The world celebrated October 10th as Mental Health Day. According to a WHO survey released shortly before on 6th October, Covid-19 has had a significant impact on MNS (mental, neurological and substance use) services in its 130 member nations, nearly all of which have faced disruptions in providing care for MNS issues. The main causes have been inadequacy and insufficiency of services in the first place, and re-deployment of mental health staff and facilities to accommodate Covid-positive patients, giving precedence to their treatment, since hospitals were running out of beds and wards to handle the rapidly increasing numbers of covid infected people.
Mental health issues have plagued societies more because they often go unnoticed, symptoms are ignored and carry the stigma of being ‘not normal’. Many people do not even realize that they are facing mental health issues that can be treated and resolved. The pandemic has brought these to the fore, with its devastating economic impact, and bringing life to a standstill. As offices and production units shut down, workers lost their incomes and were left with no money to pay for essentials even. The lockdown and travel restrictions made migrant workers lonely and homesick.
The entire set of changes have caused sufficient anxiety and stress to invoke feelings of being ‘hopeless and helpless’, impacting the mental health of the common man. The uncertainties and fears have caused emotional distress often leading to depression, post-traumatic stress disorder, anxiety disorders and drug and alcohol abuse.
These signs and signals, increased suicide rates, evidence of depression, higher alcohol consumption, bouts of violence, have made mental health specialists voice their concern about the mental impact of the pandemic and the need for seeking counselling and treatment. The larger public is often unaware of the symptoms, the availability of counselling services and that there is no stigma attached.
Reasons for stress and mental anxiety
Mental health volunteers state that the biggest complaints of most of their respondents are loneliness, homesickness and lack of someone to talk to. This is particularly true of migrant workers, both working low paying factory and office jobs, and educated professionals staying away from families, including expatriates who moved to Myanmar alone, and have not been able to visit their families in their home country.
Mobility is restricted, the unemployed unable to travel in search of work, those having jobs are fearful of losing them. Not all are permitted to work remotely, but those who can, are unable to follow their office routines, find it monotonous to be confined to the home for months. What is missing is the social interaction, the relaxing activities in groups, and travel. The habit of taking frequent breaks from home, work and the city of residence, had to be given up, and it gets monotonous to continue in the same tone incessantly, endlessly.
Even stepping out for groceries and essentials is stressful for fear of catching infection. There have been periods of panic buying just so that one does not run out of food basics. Sanitizing supplies, disinfecting packets have led to OCD (obsessive compulsive disorder in some cases), again a mental issue. This is further aggravated by the fear of isolation, hospital visits, and being taken away to quarantine centers, ICUs, ventilators and not being able to recover due to insufficient medical facilities in Myanmar.
People who have recovered from the covid infection, continue to live with the trauma. The inability to breathe well, fear of a deterioration in their condition, the possibility of a relapse, unappealing hospital conditions, all add up to cause further anxiety. This illness comes with a social stigma, since it instills fear in others, who may shun the infected friend. Being isolated and locked in, comes with a different set of woes.
As a result of one or more of these, the mind loses its calm, and a feeling of discomfort causes palpitations, being fearful and frantic, causes sleeplessness which aggravates fatigue and can cause headaches and lethargy, raise blood pressure levels, inability to concentrate and focus on work, and turning towards alcohol and other intoxicants to drown such feelings.
Ways to cope with anxiety and stress to curb mental illness
It is imperative to be aware of stress and anxiety, its current and potential harm, and where to seek redressal and treatment to get better. Information overload and fake news through social media, must be filtered and authentic reliable sources sought. Unreliable, forwarded messages have done more harm than good. Optimism, in the face of a dismal situation, may be difficult, but helps to prevent stress. Now, with 4-5 potentially effective vaccine candidates likely to get approval, there is every reason to be optimistic.
A few basics are within our control to ensure that we stay in a balanced frame of mind. Getting a good night’s sleep and adequate rest clears the mind. Eating healthy and simple exercises within the confines of the home keep mind and body fit. Some fresh air in un-crowded places is invigorating and lifts spirits. Deep breathing, and mediation help to relax the mind, entertainment like television shows and movies keep the mind away from negative thoughts.
Alcohol and smoking are two addictions that form a vicious circle, consumed to alleviate stress, after a point, they themselves become stress stimulators. Restricting their use, taking short breaks from work, maintaining boundaries between work and leisure, spending family time in lighter activities, experimenting in the kitchen, are all therapeutic activities that keep the mental balance intact.
A new set of rules and new habits, like wearing masks, sanitizing and washing hands, practicing social distancing, bring reassurance and reduce fear. A conscious effort to be mindful goes a long way in protection from contracting the infection. There is nothing wrong in wearing masks, and keeping some distance. Caution needs to precede public opinion and responsible behavior can be emulated as well.
It is human nature to enjoy closer interaction, phone calls and zoom calls are not sufficient, be it with family or friends. Unfortunately though, in the last few years distances had cropped up among family members, and interaction was restricted even under the same roof. The pandemic has helped such attitudes to reverse and family members can benefit from closer interaction and being in the company of those with whom they share deep emotional bonds.
The most affected in Myanmar include textile and other factory workers, taxi drivers since commutes have reduced and tourists are missing, street vendors since people have taken to cooking at home with remote work culture setting in, construction workers since projects have been put on hold, tourism and hospitality industry. Smaller factories have closed, and so have small distribution and trading businesses, leaving their employees without access to earning channels.
Health workers, volunteers, students and unemployed are all found to be under stress at varying levels. Constant exposure in high risk environments, huge workload and inability to take breaks, seeing deteriorating health conditions, without support of family, health workers absorb the woes of patients and while offering comfort and support, get drained physically and emotionally. Short breaks, if possible, therapeutic and relaxing activities like exercise, cooking, watching light entertaining movies, help to alleviate stress levels.
Support Systems in Myanmar
Creating awareness about the reality of mental health issues, understanding the need for counselling, and offering free advice online or on the phone through help lines, was initiated in April 2020 by a few volunteers and non-profit organizations.
MHPSS, the Mental Health and Psycho Social Support Working Group, facilitates coordination among all agencies focusing on mental health of people in Myanmar, and shares all relevant information.
A social networking site ‘Live, Laugh, Love, Care” run by psychiatrist Dr Kyi Phae Lin, offers extended hours of counselling to people feeling the need to talk to address their stress related issues.
“Call me today”, an online counselling organization started by Kyaw Zin, collaborated with a German-Swiss independent development organization, Helvetas Myanmar, to address mental issues cropping up among the country’s migrant workforce. The initiative was co-sponsored by LIFT and People-In-Need (PIN). The program continued till July 2020, and was able to assist over 500 migrants cope with covid-related issues, including being able to counsel and dissuade 6 people from committing suicide, 5 of whom were women. Kyaw Zin continues his helplines through the pandemic and with the assistance of 15 volunteers, takes phone calls between 5-11 pm. “I feel responsible for all the people who have no one to talk to, which drove my friend to suicide in 2018. So I decided to be there for anyone from anywhere, if they need to talk”. Till date they have counselled over 1000 people, from 10 states, many of whom call regularly, and 75% of his callers are women.
The UNFPA has been providing mental health and psychological support trainings to over 4000 volunteers who have been working at quarantine centers, to enable them to provide proper mental health support techniques. Sharing and talking to others helps to alleviate stress symptoms.
The problem stems for inadequate mental health specialists and facilities in the country. According to the World Health Organization, the country has only 0.4 psychiatrists for every 100,000 people, 0.3 psychiatry nurses, with most of mental health services provided through just 2 mental hospitals nationwide, 22 psychiatry wards in government run general hospitals, 36 adult outpatient psychiatry clinics and 2 for children.
Once the covid crisis is over, mental health care facilities need to be given priority in Myanmar, with more outpatient clinics, psychiatrists and special wards in every hospital, counselling services and helplines. Creating an awareness that it is acceptable to seek medical advice in case of anxiety or stress, and there is nothing wrong in having such issues and seeking redressal, is extremely important. It is for the benefit and well-being of the entire society that mental health is treated at par with physical health.