Covid-19 and Mental Health Update

This update is for informational purposes only. It does not replace the care of your doctor.
Should you have any symptoms please seek care immediately.

Mental health is incontestably linked to a country’s economic, political, and cultural landscape.
South Africa is facing serious economic, political, health and social challenges. These problems
started before the Covid-19 pandemic and have been amplified by the effects of the outbreak, the
restrictions on businesses and the ensuing lock-downs. The overall Gross Domestic Product (GDP) is
expected to decline by 5 – 8%, over the period, and recovery is expected to take the country up to 5
years (UNDP).

Female-headed households have been disproportionately affected, with increasing levels of food insecurity and gender-based violence, amongst these families. The high levels of unemployment, poverty, inequality and corruption, which hampered economic growth and social reforms prior to the pandemic, are likely to escalate and continue to place a drag on the country’s recovery.

Civil unrest paused during the pandemic but it has started to escalate over the last few months.
Driven by desperation and manipulation, the recent episodes of unrest tore local communities and
businesses apart, costing the country approximately R50 billion and placing thousands of jobs at risk.
The solidarity and unity of the country are being tested. In addition, transformation, diversity and
social inclusion remain areas of inadequate progress and growing discontent.

A chronically under-resourced health sector

South Africa has poor health outcomes given its level of economic development. Approximately 15% of the country has health insurance coverage and utilise private sector healthcare facilities; while the majority (85%) have to rely on out-of-pocket expenditure or the grossly strained, under-resourced public health system.

Prior to the advent of Covid-19, the key drivers of mortality in South Africa were related to the ‘Quadruple burden of disease’ which included HIV/AIDS and Tuberculosis, non-communicable diseases, violence and injury; and maternal and child diseases. The Covid-19 pandemic has placed a significant strain on the delivery of healthcare services, for non-Covid-19 conditions. The true influence on the burden of disease, in the country, is only likely to be understood over time.

The challenges of COVID-19

Humans, by nature are a social species, and require interactions and cooperation with others, to thrive and effectively survive within their environment. The social life of an individual consists of the various relationships that they form with others such as family, friends, communities and work colleagues. COVID-19 has severely impacted the amount of social interaction that has occurred between individuals. This lack of socializing and decreased interactions with the outside environment has had a severe effect on the mental wellbeing of South Africans.

The symptoms related to the distress caused by the COVID-19 pandemic are very personal in nature and can vary from person to person. Red flags include unexplained variations in character, mood and behaviour changes. South African doctors, psychologists and social workers have noted a sharp increase in the following symptoms:

• Racing thoughts and constant worrying
• Constant feelings of uncertainty or insecurity
• Loss of objectivity and fearful anticipation
• Short tempered, irritability, impatience and mood swings
• Indecisiveness and an inability to focus and concentrate
• Forgetfulness and absent-mindedness
• Poor judgment and risky decision-making
• Extreme concerns about the state of the country’s economy, childcare and schooling; and issues related to family health and well-being
• Fear of job loss and uncertainty and anxiety regarding the future
• Depression
• Anger and frustration

In addition, these psychological symptoms are frequently accompanied by physical symptoms, such as:

• Headaches, nausea and heartburn
• Eating and sleeping problems
• Palpitations
• Muscle pains and aches
• Feelings of being chronically stressed and generally unwell

Persistence of feelings of exhaustion, lack of energy and brain fog, amongst patients who have previously have Covid-19, have also been diagnosed. This condition is being recognized as Long Covid-19 and the full impact is still being studied.

The South African Depression and Anxiety Group (SADAG) has noted that peoples’ usual activities, routines or livelihoods have been significantly changed, which has led to a rise in levels of loneliness, depression, harmful substance use and suicidal behaviour. Companies have noted that employee motivation, morale, productivity, civility at work and strength of team engagements have been severely impacted. Key mental health conditions, which have been noted to increase over the pandemic, include post-traumatic stress, mood, anxiety, phobias, and obsessive-compulsive disorders, as well as an increase in gender-based violence and substance abuse. Healthcare workers
have been particularly affected by these conditions, given the dire circumstances under which they have had to work. A study conducted by the Human Sciences Research Council (2020) reported that 33% of South Africans were depressed, while 45% were fearful and 29% were experiencing loneliness during the first lockdown period.

The way forward

This equally ominous pandemic of mental health disease should be treated. This 2nd pandemic is deeply steeped in social stigma, which remains a barrier to seeking care and overcoming disease. It is expected that the mental health needs of the South African population will increase in the pandemic or post-pandemic environment. Specific interventions may be required to provide crisis management, anxiety, depression and substance abuse programs, as well as targeted interventions, at vulnerable communities, such as women, children and marginalized groupings. In addition media campaigns, health education programs and counselling services need to be provided, at a
community level, to address the issue of the stigma associated with mental health conditions.

There is an urgent need to develop and implement primary healthcare (PHC) and community-based mental health programs across the country, which are provided outside hospitals, in local urban and rural settings. Such programs require a well-coordinated partnership of both public and private sector players. Collaboration between the Health and Social sectors is also a critical driver of success and sustainability.

Embedding the delivery of mental health services, in the basic benefits package of the country’s future National Health Insurance, is also an important consideration. While the exact services provided by the NHI still haven’t been stipulated as yet, it can expected there will be provision of mental healthcare at a PHC level, at the very least. The Psychological Society of South Africa have called for mental health to be more effectively integrated into the National Health Insurance Bill, ensuring equitable access to mental health services for all people. In addition, they called for improved human resources; clear accreditation standards and contractual conditions for service providers; improved utilization of private practitioners; the inclusion of mental health expertise in the NHI advisory structures; establishing a robust accountability framework; and including mental health indicators in the NHI information system.

Ultimately, the wealth of a nation is dependent on the health of its people. In one of the most unequal countries in the world, Covid-19 has been a stark reminder that our collective wellbeing depends on the health and happiness of the poorest, most vulnerable person in our society.