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COVID-19 Mental Health Tool Kit

Guide for communities and patients in isolation or quarantine and their families and friends

This information tool kit is about COVID-19, also known as the coronavirus, and the consequent mental health-related factors at the community and individual levels. It is designed for people who have been diagnosed with COVID-19, who are in isolation or quarantine, as well as those who know a loved one who has been diagnosed with the virus or who is in isolation or quarantine. It will also be helpful for people who feel worried about having the infection or depressed as a consequence. The anxiety associated with the illness and the surrounding factors can, on occasions, be worse than the epidemic of the illness itself.

What is COVID-19?

The World Health Organization (WHO) has named the novel coronavirus as SARS-CoV-2 and the disease it causes as COVID-19. The CO stands for corona, the VI for virus, and the D for disease.

It is crucial during periods of pandemics to not only focus attention on physical health but also to be aware and take measures to help the mental health and wellbeing of communities affected by the virus. Concerns about transmission from person to person may affect the accessibility of social support and hence may reduce community cohesion. This consequently impacts negatively on mental health and wellbeing.

Unfortunately, the media has been an additional factor that has increased the sense of panic among the general public. But there are many positive approaches that can help in looking after the mental health of the community and individuals.

Anxiety and Depression

Anxiety is what we feel when we are worried about things that are happening or about to happen.
There is a lot of uncertainty around the coronavirus outbreak. Understandably, many people are worried and anxious about the risk of being diagnosed with the virus, as well as suffering anxiety about loved ones getting the infection. Also, people suffer anxiety about themselves or a loved one being in social isolation or quarantine.

The initial step is usually recognizing that uncertainty and anxiety during this period is perfectly normal, understandable and common. Anxiety is a natural human reaction to feeling in danger. It can be experienced through our thoughts and feelings. Our thoughts are interlinked with how we feel emotionally and physically. Worrying constructively is useful to a degree as it helps the person to take necessary actions.

Anxiety is a normal, healthy experience except when the symptoms are significant, causing distress or impacting the person’s daily activities.

Dealing with the reactions resulting from stress, anxiety and depression can improve health, quality of life and wellbeing.

Anxiety and depression are commonly associated together, and there is an overlap in some of their symptoms.

Symptoms of anxiety may include sleep difficulty, constant worry, feeling tense, lack of concentration, sleep and appetite difficulty, restlessness, shallow breathing, tremors, sensitivity towards information or constantly checking social media, and thinking a lot about everything.

Symptoms of depression include loss of interest, feeling sad, angry, crying a lot, becoming withdrawn, changes in sleep and appetite, poor memory and concentration, hopelessness, losing confidence, thoughts of death and self-neglect.

The coronavirus can present a trigger for depression and anxiety; for example, as a consequence of isolation, quarantine, bereavement or physical illness. Factors that can increase the risk of depression are a previous history of depression, social isolation, pain, physical illness and other ongoing life stresses.

Recognition: Recognize your own emotions when you are worrying or are in a low mood. Be aware that a high degree of certainty is just not possible, however much we would like it. Manage your thoughts of uncertainty by trying to separate what is in your control and what is not in your control. Attend to things that you have control over.

Challenging bad thoughts: Identify and challenge any worrying thoughts or negative thoughts of helplessness. These are central to anxiety and depression. Examine the evidence that does not support your negative thoughts. Shift your negative self-statements to positive self-statements that allow you to function with less distress. For example, rather than saying, “This is a terrible time,” you can say, “I am sure that I will overcome this terrible time.” This will normally convert your emotions into positive emotions and positive actions.

Promoting a sense of safety: Improve your sense of safety by educating yourself about mental health and the coronavirus using information from reliable sources. Following good hygiene habits and measures to limit the risk of infection, as published by the infection control authorities, will promote a sense of safety.

Connectedness: Try alternative ways of making contact with others if you cannot go out, such as phoning, texting, video calling and emailing friends and family. Contact others on a daily or regular basis and let them know how you feel.

Maintaining a routine: Maintain a healthy routine as far as it is practical. For example, make sure you have enough sleep and do some physical activity if appropriate. Modify your daily activities and increase activities that you enjoy doing.

Practical measures: Avoid excessive checking of social media and consider turning off notifications from unreliable or anxiety-provoking sites. Focus on information that provides practical steps for yourself and your loved ones. Amplify positive and hopeful stories, such as stories about people who have recovered from the virus. Use technology positively to promote community safety and a sense of control.

Reliable sources of information: Identify reliable sources and allow yourself to check one source once a day, such as the World Health Organization, National Centers for Disease and Control, and your local Ministry of Health or National Health Services.

Practice calmness: This is done through relaxation techniques and anger management. Practice slow, steady breathing and muscle relaxation at the same time. Alternatively, do yoga or another form of exercise, listen to music or practice any distraction technique that has worked for you previously.

Be positive about others: Someone who has a cough or fever does not necessarily have the coronavirus, and someone who has the coronavirus will likely recover well. Self-awareness is important in not stigmatizing others in the community. Recognize that people who are affected and are in isolation have done nothing wrong and they deserve your support, compassion and kindness. And avoid attaching the virus to any ethnicity or nationality.

Worry time: Rather than worrying all the time, try to set aside a specific time each day and call it “worry time”, but do not do this close to your bedtime.

Coping with isolation and loneliness

Most people feel the need for social interactions and relationships. Loneliness is the feeling someone can have if their social interaction needs are not fulfilled. Loneliness and isolation can impact on the symptoms of anxiety and depression.

First aid advice on managing isolation and loneliness

Identify feelings of loneliness: Learn to recognize feelings of loneliness and remind yourself about those people who can connect with you.

Alternative activities: Focus on activities that you can do on your own, such as keeping a journal, reading a book, watching television and doing some physical and mental exercises.

Hope: Establish a sense of hope through inspirational stories and resilience messages.

Additional help: Seek additional help by talking to a supportive friend, a trusted family member, your primary care physician, your social worker or other local helplines if they are available in your local community.

Problem solving: Identify the problems you would like to work on by writing them down and thinking of several solutions to the problems. Then put the solutions into action. You may seek counselling and support if appropriate.

Coping with grief

Grief is the emotional and behavioral response to any loss. This includes not only loss of life but also loss of property and freedom, sickness, unemployment, or the end of a relationship. There are five stages of grief. They include an initial shock and emotional numbness, denial followed by a period of anger, sadness and depression, and finally acceptance.

Abnormal grief can happen when the grief process is prolonged or in cases of traumatic events, such as disasters. It can also happen if the symptoms of depression occurred earlier than the grief, or if there is an associated misuse of drugs and alcohol.

Consult with your primary care physician or your local mental health services if you continue to suffer from mental health symptoms for a period of several months after the outbreak, and the symptoms are at such a level that they are affecting your daily activities or causing severe distress. Long-term effects may include the continuation of the symptoms of depression and anxiety, or developing symptoms of post-traumatic stress disorder, such as flashbacks, nightmares, hyperarousal and avoidance around the traumatic events. There is treatment and help available for any prolonged consequences, including prescribing medication and psychological therapy.

For the elderly and people with chronic health conditions, mental health symptoms can be worse compared with other healthy people. This is particularly true if they are in isolation, which is in itself an independent risk factor for depression in older people. Also, older people may be suffering from dementia and can become more confused and distressed, especially by the news. Practical and emotional support is usually provided through their families. Giving simple, non-distressing and honest information to the elderly is very important. Information may have to be repeated for elderly people, particularly if they are suffering from Alzheimer’s disease or another form of dementia.

Children and teenagers react to what they see and observe from the adults around them. When parents and care givers deal with COVID-19 calmly and confidently, they can provide better support for their children.

Children can be frightened about something they do not understand, and parents can be reassuring if they are well prepared. Children can also think they have caused the events around them by being naughty.

Not all children will respond in the same way, but some common reactions will include crying, excessive worry, sadness, unexplained headaches, petulance and irritability, avoidance of activities enjoyed in the past, and difficulty concentrating. Other symptoms include nightmares, and babyish talk and behaviors.

Children also react differently to grief and can go through the grief stages more rapidly. Remember, children can understand the concept of death when they are as young as five years old.

Make time to talk with your children and share the facts in a simple way that they can understand. Reassure them and make them feel safe. Children should know that it is ok to feel upset. If the child is in isolation, connect regularly with them such as through online platforms and phone calls. Try to devise a regular routine for them, and if schools are closed, create a schedule for both learning activities and fun activities.

Box Out: Video Visit for Psychiatry

Video Visit - Psychiatry

To maintain continuity of care with our patients during the current physical distancing precautions, JHAH’s Mental Health specialists have started MyChart Video Visit for patients currently under their care. 

To request a Psychiatry Video Visit please call 800-305-4444 and select option 5 during normal working hours.

Learn how to use MyChart Video Visit

If you need help signing up for MyChart or would like to ask a question, please call the MyChart Help Desk at 800-305-4444, and select option 8 (7 a.m. to 4 p.m., Sunday to Thursday).

Box Out: Emotional Help Line

Emotional Help Line

JHAH offers emotional counseling to selected groups through the COVID-19 Emotional Help Line. The helpline is currently offered to JHAH registered patients who are:

  • In COVID-19 home isolation or quarantine 
  • Guests at JHAH COVID-19 quarantine facilities
  • JHAH admitted patients
  • Receiving a referral from the COVID-19 Care Line

Call the Emotional Helpline at 013-870-1919

Read about Coping with the COVID-19 Pandemic

References and Bibliography

  1. COVID-19: Manage Anxiety and Stress; Centers for Disease Control and Prevention, USA, 2020
  2. Cacioppo, J. T. and Patrick, W, Loneliness: Human Nature and the Need for Social Connection; W. W. Norton and Company, 2008
  3. Coping with the Coronavirus: Worry and Uncertainty; Oxford Health NHS Foundation Trust, March 2020
  4. Coping with the Coronavirus: Depression; Oxford Health NHS Foundation Trust, March 2020
  5. Holt-Lunstad, J., Smith, T.B. & Layton, J.B, Social Relationships and Mortality Risk: A Meta-analytic review; PLoS Medicine 2010, 7 (7)
  6. Holt-Lunstad, J., et al. Advancing Social Connection as a Public Health Priority in the United States; American Psychologist, 2017.
  7. Hobfoll, S. E et al. Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence; Psychiatry, 2007, 70(4), 283-315.
  8. Managing our mental health and staying well during a virus outbreak: Responding to 2019-nCOV; Mind, UK, Feb 2020
  9. Managing fears and anxiety around Coronavirus; University of Berkeley Health Services, University of Berkeley, 2020
  10. Mental Health and Psychosocial Consideration during COVID-19 outbreak; World Health Organization, Feb 2020.
  11. Managing stress associated with COVID-19 virus outbreak; VA National Centre for PTSD, USA, 2020.
  12. No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages; Department of Health, UK, 2011
  13. Reissman, D. B. et al, Pandemic influenza preparedness: adaptive responses to an evolving challenge; Journal of Homeland Security and Emergency Management, 2006
  14. The Lonely Society; Mental Health Foundation, 2010

COVID-19 Mental Health Tool Kit
Mental Health Information
Guide for communities and patients in isolation or quarantine and their families and friends

Prepared by
Dr. Raafat Samir Mishriky, FRC Psych, Consultant Psychiatrist
Dr. Abdul Sammad Jishi, MD, Consultant Psychiatrist & Chief of Psychiatry
Johns Hopkins Aramco Healthcare, Division of Psychiatry

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