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Opinion: One year on, we're seeing the mental health impacts of this pandemic

Dr Niall Duffy and Dr Stephen McWilliams of St John of God say that many people referred to the hospital in the last year have not been helped by Covid stress.

Dr Stephen McWilliams & Dr Niall Duffy

AS WE CONTINUE to plough through the latest wave of Covid-19 and into our first anniversary as an Ireland with Covid, it is fair to say we have all been feeling rather fed up.

Gone are the rounds of applause for frontline workers that we saw in March 2020, replaced by an enduring sense of grief, fatigue and worry. While a small minority march on the streets of our cities or hold defiant house or street parties, the vast majority go quietly about their business while waiting for the pandemic to end. 

According to Professor Pete Lunn, ESRI head of behavioural research (speaking on RTÉ’s Morning Ireland on 2 March), the Social Activity Measure examining how people are coping with prolonged restrictions tells us that 73% of people remain very worried about Covid-19. The stress people have been under is abundantly clear.

For a year now, we have endured restrictions that seemed inconceivable 18 months ago. Social distancing, clean hands, face masks and coughing etiquette are all the order of the day. 

But according to Prof Lunn, 79% of people believe that preventing the spread of Covid-19 is more important than the burden imposed by restrictions. Only 10% of those surveyed do not concur. 

Meanwhile, the government outlined its hopes to open up the country gradually over the coming months, subject to an ongoing improvement in the infection and hospitalisation rates.

The Covid effect

The prospect of opening up brings its own set of worries. Healthcare workers and other frontline personnel may worry about a fourth wave, while older people and those with an underlying medical illness are anxiously awaiting vaccination. 

As schools reopen, teachers are worried about the risks inherent in the process. Still, for others, as time goes on and hopefully the virus numbers remain at bay, the gradual removal of restrictions means a partial antidote to loneliness and an opportunity to reconnect with family and friends.

Business owners, people in financial difficulty due to the restrictions, young people cut off from their social circles are all waiting patiently for things to change. But these have been trying times for everyone. It is at times like these that the risk of mental illness increases.

At the acute psychiatric hospital where we work, a high proportion of the referrals we have seen over the past year have been caused to a large degree by Covid-19-related stress. 

Some people are succumbing to psychiatric illness for the first time while others are experiencing a relapse of existing illness that they might not otherwise have had to endure. 

But most people who are anxious, stressed or fed up with Covid-19 are not mentally ill; they are simply experiencing normal and appropriate human emotion in response to a prolonged crisis. It is important not to pathologise their legitimate concerns.

In essence, stress occurs when there is a mismatch between (a) the pressures we think are upon us and (b) how well we think we will cope. It involves our minds and bodies reacting to the challenging tasks of everyday life and, at various times, the struggles inherent in much bigger life changes or events. 

Even before the pandemic, the World Health Organization was busily reporting widespread stress as the “health epidemic of the 21st century”. Of course, stress can sometimes be positive, helping us to overcome challenges and achieve milestones. But, more often, the stress we notice is negative.

Stress management

Stress can present in lots of different ways.  We may experience changing sleep patterns, loss of appetite or the desire for more junk food. We might also notice headaches, fatigue, muscular aches and pains, palpitations or other physical symptoms as adrenaline surges through the body. 

Psychological changes may include poor concentration, irritability, anxiety, sadness, fearful thoughts or a sense of feeling emotionally overwhelmed. Such experiences can disrupt our relationships with family and friends, compounding the problem.  

Understandably, many people have found it difficult to manage stress during the pandemic, given the sudden and unexpected changes we have faced. There are lots of approaches, some of which may be more practical than others. 

Eating healthy food and adhering to a solid sleep routine are helpful, as are avoiding alcohol, street drugs, smoking and too much caffeine. If stress is compounded by changes at work, it can help to break down tasks into smaller, more-manageable chunks while also taking regular breaks. 

It is also important to exercise the right to disconnect from work at the end of the day.  Try limiting media (including social media) to half an hour per day, but be well acquainted with the HSE guidelines, taking particular note of what you are allowed to do, not simply what you aren’t. 

Any type of socially-distanced exercise is positive, but this is particularly true of aerobic exercise such as walking, running or cycling. Being active can reduce the effects of stress while also providing some distraction. Skype or Zoom will afford the opportunity to discuss what you are going through or how you are feeling. Others might be feeling it too. 

Ultimately, if more serious mental health concerns emerge – such as depression, psychosis or suicidal thinking – it is important to make contact with your local general practitioner or Accident and Emergency Department so that the appropriate referral can be made promptly. Organisations such as the Samaritans or Pieta House are also very helpful.

Looking forward

Still, a year into this pandemic, we have clear reasons to be optimistic. The infection and hospitalisation rates are gradually going down. Schools are beginning to reopen.

With the government promising to ramp up vaccine rollout in the coming months, it is noteworthy from the Department of Health’s Amárach survey that, of those who have not yet received the vaccine, 72% will “definitely” accept it when it is offered. 

A further 17% of those surveyed will “probably” accept it. Barely a tenth of the population show any degree of ambivalence. The vaccines certainly provide a lot of hope.  

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Curiously, almost a quarter of those surveyed state they believe that, once people start getting the Covid-19 vaccine in Ireland, the Government should lift Covid-19-related restrictions for everyone, including for those who have not yet been vaccinated. 

Naturally, a fatigued population will be keen to get away on holiday this year, while even the EU has voiced some enthusiasm for the introduction of electronic “vaccine passports”.  

A poll reported on RTÉ’s Claire Byrne Live on 1 March asked people, “Are you in favour of vaccine passports being introduced to allow people to travel around Europe once they have been vaccinated?” Of those polled, 75% said yes, with 16% saying no and 9% stating they don’t know.

Time will tell if such an approach is feasible. Either way, things will get better. 

Dr Niall Duffy is Registrar in Psychiatry, Saint John of God Hospital, Stillorgan, Co Dublin. Dr Stephen McWilliams, Associate Clinical Professor, School of Medicine and Medical Sciences, University College Dublin, and Consultant Psychiatrist, Saint John of God Hospital, Stillorgan, Co Dublin.

The Noteworthy team want to investigate the measures being taken to tackle a pandemic-induced mental health crisis in Ireland. You can help fund this project here.

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Dr Stephen McWilliams & Dr Niall Duffy

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