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Opinion: Mental health and coronavirus: What lessons can Ireland learn from previous epidemics?

It is useful to draw some comparisons with the West African Ebola crisis before Covid-19, John Farrelly writes.

John Farrelly Chief Executive of the Mental Health Commission

REGULAR HUMAN CONNECTION is a vital tool that can help elevate our mental wellbeing, which is perhaps why many of us are struggling to adapt to this life of heightened solitude at the moment. 

While the adjustment to restrictions on movement will impact adversely on societal mental health, we must be cognisant of the distress and suffering Covid-19 will cause to those directly affected by the virus, including our frontline health staff.

It is useful, perhaps, to draw some comparisons with the West African Ebola crisis. Before Covid-19, this was the most recent large-scale viral attack to capture global attention.

While it confined itself largely to three countries in West Africa, many of the issues that confronted authorities there – hand washing, social distancing, dealing with funerals, and personal protective equipment – are the same challenges that health and policy experts are tackling worldwide today.

However, while plans to manage most of these issues were implemented as soon as it was feasible to do so, it was only in the months and years after Ebola was brought under control that the mental effects of the virus on survivors and health staff became clear.

The World Health Organization (WHO) has said that mental health issues in an epidemic often constitute “an emergency within an emergency”.

PTSD and healthcare staff

In support of this, an article in the Journal of Global Infectious Diseases in 2017 described “the unseen epidemic” of post-traumatic stress among healthcare staff and survivors of the Ebola outbreak.

The study made the stark point that with the primary focus squared on containing the virus, many failed to notice the emotional and psychological toll the crisis was having on those most directly affected.

Frontline workers were faced with the simple but frightening truth that, by providing care, they were putting themselves directly in the firing line of a lethal disease.

It is difficult for most of us to comprehend the psychological burden of experiencing this on a day-to-day basis, but it is what Irish health staff are facing right now. They will continue to confront that reality for weeks, months or perhaps even years to come.

And there is more to consider here. First, as with Ebola, frontline staff are likely to lose colleagues or team members and the stress and trauma as a result of that may, in some cases, be even more impactful than losing a relative or friend.

Second, we must also be acutely aware of the mental health of survivors of Covid-19, and those who have lost a loved one to the virus.

Research by the WHO has shown that conflict-affected populations have suffered inexorably from mental disorders in the years following trauma.

Last year, they published a review of studies across 39 countries which showed that among people who have experienced war or other conflicts in the previous decade, one in five will have depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia.

Third, and this is critical, we must recognise that people with severe mental disorders can be especially vulnerable during and after emergencies of this nature, and they will continue to require access to basic needs and clinical care.

We are prepared

The Mental Health Commission has now been formally requested by the National Public Health Emergency Team (NPHET) to risk-rate all long-term residential mental health settings based on disease progression, environment and staff and liaise with national and regional governance structures to deliver mitigating actions.

We have already requested that all approved mental health centres notify us as soon as they become aware of any confirmed or suspected cases of Covid-19, and we have asked to see any or all contingency plans that they have in place. We will be monitoring centres on a regular basis to ensure plans are adequate and appropriate. If we have concerns, we will raise them with the HSE as per our risk escalation protocol.

We have also confirmed that while all physical inspections of approved centres are suspended until further notice, services must continue to comply with the rules and regulations of the 2001 Mental Health Act, albeit applying a risk-based approach when appropriate.

For the benefit of those who are accessing our in-patient mental health services, we must ensure that standards of care do not drop and that patients continue to be treated with the appropriate level of care, dignity and respect.

Irish mental health services have come a long way over recent decades, and while progress continues, albeit, at a slower pace than we would all like, there are serious concerns amongst mental health professionals that our services may struggle to cope under the strain of a surge in demand brought about by this pandemic. It is critically important, therefore, that our services continue to provide quality care both during and in the aftermath of the epidemic.

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Just as we are helping to reduce the viral caseload now by staying at home, we can also support those who are being directly affected by the virus by staying informed, maintaining healthy routines, staying connected, and supporting each other, all of which the HSE has repeatedly pointed out.

Minding the minders

It is also heartening to see that mental health professionals are already putting their shoulder to the wheel to support our health personnel.

A group of psychiatrists have set up a website called Mind the Frontline for anyone working in healthcare who is concerned about the impact of Covid-19 on their mental health.

Advice and support are provided under a range of headings including coping with a personal mental health crisis, self-care, anxiety management and dealing with death.

Finally, to the rest of us. We will all struggle with aspects of the virus and the restrictions to varying degrees. For some, it will be very difficult.

A recently-published ESRI research paper has served as a timely reminder that social isolation has detrimental consequences for wellbeing and that loneliness is associated with increased risk for mental health problems, including depression and anxiety.

While it is impossible to say how prevalent mental health issues will be in this country because of Covid-19, it is a matter of critical importance – and one on which we must all keep a watching brief.

If you need to talk, contact:

  • Samaritans 116 123 or email
  • National Suicide Helpline 1800 247 247 – (suicide prevention, self-harm, bereavement)
  • Aware 1800 80 48 48 (depression, anxiety)
  • Pieta House 01 601 0000 or email – (suicide, self-harm)
  • Teen-Line Ireland 1800 833 634 (for ages 13 to 19)
  • Childline 1800 66 66 66 (for under 18s)

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About the author:

John Farrelly  / Chief Executive of the Mental Health Commission

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