limited wherewithal to bring bread to the table.

Through all these, the PCMH is in agreement with the guidelines set forth by the United Nations Interagency Steering Committee (UN- IASC) for Mental Health and Psychosocial Support Services (MHPSS) in Emergencies. The PCMH aims at providing support programs, to protect and promote psychosocial well-being and to prevent and treat mental health conditions.

In this regard, the PCMH recommends the following during this time of crisis due to the COVID-19 pandemic:

I. Promote Psychosocial Wellbeing in Everyone 1. Recognize that crisis occurs when sudden and/or adverse circumstances affect a

person’s ordinary life. In epidemics and disasters these events put people in extreme stress and physical and psychosocial reactions are expected from them. These reactions include being sad, afraid, worried, angry, or confused, and although they are generally unpleasant they can be expected and generally therefore considered “normal.”

2. It is okay not to feel okay. In situations of extreme stress, one can expect not to feel okay. Talking or venting feelings to somebody you trust is helpful in overcoming negative feelings due to stress. Talking with a mental health professional is also okay. People should not be afraid of feeling judged and stigmatized for doing so.

3. Engage in healthy activities that you enjoy and find relaxing. If one must stay home or in isolation, maintaining a healthy lifestyle, which includes a daily routine, exercise, eating healthy food, getting enough rest and good sleep, praying or finding quiet time for yourself, and enjoying moments with family and loved ones, can help maintain positive mental health during this time.

4. Facts minimize fear. Gathering facts and accurate information from reliable sources will help in determining risks and planning appropriate precautions. However, people should also limit their daily exposure to various forms of media. Overexposure to negative and alarming news can be very upsetting.

5. Draw on the skills that have helped in the past to manage previous crisis/ adversities, and use these skills to manage this present one. One looks at his/her life in perspective as one considers the options one needs to take to overcome the crisis. 6. Shift perspectives away from number of deaths toward number of recoveries. A change of perspective is necessary. In fact, a sense of hope instead of fear could allow leaders and every citizen to better cooperate with one another – a vital element in defeating this outbreak.

7. Words do matter. When talking about coronavirus disease, certain words (i.e. Suspect, case, isolation...) and language may have a negative meaning for people and fuel stigmatizing attitudes. They can perpetuate existing negative stereotypes or assumptions, create widespread fear, or dehumanize those who have the disease. Do talk about “people who have COVID-19”, “people who are being treated for COVID-19”, “people who are recovering from COVID-19” or “people who died after contracting COVID-19”. DON’T refer to

people with the disease as “COVID-19 cases” or “victims”.

II. Promote Psychosocial Wellbeing among the Team of Frontline Workers and their Agencies and Supervisors

1. Frontliners should be allowed to express their fears and apprehensions. Their work is tough and highly stressful and much is expected of them at this time. The demands on frontline health workers can stretch the limits of human endurance. They blame themselves for not doing enough and push themselves to work harder. In helping them recognize these, they should be guided to see that these psychosocial

reactions of frustrations, sadness, disillusionment, anger, etc. are expected and can be considered “normal”.

2. Recognizing their hard work during this crisis is important. This includes, at the very least, ensuring they have all they need to carry -out their work properly and efficiently – including providing them with personal protective equipment and ensuring that appropriate protocols are in place to keep them safe. Leaders and supervisors are encouraged to recognize the vital contributions of frontline health workers to the positive resolution of this crisis. They should listen to their concerns; give them credit for their diligence, commitment, initiative, innovativeness and personal sacrifices in the conduct of their duties. Providing appropriate incentives will help make these expressions of support more tangible.

3. Frontliners need to be given time to take care of their own basic needs too. They must be able to rest and recover from work through regular shift schedules, and encouraged to engage in physical activity, spend quality time with loved ones, pray or find quiet time with themselves, eat healthy food, and sleep well during breaks from work.

4. Frontliners may be subjected to stigma due to the nature of their work at this time, notwithstanding their possible exposure to the virus itself. They may experience stigma from different sectors of society – even among their own families, close friends, co-workers and law enforcers. This will make an already challenging and stressful situation worse and can interfere with their ability to serve. We must care for them as we would any member of our society.

5. Finding time to reflect is important to maintaining positive mental health. Drawing on skills and resources that have helped during past crises can help in managing the current crisis and minimizing the negative impact of stress on psychosocial wellbeing.

6. Frontliners are encouraged to be open to accept help from a friend whom he/she trust or seek A mental health professional and not be afraid that he’she will be judges a failure or a mental patient. Feelings of guilt arising from thoughts that one has not done enough can worsen the stress. This can feel very overwhelming. Changes in mood,

such as feeling anxious, irritable or low and tired all the time, may make it difficult to relax even outside work. Confiding with someone being trusted or talking to a mental health professional will help process these feelings.

7. Policies and protocols of hospitals and other agencies involved in the frontlines should recognize and prevent burnout. This is a common consequence of extreme stress. Work schedules and assignments and appropriate referral systems should be in place to ensure the provision of mental health and psychosocial support.

III Promoting Psychosocial Well-being in Children 1. In times of crises, it is common for children to seek more attention and be

demanding on parents. Children also often observe parent’s behaviours and emotions and derive from this for ways to manage their own emotions. Keep them close and share simple facts about what is going on. Discuss COVID 19 with them using honest language to ease up their fear and anxiety.

2. Maintain familiar daily routines at home, since they must now stay at home away from school. Encourage them to continue to have physically activities like playing, even if only with family members because of restricted social contacts.

3. Create new routines by providing regular time for learning activities such as doing the work they would have had if they were in school. Encourage contact with friends/classmates, through phone calls or texts.

4. At all times, parents should respond to their child’s reaction in a supportive gentle way, by listening to them, and showing them affection, not being judgemental and being aware that children respond to stress in various ways like being a clinger, anxious, fearful, or showing behavioural changes, being agitated or bedwetting. Be open to seek help from a mental health professional if these child’s behaviour is overwhelming.

IV. Psychosocial Well-being of Older adults, the elderly:

1. They may find it difficult to keep in touch with their loved ones and other supports during the quarantine. This can make them feel lonely and cause mental distress. Prepare a personal safety pack, which includes personal information and available contacts like family members, list and supply of regular medicines, storable food and snacks and bottles of water, for at least two weeks.

2. Provide emotional support through informal networks of families, neighbors, and health personnel. Encourage family members to call their older relatives as often as possible.

3. Encourage older people to take care of their own needs, to engage in physical activities, age appropriate exercises and their usual ways of relaxing and enjoying themselves with family members at home, to keep regular routines of eating, and sleeping, and to ask or call for help if necessary.

4. A constant stream of news reports can cause anyone to feel distressed and anxious. This can be more intense for older people. When sharing information use words that will help older people understand without much stress. Instructions need to be communicated in a clear, concise, respectful and patient way. Share facts about what has happened, explain what is going on now and give them clear information about how to cooperate. For older people, patience is necessary because this information may need to be repeated whenever necessary. It may also be helpful for information to be displayed in writing or pictures. This may be especially necessary if there are memory lapses observed in an older person.

_____________________________________________________________

IMPORTANT REMINDERS FOR EVERYONE:

There is no health without mental health.

THE WHO states that health is the state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity. The pursuit of Health for All necessarily involves the pursuit of the physical and psychosocial wellbeing of the human community during ordinary or extraordinary times.

Mental health and psychosocial support is therefore integral to a complete public health response to any crisis or emergency.

This crisis has only highlighted what we have known to be true all along – we are all connected as one human community. The Virus will only be contained if we ALL act as ONE. By being responsible and taking good care of ourselves, we are also taking care of each other.

Strength, determination, cooperation, kindness and prayers will see us through this extraordinary episode in our lifetime. Our connectedness with each other, not our differences is what matters NOW more than ever.