DR AJAZ AHMAD SUHAFF
We are continuously being tested by the unpredictable powers of nature. New threats to human health emerge often without warning in our environment. Infectious diseases have increased over the past century due to increased global travel, urbanisation, and exploitation of the natural environment. Initially there is uncertainty about the nature, spread, and impact of an infectious outbreak that may lead to epidemics and pandemics.
An epidemic is defined as a widespread occurrence of an infectious or non-infectious disease in a community at a particular time. Pandemics are large-scale outbreaks of infectious disease that spread over a wide geographic area and greatly increase morbidity and mortality. Pandemics can create fear and erratic behaviour among people and this often leads to emotional distress, even among those who have not been directly exposed to the disease. All pandemics of infectious disease potentially affect people of all age groups. Infectious outbreaks have shaped the psyche of humanity since ages and affect human beings in different ways and cause significant health, economic, social, and political disruption.
A society that experiences a pandemic show many signs of individual and collective panic. There is chaos and confusion regarding why the disease has occurred, its containing strategies, and the fear as well as social implications associated with it. As the threat of infectious outbreak grows, people start collecting or hoarding masks, sanitisers, antiseptics and other medical supplies because of the fear of contagion. In such a situation the safety and normal functioning of the community is threatened. People avoid going to public places like schools, colleges, markets, and to public gatherings. Societies are caught up in an extraordinary emotional confusion which seems at least for a time to be beyond anyone’s control.
Recent outbreak of novel coronavirus worldwide is creating a similar worry. To control its infectious spread is a very complex task, where sets of measures need to be put in place and coordinated at local, national and international levels. The most important strategies to reduce the spread of infection are: reduce transmission of infection by regular handwashing, cough and sneeze etiquette, and social distancing.
Infectious pandemics also affect mental health. Psychosocial impact can exceed the management capacity of the affected population. Increase in the incidence of mental disorders and emotional manifestations depends on the magnitude of the epidemic and the vulnerability of the population. Older persons and children may be more vulnerable than young people. The patients confirmed or suspected become fearful when they see medical staff in spacesuits whose faces they cannot see. The wait for test results is accompanied by severe anxiety and if the disease is confirmed, then waiting for the recovery aggravates this anxiety. Individuals who are quarantined, even if they never become infected, can suffer profound mental health issues that last long past the end of their quarantine. Anger outburst is another issue among due to abrupt breakdown of social support structures when they are needed the most, leaving individuals feeling isolated and vulnerable. People often do not understand or do not agree with the information provided by authorities and experts. As the community centres, schools, workplaces are shut in the attempt to stop the transmission of the infection and even smaller social interactions, such as visiting the home of a friend, cease for fear of transmitting the disease, this snapping of social support and communication may lead to outrages and fear. The psychological injuries sustained by people during epidemics include feelings of rejection, loneliness, alienation, etc.
Quarantine of confirmed or suspected patients leads to their isolation from society. This significantly affects the self-esteem of the people. A person starts believing that his thoughts, desires, wishes and most importantly his life does not matter to anyone, even if it is not the case in reality. The most frequent immediate mental disorders in survivors are depressive episodes and transient acute stress reactions and occasionally, an increase in violent behaviour. Late effects that have been reported include pathological grief, depression, adjustment disorders, post-traumatic stress disorder, generalised fear, and anxiety.
Psychosocial intervention is need of the hour not only during the outbreak but also after the epidemic. Integrating mental health interventions within the framework of public health epidemic preparedness measures, the training and the supervision of workers to provide psychosocial support and mental health care may give better results in controlling an epidemic as well as ensuring effective changes in behavioural patterns. Mental health services should not be limited to those who are directly affected but they must encompass a much broader area of specialised services including humanitarian aid, counselling for the population affected and at-risk groups. Even survivors will need prolonged mental health care when facing the task of rebuilding their lives.
It is the responsibility of mental health professionals along with other medical professionals to communicate awareness about the risk factors to the population. More emphasis should be given on vulnerable groups and finding people with serious distress reactions and attending to them first. Mental health professionals should also look after their own physical and mental well-being during disease outbreak. Even if they communicate from a distance because of safety precautions, patients should feel that they are being heard with full attention to provide the best care possible. Patients should be educated to cope with problems. Respect privacy and keep personal details of the person’s story confidential. Behave appropriately by considering the person’s culture, age and gender. Doctors and other medical staff are likely to experience severe mental distress during and after the emergency tasks are completed. Mental health care should be provided with care and a sense of responsibility. Professionals should not make any false promises or give false information but make people aware of what has happened, understand it, overcome it and rebuild their life.
—Dr Suhaff is Senior Resident, Department of Psychiatry, SKIMS Medical College Bemina