CALLIOPE HOLINGUE, M. DANIELE FALLIN, LUKE KALB, PAUL NESTADT AND ELIZABETH STUART
The daily counts of COVID-19 cases and deaths tell the public story of the coronavirus outbreak. Privately, the effects of the pandemic aren’t as clear.
The new reality of social distancing and other safety measures is testing everyone, and those living with mental illness may find this time even more challenging if the support system they rely on is not in place.
Experts from the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health put together these tips and resources on how to protect your mental health during these trying times.
As the coronavirus pandemic has unfolded across the U.S., ordinary life has been put on pause. Lockdowns, travel restrictions, school closings, work closings, and social distancing have created a level of social isolation previously unseen across the globe. Fears about finances and food shortages have placed additional stressors on an already anxious and sensitized population. The practices recommended by the Centers for Disease Control and Prevention and World Health Organization are necessary and designed to protect the community, particularly the most vulnerable individuals. However, this pandemic and the associated changes, including serious financial implications for many households, can have profound consequences for our mental health.
Traumatic or stressful experiences put individuals at greater risk for not only poor physical health but poor mental health outcomes, such as depression, anxiety, and PTSD. You may notice that yourself or others around you are more edgy, irritable, or angry; helpless; nervous or anxious; hopeless, sad, or depressed. Sleep may be disrupted and less refreshing. Practicing social distancing may leave you feeling lonely or isolated. If you are at home with children, you may have less patience than before.
Those who are especially vulnerable to COVID-19—older individuals and people with medical comorbidities or immune-comprised systems—who need to be especially stringent in following guidelines from the health authorities, may be the very people whose mental health may suffer the most. Individuals with a pre-existing mental health condition, such as an anxiety disorder, are also at heightened risk for poor mental health outcomes as a result of coronavirus.
It is important that as a population, we learn how to protect our mental health during this stressful and ever-changing situation, while also following the guidelines set by health authorities to protect our physical health. Here are some strategies that can be used during these challenging times to protect your and others’ mental health.
- Create a daily schedule for you and your family. Feelings of uncertainty can lead to increased mental health symptoms.
- Try to limit the amount of time you spend watching, reading, or listening to the news. Get your information on the coronavirus outbreak from a trusted source, such as the CDC or WHO, once or twice a day.
- Make space for activities and conversations that have nothing to do with the outbreak.
Maintain your physical health
- Protect your sleep. Good quality, sufficient sleep not only helps to support your immune system but also helps you to better manage stress and regulate emotions. Adults should aim for 7–9 hours, while children and teenagers need even more. [See recommendations by the National Sleep Foundation].
- Try to eat at regular times and opt for nutritious foods whenever possible. Some people may crave junk food or sugary snacks and be tempted to snack mindlessly when stressed or bored, and others may skip meals altogether.
- Maintain an exercise routine, even if you can’t go to your local gym. Exercise at home using an online workout video, or go for a walk, run, or bike ride in a sparsely populated area.
Support--and create--your community
- Create a virtual support group and check in with those around you. There are many options for connecting, including video conferencing software, such as Google Hangouts and Facetime. During this time of isolation, connecting face-to-face (online) is more important than ever. If you can’t stream, then calling and texting is important. Check out some ideas at Wirecutter and Prokit for how to be social during the quarantine.
- Crises offer a time for community cohesion and social solidarity, and volunteering is one way to not only help others, but yourself as well. Science has repeatedly shown that volunteering can improve mental health. Check out this article for a list of organizations to donate to and this article for other ways to help your neighbors and community.
- If you have children, talk to them honestly about what is going on in an age-appropriate manner. Help kids express their feelings in a positive way, whether playing in the backyard, drawing, or journaling. Check out these guides by the Substance Abuse and Mental Health Services Administration, Child Mind Institute, or National Association of School Psychologists for tips on how to talk to your kids about coronavirus.
Take care of your spirit
- Find a place of worship that is streaming or recording services. If prayer is an important part of your life, make time for it. Stay connected to your church community through phone calls, emails, and video chats.
- Try meditation, deep breathing, progressive muscle relaxation, or another mindfulness or relaxation technique. Check out YouTube or phone apps such as Calm or Headspace for guided meditation exercises. Consider enlisting friends and family and practicing meditation together at least once a day. Mindfulness can help lower blood pressure, reduce stress, support your immune system, and protect brain health.
Continue or seek out mental health treatment
- If you are currently in mental health treatment, continue with your current plan if possible, being mindful of approaches to minimize contact with others. Consider reaching out to a mental health professional even if you haven’t before. Make sure you have ongoing access to any medications you need.
- Ask about video therapy or phone call appointments. Most states have already made emergency exemptions to insurance coverage for telehealth. Regulations have been temporarily relaxed to allow even non-medical software like Skype, Facetime, and Zoom to be used for telehealth. Even if this option wasn't available with your provider previously, it may be now! Contact them to ask about remote services.
- Avoid drugs and alcohol, particularly if you have a pre-existing mental health or substance use disorder. Check out online support groups and meetings, such as Alcoholics Anonymous, Smart Recovery, and In The Rooms.
- The need for social distancing may make it difficult to see symptoms of depression in others. In "hunker-down" mode, the in-person opportunities that we usually have to notice that friends, family, and colleagues may be struggling with a problem are no longer there. One way to think about it is that child abuse or intimate partner violence is missed more often in winter because long clothes cover bruises. Conduct regular "check ins" with your network and stay attuned to symptoms of depression, such as persistent feelings of sadness, hopelessness, loss of interest or pleasure in activities, or changes in sleep and weight.
Remember that the emotions you may be experiencing are normal reactions to difficult circumstances. Accept that things are different right now and everyone is adjusting. Prioritize what’s most important and know that it’s okay to let some things go right now.
Be kind to yourself and others. Try to stay positive and use this time to spend more time with your children or spouse, try things you’ve been putting off, such as taking an online class, learning a new skill, or getting in touch with your creative side.
It can be hard to think past what is going on today, let alone in a week or in six months, but give yourself permission to daydream about the future and what is on the horizon. Remember that this is temporary, and things will return to normal.
- The Crisis Text Line
- Suicide Prevention Lifeline
- Veterans Crisis Line
- American Foundation for Suicide Prevention
- World Health Organization
- Centers for Disease Control and Prevention
Calliope Holingue, postdoctoral fellow in the Department of Mental Health and the Department of Neuropsychology at Kennedy Krieger Institute; M. Daniele Fallin, Mental Health chair; and Mental Health faculty Luke Kalb, Paul Nestadt, and Elizabeth Stuart co-authored this piece.