Addressing the challenges of underinvestment in mental health care
You may be caught right in the middle of a pandemic. People around you may be falling ill. Your acquaintances and relatives may even have succumbed to the virus. But, you never really expect to contract the virus yourself.
Indeed, that was how I felt for the first two and half months of lockdown – from late March to mid June. After all, we had taken the requisite precautions. Strict protocols were in place to regulate the delivery of groceries. Entry of outsiders was essentially blocked. Door knobs were constantly being disinfected. And yet, in mid June, the dreaded virus managed to sneak into our household, wreaking havoc.
By the third week of June, most of our household had begun to exhibit the telltale symptoms of the coronavirus – persistent fever, acute cough, and severe muscle pain. In a country reeling from a shortage of medical professionals, suddenly everyone was an expert in the treatment of coronavirus.
‘Take Ivermectin. Three 6 mg tablets. It’s used to treat worms but it also works if you are infected with coronavirus’. ‘Top it up with Doxycycline or Azithromycin twice a day. And you will be fine in a week. It’s just like the regular flu’.
In a sense, I was somewhat relieved to find laypersons so confidently prescribing antibiotics. Maybe, it’s not going to be that bad after all.
A week later, I had completed my first course of antibiotics. I had supplemented my diet with a healthy dose of vitamins, zinc tablets and a special masala tea, which the children called ‘corona tea’. However, the fever did not subside.
In the end, I was prescribed a second course of antibiotics, which was suspended midway because it wasn’t potent enough, and had to be prescribed a third course of antibiotics. Another week would pass before I’d experience a complete remission of fever. I would later come to know that the impact of the virus on its prey varied, being dependent on factors ranging from one’s unique immune response to one’s genetic makeup.
Of the many debilitating effects of the novel coronavirus, I had been made aware of the persistent fever and the muscle pain, and was somewhat prepared for it. Everyone has, at some point in their lives, suffered from fever and body ache – there was nothing novel about it. But what I had not been advised about was the mental stress and anxiety that may accompany Covid-19.
This was all very new to me, which I found rather disturbing. A few days into being infected, I began to experience an overwhelming feeling of helplessness and restlessness. I lost all interest in working. Reading, which I had always enjoyed, had become a strain not only on my eyes but also on my mind. I could not bear to watch television. I found communicating with people downright stressful. Phone calls and messages were mostly left unanswered.
The vast majority of my time was spent in the balcony staring at the skies. Sustained inactivity perpetuated the feeling of anxiety and vulnerability. I tried to analyse my feelings, but could not pinpoint any reason for my particular state of mind. How much more difficult it must be for elderly people infected by the virus, I wondered. More than the physical weakness, it was the mental fatigue and anxiety that was affecting my general well-being.
The stress experienced by people during lockdown is well-documented. Isolation under compulsion has adversely affected the mental health of millions across the world. Whole swathes of population have been practically cooped up in their homes, often tiny apartments in run down urban neigbourhoods.
Globally, anxiety and depression cases have spiked. Suicides have been committed by those who could not bear being ‘locked up’ indefinitely. Domestic violence cases have risen at an alarming rate. While the scourge of the pandemic will eventually subside, the collective psychological trauma is likely to linger for years to come.
Unfortunately, in Bangladesh, there is very little, if any, study on the mental health of Covid-19 patients. Without a doubt, the country’s scarce resources have to be devoted towards preserving the physical well-being of patients. However, the mental health care needs of people infected by the virus, particularly, the elderly and the vulnerable, must not be neglected.
A recent study published in The Lancet Psychiatry found that among people susceptible to coronavirus infection, the prevalence rate of traumatic stress was at 73.4%, depression was at 50.7%, generalized anxiety was at 44.7%, and insomnia was at 36.1%. Left unaddressed, the psychological stress of those infected and/or fearing infection in Bangladesh will translate into a heavy economic burden for the state.
Trauma and stress arising out of the pandemic have to be addressed on an urgent basis. Good mental health is essential for the proper functioning of society. While the authorities in Bangladesh are not entirely unmindful of the challenges, a historic lack of investment in mental health care has compromised their response during Covid-19.
With the long term social and economic costs of diminished mental health looming on the horizon, the Bangladesh authorities would do well to begin implementing recent UN recommendations in this regard (UN Policy Brief on ‘Covid-19 and the Need for Action on Mental Health’ dated May 13).
Existing mental health services should be strengthened by increasing investment and enhancing human resource capacity to deliver psychological support and social care. Emergency psychological support services should be introduced with a view to alleviating anxiety and loneliness and enhancing social cohesion and bonding.
And in the days ahead, mental health considerations should be incorporated in the country’s Covid-19 response plans so as to develop an integrated approach to preservation of physical and mental well-being, which would foster a healthy environment for people undergoing isolation and ensure access to urgent counseling for those infected by the virus.