COVID-19

Mental Health and well-being

Mental Health Impacts of COVID-19

The sudden changes in lifestyle, daily routine and social infrastructure due to home confinement during the COVID-19 pandemic may have a negative psychological impact. Stressors include uncertainty, anxiety about contracting COVID-19, lack of social contact, boredom and frustration (Wang et al., 2020). Studies report that quarantines can lead to irritability, low mood, fear, confusion, anger, grief, stress, depression and insomnia (Brooks et al., 2020). The COVID-19 pandemic could also exacerbate existing mental health conditions or cognitive conditions, for example worry may increase symptoms of anxiety and obsessive-compulsive disorder and isolation may exacerbate symptoms of depression (Druss, 2020).

Supporting and Protecting Mental Wellbeing During COVID-19

There are a number of practical actions that can be taken to support and protect your mental health during the COVID-19 pandemic and home confinement (BBC, 2020; Masters, 2020; Mind, 2020; NHS, 2020a-b; WHO, 2020):

• Develop and maintain a routine, which brings a sense of normality in a time of uncertainty,
• Maintain physical health: eat healthily, stay hydrated and undertake physical activity,
• Try to maintain regular sleeping patterns and get enough sleep,
• Maintain a clean and comfortable living space,
• Take time to relax and focus on activities that you enjoy,
• Maintain social contact,
• Talk about your feelings with a trusted person or a specialist helpline,
• Acknowledge your feelings and try to manage anxiety, for example by practicing relaxation techniques,
• Minimise the amount of time spent reading or watching news about COVID-19 if it makes you worried or distressed. Get information about COVID-19 from trustworthy sources like the NHS, because misinformation can increase fears.
• Plan how you can access household and medical supplies that you need, either in person, online or through social contacts. 
• If undertaking mental health treatment, try to continue accessing support through remote appointments.
• Understand your work and benefit rights and access support where required to help with financial worries. 
• Help and support people in your community who might need assistance. 

Trauma in Children

Children are particularly at risk of the adverse psychological impacts of COVID-19 and home confinement. Research has shown that children who were quarantined or isolated during a pandemic were at increased risk of acute stress disorder, adjustment disorder and post-traumatic stress disorder (Liu et al., 2020). In particular, isolation of children away from parents or caregivers, or loss of a parent, can have a long-term impact on mental health (Liu et al., 2020). 

Laxton and Leask (n.d.) describe the signs of trauma in children as:

• clinginess,
• separation anxiety,
• distress,
• worrying about safety of themselves or others, or a repeat of the traumatic event,
• behavioural changes,
• disturbed sleeping routine,
• lack of developmental progress and/or regression,
• more frequent somatic ailments,
• changes in reaction to loud sounds, sudden movement, bright lights or physical contact,
• different fears,
• talking or asking about dying/death.

Supporting Children Facing Trauma and Disruption Caused by COVID-19

Educators and caregivers supporting children facing trauma and disruption caused by COVID-19 should enable an emotionally and physically secure environment for the child, foster relationships based on respect and trust, and help to build resilience (Laxton and Leask, n.d.).

In particular (Laxton and Leask, n.d.; WHO, 2020):

• Maintain or establish familiar daily routines,
• Maintain and encourage safe social contact,
• Provide engaging activities, including those to support learning, express feelings and build resilience, 
• Encourage positive expression of feelings and provide a safe space for children to talk about their trauma,
• Address their concerns and answer questions about traumatic events,
• Set clear boundaries for behaviour.

The use of engaging activities can help support psychological wellbeing and promote emotional and social resilience in children. Laxton and Leask (n.d.) advise on play types for different age groups to support social relationships, language and listening, physical  skills, problem solving, art and music, maths and understanding the world with example sessions for early years. Moreover, the UNRWA Department of Education (2020) produced a booklet containing a number of activities to support the mental wellbeing of children aged 5-16 years old living in challenging contexts. The activities include games, crafts, visual arts, music, drama and relaxation activities, each lasting 10 to 40 minutes, and are tailored to different age groups from 5-16 years old. The activities are based on 3 themes: ‘myself’, ‘my peers’ and ‘my community’. The ‘myself’ theme strengthens personal skills such as concentration, self-confidence, empathy and emotional awareness; ‘my peers’ activities aim to strengthen social skills; and the ‘my community’ theme strengthens awareness of the wider community, with a particular focus on conflict resolution. 

Resources

BBC (2020) Coronavirus: How to Protect your Mental Health [Online] Available from: https://www.bbc.co.uk/news/health-51873799 [Accessed 21/04/2020].

• News article with tips for the general public on protecting mental wellbeing during the COVID-19 pandemic.

Department of Education (2020) Psychosocial Support Recreational Activities Resource Guide. Amman: UNRWA. 

• A booklet containing recreational activities for children living in challenging contexts to support their mental wellbeing. The activities include games, crafts, visual arts, music, drama and relaxation activities, each lasting 10 to 40 minutes, and are tailored to different age groups from 5-16 years old. The activities are based on 3 themes: ‘myself’, ‘my peers’ and ‘my community’. The ‘myself’ theme strengthens personal skills such as concentration, self-confidence, empathy and emotional awareness; ‘my peers’ activities aim to strengthen social skills; and the ‘my community’ theme strengthens awareness of the wider community, with a particular focus on conflict resolution.

Fricchione, G. (2020) How to Conquer Your Anxieties During the COVID-19 Outbreak [Podcast] Harvard Health Publishing. 23^rd March. Available from: https://www.health.harvard.edu/diseases-and-conditions/coping-with-coron... [Accessed 20/04/2020]. 

• A podcast for the general public on managing anxiety during the COVID-19 outbreak.

Laxton, S. and Leask, M. (n.d.) MESHGuides: Early Childhood Education in Emergencies (in partnership with VSO): Supporting Children Exposed to Trauma [Online] Available from: http://meshguides.org/guides/node/1343?n=1274 [Accessed 20/04/2020].

• A guide on how to support children exposed to trauma, including signs of trauma in children and how to support them.

Laxton, S. and Leask, M. (n.d.) MESHGuides: Early Childhood Education in Emergencies (in partnership with VSO): Daily Interactions and Managing Young Children’s Experience of Trauma and Disruption [Online] Available from: http://meshguides.org/guides/node/1343?n=1358 [Accessed 20/04/2020].

• A guide on how to support children exposed to trauma, with example activities on to help children become resilient in traumatic situations. 

Laxton, S. and Leask, M. (n.d.) MESHGuides: Early Childhood Education in Emergencies (in partnership with VSO): Personal, Social, Emotional Development and Mental Health [Online] Available from: http://meshguides.org/guides/node/1343?n=1264 [Accessed 20/04/2020].

• A guide on how to support children exposed to trauma providing evidence and solutions to support personal, social, emotional development and mental health. 

Master, S. (2020) Supporting student wellbeing by encouraging them to use the ‘Five Ways to Wellbeing’ (while staying at home!) [Online] Available from:  

https://my.chartered.college/2020/03/supporting-student-wellbeing-by-enc... [Accessed 20/04/2020]. 

• Guidance and resources to support the ‘Five Ways of Wellbeing’, which can be used to support. student wellbeing. The ‘Five Ways of Wellbeing’ are: connect with others, keep physically active, keep learning and give to others.

Mind (2020) Coronavirus and Your Wellbeing [Online] Available from: https://www.mind.org.uk/information-support/coronavirus/coronavirus-and-... [Accessed 20/04/2020]. 

• Advice for the general public on how to cope if you are feeling anxious or worried about COVID-19, from the mental health charity Mind. The guide covers how to take care of your mental health and wellbeing, manage anxiety, feeling trapped or claustrophobic in addition to practical advice for staying at home. There are also links to resources on support for work, benefits and housing. 

NHS (2020) 10 Tips to Help if You are Worried About Coronavirus [Online] Available from: https://www.nhs.uk/oneyou/every-mind-matters/coronavirus-covid-19-anxiet... [Accessed 20/04/2020]. 

• Tips for the general public who are anxious or worried about the COVID-19 outbreak on improving mental health and wellbeing whilst staying at home

NHS (2020) Metal Wellbeing While Staying at Home [Online] Available from: https://www.nhs.uk/oneyou/every-mind-matters/coronavirus-covid-19-stayin... [Accessed 20/04/2020]. 

•  Tips for the general public on improving mental health and wellbeing whilst staying at home.

University and College Union (2020) Taking Care of Yourself: Supporting Your Mental Health During the COVID-19 Pandemic [Online] Available from: https://www.ucu.org.uk/media/10836/Taking-care-of-yourself---Covid-19-gu... [Accessed 20/04/2020]. 

• A poster with guidance for educators on supporting their mental health whilst staying at home.

World Health Organization (2020) Coping with Stress During the 2019-nCoV Outbreak [Online image] Available from: https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.... [Accessed 20/04/2020]. 

•  A poster for the general public with tips on how to cope with stress during the COVID-19 pandemic.

World Health Organization (2020) Mental Health and Psychosocial Considerations During the COVID-19 Outbreak [Online] Available from: https://www.who.int/publications-detail/mental-health-and-psychosocial-c... [Accessed 20/04/2020]. 

• A report on how to maintain mental wellbeing during the COVID-19 outbreak with sections relating to the general public, child caregivers, healthcare workers, people with underlying conditions and their caregivers.

References

Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N. and Rubin, G.J. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet 395(10227), pp. 912-920. 

Druss, B.G. (2020) Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness. JAMA Psychiatry. DOI: 10.1001/jamapsychiatry.2020.0894. 

Liu, J.J., Bao, Y., Huang, X., Shi, J. and Lu, L. (2020) Mental Health Considerations for Children Quarantined Because of COVID-19. The Lancet Child & Adolescent Health. DOI: 10.1016/S2352-4642(20)30096-1. 

Wang, G., Zhang, Y., Zhao, J., Zhang, J. and Jiang, F. (2020) Mitigate the effects of home confinement on children during the COVID-19 outbreak. The Lancet, 395(10228), pp.945-947.

Yao, H., Chen, J.H. and Xu, Y.F. (2020) Patients with mental health disorders in the COVID-19 epidemic. The Lancet Psychiatry, 7 (4), p. e21.