The Sunday Mail
Gender& Community Editor
AS Covid-19 ravages the world, governments are pulling all the stops to ensure sundries required to help their populations survive this scourge are available. However, mental well-being seems to have been forgotten, with the United Nations (UN) raising concern that a mental health crisis could emerge post Covid-19. Noreen Kudzanai Wini-Dari, president of Zimbabwe Psychological Association and Kelin Zvomuya, a final year student of psychology at the University of Zimbabwe, recently presented a paper raising awareness on the importance of dealing with mental health in the fight against Covid-19. Our Gender and Community Editor, Fatima Bulla spoke to Noreen Kudzanai Wini-Dari about mental health in Zimbabwe amid the Covid-19 crisis. Here, we publish excerpts of the interview.
Q: What impact has Covid-19 had on the mental health of Zimbabweans?
A: Mental health is just like physical health. There is good mental well-being then there is mental illness. Mental illness is a health condition which involves changes in emotion, thinking or behaviour, or a combination of these, and it affects how the person functions.
When we talk about a person’s mental health in the face of Covid-19, people sometimes get distressed. It is like the trauma that happens when one is involved in an accident.
The mental distress which comes out after such happenings can then give us new cases of mental illness or exacerbate cases that already exist.
Q: How do things like job losses, salary cuts, quarantine or failure to bury loved ones contribute to mental illness?
A: They cause stress and stress is normal. All human beings will experience a certain amount of stress in their lifetime. It is only when stress begins to impair the individual that we consider it problematic. By not going to work, there is a certain loss that the individual may experience or fear of the loss, which may be stressful. It could be loss of income or social interaction.
Failure to cope and adjust to the losses or incapacity to manage their fears of possible losses may catapult the individual to feelings of depression and anxiety.
Left unmanaged, this may degenerate into more serious psychiatric conditions popularly referred to as mental illness.
Fear of the virus, restrictions on travelling, physical isolation, loss of rituals (funerals, birthdays, baby welcome, weddings) can all contribute to poor mental health and give rise to psycho-social problems such as substance abuse, child abuse and intimate partner violence.
Poor social support and stigma against families, and contracting Covid-19, can be things some people struggle with. It’s just that as a nation we have not yet had many cases. Some people who are already at risk of developing mental health conditions can be triggered by conditions presented by Covid-19.
The new order presents a very stressful environment for many, if not all, thereby posing a risk for mental illness among members of the population.
Q: How can one tell that they may not be coping?
A: Sometimes lack of sleep or waking up tired no matter how long you sleep are some of the signs. You can also feel sad all the time or easily get angry. Such reactions could be signs of poor mental health. Then there is the inability to relax, hearing voices of people that are not present and loss of appetite or overeating, increased use of alcohol or other drugs, lack of energy, thinking of death, being easily distracted, trouble with concentration and trouble remembering.
Withdrawal for people that are normally active either on social media platforms or gatherings is also a sign to look out for.
When you suddenly have exaggerated use of social media platforms by someone, which was never present before, that also could be a sign of low levels of psychological well-being.
Q: Who is more susceptible to mental health challenges between men and women?
A: This differs depending on specific illnesses. There exist quite several conditions which can be classified as mental illness.
Research shows that women are more susceptible to mood disorders such as depression than men.
There are various systemic and structural explanations which have been given for this. They include gender-based violence, socio-economic disadvantage, low income and income inequality, as well as unremitting responsibility for the care of others at own expense.
Gender roles, as determined by culture, place an extra burden on most women. I remember doing a webinar and a participant said she was trying to meet work deadlines while at home. Because she is present, chores are ever-present and the children needed her, she was not coping.
So the cultural burden is added and Covid-19 worsens it because one still has to be superwoman (musha mukadzi). Maybe what we need to communicate to women is that it’s okay to come first and it’s okay to take a back seat.
Sexual violence also places women as the largest single group of people affected by post-traumatic stress disorder.
Q: If I don’t present with a mental health challenge now does it mean I am safe?
A: Covid-19 and the surrounding circumstances can be considered a traumatic event. Some people may seem okay and getting by, however, they may experience the psychological impact of this trauma in the next six to 18 months or more.
Q: What is trauma?
A: Trauma is defined as a deeply distressing or disturbing experience such as the death of a loved one or getting involved in an accident. It is also something that can be passed from generation to generation. Looking at Zimbabwe, the nation has experienced, as a whole, a couple of traumatic events and there have been no active efforts to help us process and heal from the trauma. The unprocessed trauma is passed on from generation to generation in what is termed inter-generational trauma. It manifests itself in different forms. So the current generation could be trying to survive the trauma it’s presented with and also to process the inherited trauma.
Q: What is your opinion on Government’s intervention on Covid-19?
A: Government’s response to Covid-19 is focused more on physical health despite the cliché ‘no physical health without mental health’. In the face of such a pandemic, mental health issues are certainly going to arise.
In the end, we are dealing with one side of the equation and the unsolved side will come back to haunt us. I always say mental health is the Cinderella of healthcare, the step-daughter who does not get invited to the ball.
Just like the fairy tale Cinderella, mental health is important.
The role of mental health specialists in ensuring behaviour change has not been adequately tapped into. However, we can only ignore mental health issues at our peril because there is so much that mental health has to offer.
For instance, when you move around you see people have their masks but they are not properly secured and it’s done more to appease officers of the law who are enforcing the regulation. Policing people on a behaviour change issue is not enough, you need to communicate so that people are fully aware. Mental health specialists must be involved in communicating behaviour change issues.
Q: Has the Covid-19 response taken into account mental health issues?
A: Let’s look at the Covid-19 response protocol. People arriving from outside the country are taken to quarantine centres. What psychosocial support is made available for those people and their families? What support is available for them to process the circumstances?
Remember, some of the people are coming back home after losing jobs and income. Some are returning to family members who may not be well and if the relative passes on while they are in quarantine, they have to process the loss amidst many other challenges. Let’s look at the families who have lost their loved ones to Covid-19, there is a loss of culture, how you bury a loved one and the families have to continue, the stigma of having your relative labelled as reckless, virus spreader, etcetera. What psychological support is available?
Q: What should be done?
A: I think what we are seeing now is the many years of poor structures to support mental health as part of healthcare. The absence of mental healthcare at the primary level in the healthcare system complicates the support that can be availed to the population. Research has shown that stress may manifest as a body ailment like headache or stomach ache.
So we always refer to physical pain as a symptom of our stress. If a person reports to a clinic with a headache, they have their blood pressure checked and a couple of other screening tests done. The same screening tests are not done to eliminate possible mental health challenges.
It means people may filter through our systems undiagnosed. The general understanding of mental illness is someone violent, unkempt and living on the streets. Maybe that’s the major challenge we have. The face of mental illness has to be reconstructed to include you and me.
Q: What then is the way forward?
A: The ratio of available human resources for mental healthcare is low. There have been efforts to train mental health practitioners from across the board: psychologist, psychiatrist, occupational therapists etcetera to offer support.
These cadres are not necessarily employed by Government but are volunteering their time to offer much-needed support. I hope this whole episode (Covid-19 pandemic) helps us learn about the need to integrate mental health services fully into healthcare. Cinderella has to attend the ball with everyone else.