Disease management during a pandemic requires healthcare professionals to maintain access to care while managing the risk of infections. This has been achieved to varying degrees across Southeast Asia, however, amid the stress and confusion of shutdowns and social distancing, the pharmacy network is concerned for another looming health issue– mental health.
The implications of COVID-19 on our mental health
Fear, worry, and stress are normal responses to threats, (whether they be real or perceived) but even as the pandemic is showing signs of being brought under control, experts predict that grief, anxiety, and depression will likely continue long after the virus is gone.
This has been triggered by job losses, changes in work practices and our personal routines, the influx of news coverage, financial difficulties, death of loved ones, and of course isolation from one’s support system.
On top of that, the uncertainty of the second wave of infection looms, for others, the frustration of not being able to return to normal and the confusion felt by ongoing adjustments could challenge our sense of meaning and purpose. For others, the isolation experience may even spark an old trauma. Patients with pre-existing psychological health issues are also at risk as counselling and medication adherence has been hindered due to the lockdowns.
Some experts have also talked about the consequences of economic and social disruption in the years that follow the pandemic, including the possible impact on medication affordability.
Increasing rates of mental health problems globally
Across the globe, increasing rates of mental health problems have been reported and many predict that it is only the beginning. The pharmacy network, together with other healthcare professionals, are now concerned that the COVID-19 pandemic now has the potential to become a global mental health crisis.
In a survey conducted March 27-29 of 1,062 Americans by McKinsey & Company, 35% of respondents raised concerns of depression and anxiety.1 Of particular concern is findings that showed that one out of four respondents reported “binge drinking,” one out of five reported to be taking prescription drugs for nonmedical reasons, and one out of seven reported using illicit drugs. This is particularly concerning as officials in the US have reported that a commonly prescribed antidepressant and anxiety medication, Zoloft, is in limited supply.2
In a survey in Malaysia conducted by Think Tank from April 5-10, 1,084 Malaysians were surveyed, and it was found that 50% of respondents were experiencing negative mental well-being and 22% claimed they were going through severe or extremely severe anxiety.3
If we reflect on the mental health studies after other global crises, history confirms that there is expected to be an increase in suicide, overdose deaths and substance abuse. According to the BBC, suicide rates in Europe continued to decline until 2007, but in the wake of the global banking crisis of 2007-2008, 2009 saw a 6.5% increase and this was sustained until 2011.4
This increase was attributed to the rapid rise in unemployment. A similar trend was seen in the US. This was also seen in Asia in 1997 following the Asian financial crisis. Post-crisis, suicide rates among men rose 45% in South Korea, 44% in Hong Kong and 39% in Japan.5
Experts from the United Nations have also warned that many people are under severe psychological strain and the United Nations has called for as much focus on the mental health of communities as the physical health and stimulus packages.
Mental health in Southeast Asia
Even before the events of 2020 took place, the World Health Organisation reported in 2017 that anxiety affected 60 million people in Southeast Asia and close to 86 million people (over 10% of the population in this region) live with depression. These numbers may even be higher due to the social stigma of mental health in this part of the world which prevents people from being truthful about their mental state.
The UN has tried to kickstart these conversations by urging governments to include access to psychological support and emergency mental health care in their stimulus packages. Given an average of only 2% of public health budgets are used to support mental health, the UN also called for a significant increase in spending on mental health support.
As we look at the events that are unfolding around Southeast Asia there is a very real concern that such support is required:
In the Philippines …
An influx of migrant workers was forced to return home as their jobs were decimated worldwide. The financial burden aside, families were under significant stress as the country had limited quarantine facilities and virus-testing capabilities for those returning. As a result, the country’s capital felt chaotic delays and congestion in hospitals, hotels, and isolation facilities which put these workers at risk of infection. Public transport and flights were also restricted which meant that workers were effectively trapped from reaching their families in the provinces. Philippine President Rodrigo Duterte warned government agencies that they would face sanctions if they failed to accept overseas Filipino workers returning to their hometowns.
In Indonesia …
Hospitalised patients in Indonesia have publicly shared their suicidal thoughts while being hospitalised with COVID-19 for over a month. A report revealed that five psychologists, five assistant psychologists and one psychiatrist were responsible to take care of the mental health of 800 patients.6
Experts have said that the suicidal thoughts are likely to have been manifestations of the stress, loneliness, and helplessness they experienced. Since the outcry, psychologists have created preventive programmes to try to keep the patients, as well as the healthcare workers, mentally healthy. This includes an increase in one-to-one counselling sessions, a hotline service, and the use of positive messages broadcasted through messaging apps and loudspeakers.
In Malaysia …
Several ministries have reported a rise in the number of cases of physical and emotional abuse since the enforcement of the country’s lockdown. The Women’s Aid Organisation (WAO) reported a four-fold increase in the number of calls in the third week of the country’s lockdown, The Women, Family and Community Development ministry also reported 353 enquiries through its helpline over a 1-month period, and The Islamic Development Department reported over 900 calls and email messages within 2-weeks of launching a new service. Government agencies and non-governmental organisations (NGOs) are stepping up efforts to help the victims of domestic abuse many of which do not know where to seek help, particularly during the lockdown.
In Singapore …
Migrant workers have had to face the negative opinions from some citizens who have accused the migrant community and voiced that the country’s resources should only be spent on its citizens. Singapore’s Prime Minister, as well as other government ministers, have slammed such messages as being insensitive and xenophobic. Amid the growing anxiety and fear felt by many the deepening of societal divisions is worrying.
Healthcare professionals at a heightened risk
The World Health Organization has also commented on the rising suicides and substance abuse among medical workers who are facing extreme stress. 7 While healthcare professionals are hailed as heroes, they are on the frontline of the fight tackling their own mental health problems.
Those on the frontline are afraid of getting infected and spreading the disease to their loved ones, frustrated by a lack of personal protective equipment, and overwhelmed with a sense of helplessness for those who are unwell.8 Coping mechanisms are difficult as these workers are exhausted by long hours of work with no end in sight and lacking in social support
History also shows that workers who are at risk of contracting the virus have a greater likelihood of suffering post traumatic stress symptoms. While it will be years before the mental health toll on today’s healthcare workers is fully understood, early reports do not paint a good picture. In a study of 1,257 healthcare workers caring for COVID-19 patients in China it was found that 50.4% reported symptoms of depression, 44.6% reported symptoms of anxiety, 34% experienced insomnia, and 71.5% reported distress.9
Informed patients have better outcomes
May was mental health awareness month, and never before has the topic of mental health been so important. As the challenge is particularly complicated in Southeast Asia due to the stigma of mental health conditions, it is critical that healthcare stakeholders work together to improve the awareness of mental health risks and symptoms.
The problem with depression and anxiety is unlike most disease management scenarios, mental disorders do not always show immediate symptoms until it develops into a severe state over time.
The most common symptoms of depression include sleep disruption, changes in eating habits, poor concentration, focus and memory, a lack of energy, and loss of interest in once enjoyable activities.
Anxiety, on the other hand, results in increased adrenaline which may lead to an increased heart rate and blood pressure, while cortisol changes may cause various physiologic effects. Anxiety can suppress the immune-inflammatory response which makes patients more vulnerable to getting sick, while continuous stress may increase the risk of developing cardiovascular disease, infectious illness, and cognitive deterioration.
If you are experiencing such symptoms it is important that you seek help. Please inform a loved one and reach out to your nearest healthcare professional, including your nearest pharmacist for advice.
Mobile health solutions
Many healthcare professionals are advocating for the use of mobile health solutions and patient engagement tools to ensure people suffering from mental health conditions can continue to get the support they need both during and after the outbreak.
Digital patient assistance programs represent a positive step forward. Offered under mClinica Patient Solutions, it is a win-win solution for healthcare providers and patients. These digital programs not only help patients afford their medication, but also digital refill reminders and educational text messages have been shown to boost medication adherence.
Digital patient assistance programs also help doctors to also ensure patients are compliant with their medication. It has been proven to increase patient loyalty as patients can receive free medication or discounts. To read more about the positive impacts that patients can receive from a digital patient assistance program read this article.
Pharmaceutical manufacturers and consumer healthcare companies can also provide pharmacy support via a pharmacy mobile app, SwipeRx which is offered under mClinica Trade Solutions. As it is the largest pharmacy network in Southeast Asia it can be used to enhance pharmacy education on mental health or other therapeutic areas via digital continuing professional development courses.
Government agencies can also lean on SwipeRx, to gather comprehensive pharmacy insights on depression and anxiety via pharmacy surveys and guide pharmacies on the avenues to refer patients to clinics. They can also push educational content so pharmacies know how to better manage their own mental health. The findings gathered through pharmacy surveys can help facilitate the design and implementation of improved mental health programs.