Navigating mental health crisis during a pandemic

Margaret Kagwe

Counselling psychologist and mental health specialist Margaret Kagwe.

Photo credit: Pool

The Covid-19 pandemic has turned our physical health, our livelihoods, and our economies upside down. At the same time, an unseen mental health emergency is sweeping across the globe because of the fear, stress and worry associated with the pandemic.

The World Health Organization (WHO) reports that by far, the largest public mental health impact has been in the form of stress and anxiety, and predicts a rise in depression, suicide and substance use in the coming days.

A review of the mental health response to the Covid-19 pandemic in Kenya by the International Journal of Mental Health Systems showed that the country has no formal mental health response plan, and there is an unmet need for psychological first aid. Access to mental healthcare and psychosocial support during the pandemic remains a challenge and there is no systematic collection of data on the mental health impact of Covid-19.

This shows the lack of mental healthcare was there prior to the pandemic, meaning those who had mental health conditions before have also seen drastic changes in their illnesses in the past one-and-a-half years

We talked to two patients who shared their stories, fears and hopes around living in a pandemic in their conditions.

Jennifer Wangui, 36

“I am a housewife and mother of three wonderful boys. My firstborn, who is 15, was diagnosed with dyslexia and epilepsy when he was one year and eight months old.

I am his full-time caregiver, but it has not been easy for us. He has to attend a special school. He cannot tell the time, value of money or who is good or bad. Additionally, he gets surplus convulsions. That also means he needs full-time care and attention.

The pandemic has not been easy for us. He has been on Rivotril, Epilim and Rivotrol ever since he was diagnosed. With the first lockdown in April last year, we could not get his medication anywhere. Only generic ones could be found; which would be detrimental to his health. When we eventually found some, in Meru County, we had to cough up double price.

My husband, Steven, also lost his job when the pandemic started. He got so stressed and was eventually diagnosed with bipolar disorder; meaning I had to be a caregiver to him and my son. He has been on medication since and his condition is improving.

I definitely have fears for the future. One: I don’t want my husband and son to feel as if they are a burden to me. I’m also afraid that I may one day be overwhelmed with all the responsibilities and that I would get a diagnosis, just like my husband did.

But above all that, I have accepted that my son will have to live with his condition. I’m also hopeful that my husband gets well. He’s very open to getting treatment and is hopeful that he will be back on his feet soon. God has also blessed me with good friends who have been very supportive in our journey.

I plan to start a mtumba business in the near future, which we are hopeful to God to see it through.”

Charles Mobagi, 53

“My sister-in-law, Elizabeth Musyau, was diagnosed with bipolar disorder in 2000. She has been in and out of treatment facilities ever since.

Elizabeth was part of the affected patients when the country’s highest level specialised care facility, Mathari, where she was receiving treatment at the time, halted its inpatient services and weekly clinic sessions owing to the Covid-19 pandemic in April last year.

The move to curb crowding at the facility dealt a major blow to families and caregivers of the mentally ill, some of who, like Elizabeth, were discharged from the facility before they could recover.

She had to go back home, something that had always posed a risk to her husband and four children because of how violent she got with them, to the point of chasing them away from the house.

Due to her condition, she cannot sleep at times. She would leave the house at any time of the day or night because she cannot comprehend the lockdown or curfew rules put in place to control the spread of the virus. Do you think the police would understand that she is unwell if caught violating the rules? What of the husband or the children?

She has also recently started complaining of joint pains after she fell during one of her violent episodes while in hospital. The doctors think it could be related to arthritis, which she is taking medication for. That has become an additional cost for us as a family. We have been supporting her both emotionally and financially since her diagnosis.

Her mental health is a bit stable for now, and we hope that it will remain that way for the long run.”

Margaret Kagwe: Mental health specialist and online trainer at Esteem Counselling & Consultancy

“I am a counselling psychologist and my job involves using psychotherapy to help people with psychological problems and mental health conditions. The psychological issues that people struggle with include family conflicts, parenting, bereavement, traumas and sexual violence. Mental health conditions include depression, eating disorders, phobias and sleep disorders.

The pandemic has definitely affected people with existing mental health conditions just like the general population and probably to a higher degree.

The fear created by the pandemic worldwide can be a trigger for anxiety in a person with existing mental conditions. Fear that does not seem to have a definite solution can make an existing mental condition worse.

The measures that have been put in place to manage the pandemic have also resulted in limiting social interactions and this may also limit social support for those with existing mental conditions. For instance, online therapy has its limitations especially when dealing with sensitive matters. Since it is the only option during the pandemic, those who were used to face-to-face therapy are likely to feel the difference.

The face mask is another limitation that prevents the therapist from observing the full range of non-verbal behaviour that is very important during a therapy session. Masks may end up making feelings besides shielding from coronavirus.

Before the pandemic, it was possible to access all interventions options that have been limited in an attempt to curb the spread of the virus.

Stress and anxiety from the fear of the virus and the measures put in place to prevent the spread are likely to make existing conditions worse or even trigger mental conditions in those who were previously healthy.

Loss of income may also affect people’s mental health as well as make it difficult to support those with existing mental conditions

Persons who have been diagnosed with mental health conditions should ensure they keep close contact with their healthcare professionals for close monitoring. This may mean frequent visits or online sessions.

Those in any form of medication should strictly adhere to their prescriptions. Networking with others with similar conditions can be helpful – one is able to learn how others are coping as well as get moral support.

Those with mental health conditions should also advocate for themselves so that their special needs are addressed. This is especially in the workplace and family environment. Educating people on their mental condition can help in reducing stigma and getting the support they need.

Remaining hopeful and positive is the best approach to reduce anxiety and stress.

Support for people with mental health conditions can be found in hospitals offering psychiatric services, psychotherapy clinics, from trained mental health champions, workmates, people of goodwill and family. Being supportive and non-judgmental is one way to make life easier for a person with an existing mental health condition. We all can do it, and sometimes all we need to do is to be there and remain silent.”

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