COVID-19: Its Effects On Our Mental Health and How to Deal With It

In the beginning...

With COVID-19, the world will never be the same again. As much as the virus itself is a threat to our physical well being, with several millions of lives being lost to it, it has also been rather unkind to our collective psyches. In preventing the spread of COVID, governments have all imposed some form of social restrictions, disrupting our social lives, which has deprived many of a healthy means of emotional regulation. As such, the drastic changes in people’s routines have plagued humanity with a wave of mental health issues.

International Impacts

As the pandemic swept across the globe, the virus continues to single-handedly cripple economies, displace millions, and destroy the social fabric that holds communities together. Needless to say, this catastrophe is traumatic, especially for those who lost the means to support themselves and have to face the looming, unpredictable future. Research from prior economic downturns showed that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide. In this pandemic, the rate of symptoms of mental illness in adults in households with job loss or lower incomes than those without job or income loss was measured to be 53% and 32% respectively, as of May 2021 (6). If it were not for Covid-19, such high numbers would have been alarming. However, the pandemic is not only stretching the wallets of individuals but those of governments as well, which restricts how much aid can be distributed, leading to the erosion of whatever that serves as a reliable safety net for those struggling to make ends meet. As a result, the lack of aid in addition to an unstable and gloomy economic outlook is causing Covid-19 to hit households much harder than anticipated, which only aggravates the detrimental impact inflicted upon one’s mental wellbeing.

Admittedly, developing countries may suffer more from the lack of aid due to constraints on government budgets than developed countries as the latter are at advantage with a greater budget surplus. Out of the $11.7 trillion spent by countries globally to cope with the effects of Covid-19, a meagre 0.4% of it came from low-income countries which clearly reflects that it is an uphill task for developing countries to fund domestic aid efforts in the face of a pandemic compared to its richer counterparts (9).

Local Impacts

In countries less fortunate, the pandemic has spread like wildfire, and governments have been mired in putting an end to the burgeoning disease. While Singapore has been rather successful in keeping the disease under control, it has taken a large toll on people’s mental health, which has in turn led to dire social implications.

Since its spread here, COVID-19 has become a mainstay of our lives for these two years. Many restrictions were imposed and implemented to curtail the virus in our population, some of which include social distancing, the infamous Circuit Breaker, and Home-Based Learning (HBL) for students. Singapore’s Work From Home (WFH) and HBL policies have rendered work and private life inextricably linked. As people are unable to physically separate themselves from work, detaching themselves from thoughts about school and work poses a real and definite challenge. Thus, not only is personal productivity reduced due to a restrictive home environment, many are also experiencing more stress due to increased worries over competence due to that same ‘Covid fatigue’ that many have started to experience throughout this period. Singapore’s competitive and face-focused culture have also left many individuals inherently susceptible to being overly self-conscious over their work ethic in this time, especially in comparison to others.

Reports of issues related to mental health have shown a spike during this period. Almost parodying the events outside, it seemed like mental health issues were experiencing a pandemic of their own. The Singapore Counseling Centre saw a 40 percent increase in clients from 2019 to 2020, reports Mr John Shepherd Lim, its chief well-being officer (6). At the same time, The Samaritans of Singapore, our go-to suicide prevention organisation, received over 39,000 calls for help in 2020 — an 18 percent increase from the year before. The 22 percent increase in family violence as compared to before the Circuit Breaker period is no small testimonial in regards to the dangerous extent to which Singaporeans have been feeling pent-up. The strict enforcement of safety measures has proven stressful to say the least. The news coverage on Covid-19 has inundated our senses with a constant dread. The legion of Safe Distancing ambassadors, like sirens, panopticons, lurking in public spaces, bring the average person no sense of calm. The SafeEntry and Check-In stations at every entrance, despite their ease of access, still act as a subtle reminder of how things are no longer as they were. While the virus count in our island system has stayed (up till now) consistently low, virus paranoia and now-fading memories of SARS has left Singaporeans on a constant DEFCON 1.

During this period of isolation, many were forced to stay home, entertaining themselves with the latest trends like Dalgona coffee or workouts. However, these efforts to keep up the activity in the lives we once had pre-COVID did not always land. These extended stay-ins created an unchanging, oppressive environment, where people have to follow the same non-existent cycle that lacked clear night and day. The supposed comfort of our homes proved an unlikely, but not unexpected source of mental health issues. This lack of social interaction was further exacerbated by the inability for us to go out. As social creatures born in the African savanna, humans naturally crave and are attracted to the outdoors, and journeying perhaps with a friend or two. The COVID-induced restrictions managed to not only shut us out from our usual places of gathering, such as restaurants, schools and workplaces, but also turned meeting people at the places we could go to into absolute nightmares, like the supermarket or the doctors’.

Facing an all-out, multi-front assault on the usual habits that kept us sane, connected and busy, Singaporeans have been taken ill by the unintended prices of health and safety. However, in trying times, in hardships faced by all, we can do our part to better our situation by trying to be here for one another. Not face-to-face, of course.

What have governments done?

The government has not been shy in its efforts to support Singaporeans with their mental health needs amidst the Covid-19 pandemic. During the World Health Organisation's virtual event, The Big Event for Mental Health, PM Lee stated that “Health authorities around the world must not only fight Covid-19, but also manage its impact on the mental health of their populations" (4). The government has acknowledged the huge toll that the pandemic has on the mental well being of all Singaporeans. They have thus rolled out two solutions in an effort to combat such problems - one being the National CARE Hotline and the second being the Covid-19 Mental Wellness Taskforce.

The National CARE Hotline was launched in April 2020 to support those facing mental health concerns such as anxiety and adjustment issues related to COVID-19. The 24 hour hotline is manned by a roster of about 500 volunteers and about 22 to 25 professionals from a pool of psychologists, counsellors, social workers, psychiatrists and public officers (3). They serve as a listening ear to the distressed, and provide advice to callers on future actions to take. As of end December 2020, the hotline has handled almost 38,000 calls. The monthly number of calls has decreased by about 80 percent since its launch, thus showing the effectiveness of this measure, however, the number of calls is still on average higher than pre-covid calls.

The Covid-19 Mental Wellness Taskforce was convened by the Ministry of Health in October 2020. This Taskforce is made up of governmental representatives and those from social service organisations. Their purpose is to review the psycho-social impact of the Covid-19 pandemic on the population, take stock of the initiatives introduced across the Government to address the impact so far and identify gaps that will need to be addressed to better meet the mental health needs of the population during this time (5).

PM Lee further mentioned that "Today, on World Mental Health Day, let's resolve to work together to understand mental health better, and to care for one another during these difficult times". The government has put in the work to increase awareness surrounding mental health issues and provide assistance to those suffering from it, and whose situation has been worsened by Covid-19. Hopefully, with the current and future support by the government, Singaporeans will not only be able to get through, but also grow stronger from these trying times we live in.

The new norm

Many of us deal with mental distress by using maladaptive coping strategies, which are highly effective in reducing symptoms of mental distress in the short term (10). We avoid engaging in situations that give us mental distress, preventing high anxiety levels. Hence, while these methods are indeed successful in removing our state of distress, they only serve as a temporary outlet for escapism. However, we are even more vulnerable to such coping strategies as we remain within the confines of our houses during the pandemic. Owing to multiple stress factors from COVID-19, many of us might have resorted to non-adaptive coping strategies to cope with stress. Between April to July 2020, there was a 60% increase in the number of calls to the Institute of Mental Health Helpline in Singapore as compared to 2019 (1). Thus, it is of utmost importance to recognise such dysfunctional behaviors, and to gain more awareness of our mental state of mind.

A type of maladaptive behavior is named safety behavior, which refers to the state where individuals have grown to rely on something, or someone, as a means to cope with their mental distress (10). Individuals dedicate large amounts of time to seek reassurance and gain a comfortable and relaxed state of mind. Examples of safety behaviors would include listening to an unhealthy amount of music, constantly seeking approval and reassurance from acquaintances or loved ones, or eating disorders. Other types of safety behaviors include daydreaming and procrastination, which enable us to separate ourselves from reality and gain a temporary state of peace. A KFF Health Tracking Poll from July 2020 found that many adults are reporting specific negative impacts on their mental health and well-being, such as difficulty in sleeping (36%) or eating (32%), increase in alcohol consumption or substance use (12%) and worsening chronic conditions (12%), due to worry and stress over the coronavirus (11).

These behaviors might evolve into habits that remain with us even after COVID-19. Virginia Satir, a prominent clinical therapist, states “Problems are not the problem; coping is the problem (12). While undertaking maladaptive coping mechanisms, underlying issues are not being addressed; Instead individuals are made more aware of their state of distress and hence more sensitive to their problems, exacerbating emotional, mental or physical symptoms. This causes most to gravitate towards escapism even more. Given this, adaptive strategies, which involve tackling the root of the problem and developing ways to cope with mental distress while facing the problem head-on are highly encouraged by clinical therapists.

Better coping mechanisms

Especially when working and learning from home, experts recommend creating new routines to strive towards achieving work-life balance (7). This includes scheduling dedicated time for recreation and physical activity, as well as maintaining a consistent sleep schedule. Following a schedule ensures that we have appropriate amounts of rest so as to avoid overworking ourselves and burning out, regulating our stress levels on a day-to-day basis.

Additionally, experts also recommend staying connected with others during the pandemic (9). Although social distancing has decreased the face-to-face interaction we have with others, social interaction is still critical to boost our emotional well-being. As such, we can opt for online communication services such as Zoom and FaceTime to continue interacting with our friends and loved ones, or even turn to online communities such as book clubs to stay connected. Quoting the Weill Institute for Neurosciences, “‘Social Distancing’ is actually a misnomer, it is actually physical distancing while we work hard to stay socially connected” (2).

Should individuals be facing high amounts of distress, the Singapore Psychological Society has ensured that psychological services remain accessible during the pandemic, with 11 psychologists offering pro bono services and 17 offering reduced rates during this period (8). Furthermore, online therapy services such as 7 Cups of Tea and BetterHelp also provide similar counselling services at affordable prices and can be accessed even from home.

So, what now?

While some time has passed, it still might take a while before we are able to eradicate Covid-19 once and for all. Whether or not we like this turn of events, there is no denying that we will have to make the most of our current norm without compromising our wellbeing.

Our current situation may be out of the ordinary but the solution does not necessarily have to be an extraordinary one. With the number of physical and social options being limited, negative emotions like stress might accumulate over time thus it is important to check in on oneself. Simple methods include regular chat sessions with family or friends in a safe space where one can relieve oneself of any lingering negative emotions, journaling to record one’s thoughts and feelings and clear one’s head, or physical activities like walks and exercises.

Systems may short circuit, tires can wear out and even engines run out of fuel occasionally. Machinery is prone to breaking down too so fret not for no one expects you to be an exception. We may be tempted to forgo work-life balance in the midst of the chaos that Covid-19 has sent us, but it does not do any harm to take a pit-stop break every now and then either.

Written by: Jamie Khoo, Wong Yi Xuan, Poh En Xi, Christopher Wong, Hear Li Yang

Bibliography:

1. Cheng, L. H. (2020, September 4). MOH | COVID-19-RELATED STRESS FROM WORKING FROM HOME. MOH. https://www.moh.gov.sg/news-highlights/details/covid-19-related-stress-from-working-from-home

2. Emotional Well-Being and Coping During COVID-19. (2020, March 22). Retrieved May 29, 2021, from UCSF Department of Psychiatry and Behavioral Sciences website: https://psychiatry.ucsf.edu/copingresources/covid19

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7. Northwestern Medicine Staff. (2016, August 15). Health Benefits of Having a Routine. Retrieved May 29, 2021, from Northwestern Medicine website: https://www.nm.org/healthbeat/healthy-tips/health-benefits-of-having-a-routine

8. One Psych Community Tackling the COVID-19 Crisis. (2020, February 21). Retrieved May 29, 2021, from Singapore Psychological Society website: https://singaporepsychologicalsociety.org/events/onepsychcommunity/

9. Oxfam International. (2020, December 15). 2.7 billion people have had no social protection to cope with Covid-19 economic crisis. Oxfam International. https://www.oxfam.org/en/press-releases/27-billion-people-have-had-no-social-protection-cope-covid-19-economic-crisis

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