Before the Coronavirus hit, we were already living through a mental health crisis. Aislinn Shanahan Daly looks at how the pandemic exacerbates this precarious situation, and argues that solidarity will be more important than ever in the coming period.
“Indeed the combined effects of fear, confinement, income loss and the potential destruction of family savings augur a mental-health crisis on an even larger scale than the pandemic itself. This isn’t simply collateral damage but rather an integral and extremely dangerous part of the health threat that has so far been neglected. Consider solidarity an essential vaccine.” – Mike Davis
Recently, I found out someone I followed on Instagram, who I had no personal relationship with, had died. It is such an odd experience to see someone who I had never really known as a physical human being, suddenly not existing. There is a strange guilt that, for me, all this amounts to is that their pixelated posts won’t grace my phone screen again. To their loved ones, of course, it is a life changing and devastating experience. Coming from a country where the grieving process is so traditionally collective, it leaves me with great discomfort that, during the pandemic, each person must experience grief in a manner so much more alone than they may have otherwise.
And this is but one aspect of the wider mental health issues during this COVID-19 situation. Many researchers have predicted that economic depression and mass unemployment will follow this pandemic. The resulting effect on mental health, not to mention suicide rates which are already at crisis levels, will be drastic. It can be terrifying to anticipate what will happen in the near future. Struggle for a better society has become all the more critical.
Exacerbating Mental Illnesses
Speaking about the effects of the COVID-19 situation and depression, Andrew Solomon notes that while quarantine methods protect those who are not ill, they are absolutely toxic for people who suffer from mental illnesses. Being cut off from coping mechanisms and routines can be very difficult alongside the natural stress that comes with dealing with an international pandemic. It is a relatively new phenomenon to quarantine during major outbreaks of contagious illness. The Ontario chief medical officer stated after the SARS outbreak that the psychiatric dangers outweighed the physical benefits of quarantine. 7000 people in Toronto were instructed to self-quarantine at the time.
This is not to say that some kind of quarantine is not necessary to stop the spread of COVID-19. It is to say that we need to be acutely aware of the effect this is having on people’s mental health.
Telehealth practices, whereby consultations occur over the phone or online, are simply not suitable in treating some mental health conditions. The value of face to face intimacy in therapeutic methods is indisputable. An anonymous report from a UK psychiatric ward stated that some patients can’t cope with social distancing measures, as they do not have the capacity to understand why they are needed, and take it as social rejection.
People suffering with florid psychosis are prone to believing that COVID-19 is a conspiracy; a tool of biological warfare or a staged phenomenon. Many patients in psychiatric wards engage in suicidal behaviour and self-harm. It is feared that this will not be prioritized in emergency rooms that are running over capacity. The same report also mentions how normal it had become to see coworkers breaking down on shift.
A recent study from Wuhan showed that almost half of healthcare workers surveyed were experiencing increased mental anguish (depression and anxiety particularly) amid the outbreak. Healthcare workers are particularly vulnerable due to being on the frontline of this traumatic situation. Couple that with understaffing and an inadequately funded healthcare system, and you have a recipe for disaster.
It seems there is no funding strategy being proposed by governments to mitigate the knock-on effect the COVID-19 situation will have on workers, patients, and the aggravation of mental health issues across the board. This comes as no surprise when they are religiously tied to a neoliberal dogma that sees mental health as an individual problem.
The crux of this worsening crisis in mental health services is the issue of class inequality. Countless studies show that unemployment, poverty and education access have major effects on the demographic rates of mental illness. Social marginalization can greatly exacerbate this, starkly exemplified in the case of Travellers where 11% of deaths are due to suicide, and the suicide rate is 6-7 times higher than their settled counterparts.
Treatment for chronic mental health conditions is very difficult to access in the south of Ireland with incredibly long waiting lists and a lack of resources. People can be waiting more than 6 months for an initial psychiatric assessment in the public service, and this is after they have seeked a referral from their GP in what is usually a crisis situation.
In the North of Ireland suicide rates are on the rise, with direct links to intergenerational trauma, with working class communities facing the worst of traumatic experiences during the Troubles. The continuous outsourcing and underfunding of NHS mental health services is the complete opposite of what is needed to help people who are suffering and have no access to services. All across the island, those who are most affected by mental health issues have the least access to the help they need. But this issue is pervasive across all of capitalist society.
Historically, suicide rates have skyrocketed in times of economic instability. For example, after the stock market crash in 1929, suicide rates in the US raised by 50% within a year. According to psychologist Glenn Sullivan, “For every one-point increase in the unemployment rate, the suicide rate tends to increase .78 points”. There is a direct correlation between unemployement and suicide, which disproportionately affects men.
Yet there is a narrative that this is due to the socialization of men to be unemotional, and inexpressive. There is some truth to the socialization argument, but economic conditions may be found a more pertinent causal relationship.
The way that mental illness is characterised in capitalist society is highly medicalised and individualised. The hyperfocus by psychiatrists on diagnosis from the DSM (Diagnostic and Statistical Manual of Mental Disorders) may validate suffering for many, but it has also alienated the discussion of mental illness from the material conditions which gives rise to it.
A plethora of social and historical circumstances shape the experience of mental illness which is notably subjective. Rather than the emphasis being on finding the most profitable pharmaceutical solution, which hasn’t been a majorly successful endeavour so far, focus needs to return to state and community roles in the treatment of mental illness.
Fear and Hope
In a scenario embedded with fear, those of us with mental illnesses will find it hard not to let them thrive. Everywhere you look there is a reminder of this zeitgeist; the constant scare-mongering in the media, the worried conversations with family members and friends, the tentative avoidance of people in the supermarket.
Every time someone walks past you, you might think, what if they have it? Did I inhale droplets as I passed them? Your OCD related hand washing compulsion may be in full swing now after years learning to suppress it. Your eating disorder may be exacerbated by the need to regiment your days with a strict structure including meal times, as there is nothing else to do. Your depressive tendencies might be telling you there is no point in getting out of bed because every day is the same lonely and unfulfilling slog. Or you may be looking at a post-COVID-19 situation where you have no job and rent in arrears.
We have a challenging time ahead of us. But hope lies in the spirit of solidarity that has arisen between people amongst the crisis. Very quickly after measures were taken to reduce social contact in Ireland, mutual aid groups were set up all around the country, helping vulnerable people to access resources such as food and medicine through help from their communities. The support for frontline workers is immense, with people coming out to clap for the health workers at 8pm on Thursdays.
People are seeing the necessity of public services and hopefully this experience will give them the confidence to demand the retention of measures such as the eviction ban and the use of private healthcare facilities for public good. We need to encourage this political consciousness to grow whenever the opportunity arises. The pain of austerity and global recession is something we cannot afford to fight alone.
All crises open up a fork in the road. It is up to us, collectively, to choose the one of solidarity and socialism over the pain and punishment of our current system.