October 2020 was when I realized I would have to ask for help. I developed health anxiety because of the Pandemic. The respite we had over the summer felt like it was slipping away. When I finally got to sleep, I had nightmares. I had to give up coffee because my stomach churned and my hands shook. I had to book a test to be able to function after I developed a chronic cough and got into an irrational spiral about Covid.
The on and on-ness of the epidemic is one of the most incomprehensible aspects of it. If humans can recover from turmoil, they can do it. Ripley studied people who survived tornadoes and terror attacks and found that the mental health consequences were better understood than the long, slow-burn, seemingly endless one we find ourselves living through.
Ripley knows that this is not the first disaster humans have had to endure, so are there things we can learn from other disasters about what they do to our brains, relationships and communities? How to make things better?
The mental health aftermath of everything from earthquakes to the Ebola epidemic can be learned from previous emergencies, according to Dr Brandon Kohrt, professor of Psychiatry at George Washington University. South Africa, India and Uganda all rolled out mental health and psychosocial plans in February, March and April 2020. He told me that they had experienced prior disasters, but that these approaches could be beneficial in high-resource places like the US and UK.
The on and on-ness of it all is one of the most incomprehensible aspects of the Pandemic.
We heal socially when there is a war, a terrorist attack or population-wide trauma. It's crucial to be together when something bad happens and then heal together. People who come together in that healing process tend to do better than those who don't. I think that the isolation we all experienced in the context of stress and trauma is eating away at us psychologically, and that is what has happened with Covid.
Some people who have been through traumatic events such as a terrorist attack will develop a mental health problem, but not everyone will.
One in five people who experience a humanitarian emergency will go on to develop a mental health problem, and the rate of serious mental health disorders will increase from 1-2% to 3-4%. Mental health problems double in emergency settings. The global Mental Health and Psychosocial Support Network, which helps people working in crises, would be surprised if that turned out to be the case.
Many practitioners feel that the psychological challenges of Covid aren't being addressed. The Mental Health in Complex Emergencies course was co-created by Willem van de Put. Covid has made things worse and leaders in global mental health are saying we should do something but, basically, nothing is happening. Governments are unwilling to address it. Every country is a developing country when it comes to mental health services.
According to research by the Centre for Mental Health, 8 million British adults and 1.5 million children will need mental health support in the next 10 years as a direct result of the Pandemic. According to the Office for National Statistics, the rates of depression have doubled since the beginning of the epidemic. People who had pre-existing mental health problems, people of colour, those living in deprivation and young people are the ones who have been impacted the most.
Family members become threats during the Pandemic.
Andy Bell from the Centre for Mental Health says that the UK has a system based on late intervention and crisis response. Only a third of people with common mental health problems get help. We don't offer it quickly and we wait until people's needs are so severe that they need specialized treatment.
Early intervention for common mental health problems, such as depression and anxiety, can be done without the need for highly trained professionals. Problem Management Plus is a community-level post- emergency support programme that he implemented in Nepal after successfully trialing it in Pakistan and Kenya.
Anyone with a high-school education can be trained in just a few weeks to deliver psychological support to those who need it, often embedded in places where people seek help for problems with housing or employment, rather than specifically for mental health. Clients get five weekly 90-minute sessions, usually one-to-one, or longer sessions in a small group, and are taught stress-management skills, breath control, problem solving, how to overcome inertia and how to develop a social support network. The final session is about how to stay out of trouble.
We are using interventions that were developed for earthquakes, floods or war in New York City. It doesn't have to be done by psychiatrists or psychologists.
In the UK, similar early intervention projects exist, but they are few and far between. A coalition of charities, including the Children and Young People's Mental Health Coalition, Mind, YoungMinds and the Children's Society, is trying to push government to fund the Hubs and create a network of informal community support centres for children and young people. The Nest is a hub that is already up and running in the London area of Southwark, and 98% of its users say their wellbeing has improved.
The ongoing nature of the Pandemic is not good for us. Our brains are different when we experience threats because we are constantly on edge and alert. Everybody else seems a threat as we become more focused on a very tight-knit group. Pre-vaccines are the most challenging part of the Pandemic. If kids are going to be a threat to their grandparents, we are on alert even with people who should be helping us. This makes it harder for us to be compassionate in general. We become more prejudiced, we become more stigmatising. Imagine how much worse societal discrimination and stigmatisation is if we discriminate against our loved ones. It explains a lot about now.
I can identify with the idea that some of us may find it harder to regulate our emotions. It is always a mix of self-regulation and regulation with others. It doesn't work to rely on self-regulation of emotions. We regulate our emotions with our peers. It might not have helped if you were locked down with your family. Family units are connected to many other people as well, and if they don't have contact with extended family, friends, peers, then that family's own emotional regulation gets disrupted
One of the biggest things we do in humanitarian emergencies is make sure people have a sense of control. The social fabric is often destroyed when there is a disease. Schools, churches and community centres were so hard to access that they might as well have vanished. Lack of social connection, lack of community and feeling out of control are some of the causes of mental health issues.
Between 5 and 10% of people who have been through traumatic events such as a terrorist attack will go on to develop clinical levels of post traumatic stress disorder. Christopher Thomond is the photographer.
The first thing we need to do is repair the social fabric. People come to me all the time and say they don't know what to do because their town is exploding with conflict. We will find a target of convenience when we see the amount of frustration, sadness and alienation that has not been dealt with. There is a short golden hour of solidarity after every disaster. A deep valley of division followed by a clap for carers. Repairing the social fabric is an explicit mission.
The repairs can be done quickly. I will have parents come to an event in person if I am a head teacher. Afterwards, I serve drinks and snacks outside for half an hour so that we can connect and get out of a deficit situation. The school plays, the church ftes, and casual socializing are more important than we thought at the time. Those things are investments in your future sanity and wellbeing. The way to build community resilience is to know each other so that we don't assume the worst, and that it gets harder to demonise each other, and that prepares us for the next disaster.
Bruce Daisley is a former VP of Twitter. Police and firefighters who were in the thick of the events of 9/11 have been well researched and the closer they were to their colleagues, the better protection they felt for their mental health. resilience is social strength and helps us recover better from operations, prevents us from falling into depression and generally improves wellbeing.
If you look at other species, grooming and other non-sexual touch among group members is the way that that part of emotional regulation is done. We have had very little opportunity for that. It is even more powerful when we are in distress. He says he can help regulate your distress if he is not the one in distress. Helping others may reduce our inflammatory responses and improve our antiviral responses because of the feedback loop between the helpers and helpee.
She says we are vulnerable to conflict entrepreneurs if we remain in Ripley's valley of division. It is easy to turn us against each other. We need to remind ourselves that we don't want to be played that way. We are not going to be aggressive.
One way to offset that particular danger as well as helping us to cope with the aftermath of an emergency is to tell ourselves a story of the experience which allows us to have agency within it. Ripley says that appraisal is one of the most sophisticated tricks of the mind. Is there a story we can tell ourselves that is true and also leave us some hope? There has been real suffering and hardship, but maybe you or your child showed remarkable resilience in finding a way to adapt or to be with that loss and still create new things.
Ripley suggests that you spend 15 minutes writing your own story, but as though you were a benign third party, observing. When you are in a disaster that keeps going on and on, there is a kind of organisation of the experience that happens in the brain, that you don't have the space to do. Since there is not enough space for recovery in a slow disaster, we have to create it by writing a story.
Daisy Dowling wrote an article in the Harvard Business Review that inspired me to try something similar. She encourages us to list our achievements throughout the pandemic, which could include not snapping all your child's pencils in an impotent rage while home school, or cooking 654 dinners in a row since March 2020, as well as more traditional wins. It was an uplifting way to look back at the last two years.
Is writing a story a good way to end an emergency? Ripley says that the brain needs psychological certainty. There is no end, but we could give it an end by creating a narrative that has a conclusion.
Samaritans can be reached by phone on 116 123 or by email atjo@samaritans.org. You can reach Mind at 0300 123 3393.
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