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Disease and treatment

Corona crisis stresses people with mental health problems

According to researchers, lack of contact with mental health services and relatives can stress people with mental illness so much that they end up taking their own lives. The researchers also indicate several areas in which governments should intervene to ensure that people with problems can get help.

Forty-four researchers from around the world have teamed up to write an article in Lancet Psychiatry focusing on the many people with mental health problems, who have been stressed to the limit by the COVID-19 crisis.

Physical distancing has meant that many people with mental health disorders have no contact with family members or the mental health services, and this may worsen their mental health or well-being.

For some, this may mean being stressed to the limit and ending up taking their own lives.

“The restrictions we all currently experience can have major consequences for people with mental illness. This therefore places additional demands on the mental health services, which must be especially vigilant that we do not let any of these people fall through the net as a result of the changes during the current situation,” says a contributor to the article, Merete Nordentoft, Clinical Professor, Department of Clinical Medicine, University of Copenhagen.

Previous public health crises have increased suicide rates

Although the article in Lancet Psychiatry is not, as such, a scientific article, the researchers present some data that illustrate why the problem should be taken seriously.

Evidence indicates that deaths by suicide increased in the United States during the 1918–1919 influenza pandemic and among older people in Hong Kong during the 2003 severe acute respiratory syndrome (SARS) epidemic.

Further, there is a well-known association between having a mental disorder and worsening of the disorder when it is not managed professionally.

For example, if left untreated, someone with anxiety might experience worsening symptoms and find these harder to get rid of again. The pattern can then become established.

“Within my field, psychosis, the duration without treatment clearly indicates the outcome for patients in the long term,” says Merete Nordentoft.

Social isolation makes life difficult for many

The social isolation associated with the COVID-19 crisis causes a whole host of unfortunate effects that the mental health services should manage both now and also after the social restrictions are eased, which hopefully will happen soon.

• People with a mental disorder often need help to take care of themselves. Although a phone call or videoconferencing suits many people who usually talk face to face with a therapist, not all feel comfortable having a potentially helpful conversation over the phone or can master the technology required to use a computer videoconferencing program.

• Unemployment can have adverse social effects for people whose everyday lives depend on having a purpose for getting out of bed every day.

• It is well known that many people drink more alcohol when they lose their job, and alcohol abuse brings its very own palette of problems related to mental health, social networks and social capital.

• For some people, the opportunity to be together with their partner 24 hours a day for 2 months is a blessing, but others find themselves trapped in a domestic violence prison.

“We face a major challenge in helping those who have been hard hit by the loss of social contact or contact with the mental health services. In addition, we have not always had the opportunity to monitor people and see how they are really coping,” says Merete Nordentoft.

Vulnerable people can become superspreaders of coronavirus

Merete Nordentoft explains that positive experiences can also be harvested in the current crisis.

Many therapists have found that some conversations that previously required the therapist and patient to be in the same room can be managed through videoconferencing with the same positive effects.

However, many meetings cannot be managed over the phone, and many patients still need physical meetings and home visits and will need these in the future.

A completely independent perspective of not taking care of people with mental illness is that some may turn into superspreaders of coronavirus, since regular handwashing and physical distancing may be far down the list of priorities in a stressful daily life.

“Vulnerable people often live together in limited space, and following all the rules and guidelines issued by governments to reduce transmission can be difficult,” explains Merete Nordentoft.

Everyone needs to help to minimize suicide

In the article, the researchers indicate that the current situation can affect vulnerable people in eight areas and therefore propose interventions governments should consider resourcing in their efforts to avoid increasing numbers of suicides.

• Mental illness. Mental health services should be aware of initiatives that can counteract social isolation. These may include an increased emphasis on web consultations.

• Attempted suicide. Ensuring that people who are or may be suicidal have access to mental health professionals when required, possibly through helplines.

• Financial stressors. The current crisis is worsening many people’s finances, and losing your job can be the straw that breaks the camel’s back for already vulnerable people. The researchers therefore recommend that governments put extra focus on providing financial safety nets for those who need them most.

• Domestic violence. Governments should note the rise in domestic violence and implement the necessary initiatives so that those facing domestic violence have access to support and can leave home.

• Alcohol consumption. Initiatives should be taken that include messaging about monitoring alcohol intake and reminders about safe drinking.

• Isolation. Many people feel isolated and lonely. This problem can be solved by interventions that involve both friends and family and mental health professionals paying extra attention by regularly visiting vulnerable people.

• Access to means. People who want to take their own life often have to resort to methods such as drugs to do so. Pharmacists and others should therefore pay extra attention to people who are potentially at high risk to restrict their access to highly lethal suicide methods.

• Media. The media have great responsibility for how the world is portrayed to people with mental health problems. They should therefore also be aware of their role in preventing vulnerable people from taking their own life.

“We should remember that these are unprecedented times, so we are all in the dark. But here we have come together and written about our hopes and fears and how to act to make the lives of vulnerable people better than they might otherwise be,” says Merete Nordentoft.

Suicide risk and prevention during the COVID-19 pandemic” has been published in Lancet Psychiatry. In 2020, the Novo Nordisk Foundation awarded the 2020 Novo Nordisk Prize to Merete Nordentoft, Clinical Professor, University of Copenhagen and Preben Bo Mortensen, Professor and Scientific Director, iPSYCH, Aarhus University.

Merete Nordentoft
Clinical Professor
Merete Nordentoft is an expert in epidemiology, suicidal behavior, psychopathology and early intervention in psychosis. She was PI for many large randomized clinical trials, evaluating the effect of psychosocial intervention, of which the Danish OPUS trial (specialized assertive intervention in first episode psychosis) is the most well known. She has worked with suicide prevention at a national level since 1997. Together with a group of epidemiologist from Nordic countries, she has proved that life expectancy in schizophrenia is 15 to 20 years shorter than in the general population. She is involved as one of the PI’s in iPSYCH, the Lundbeck FoundationInitiative For Integrative Psychiatric Research, which aims at investigating genetic and environmental causes of mental disorders. The initiation of the large Danish High Risk and Resilience Study VIA 7 is an important part of iPSYCH. She was given the prestigious award “Global Excellence in Health” in 2012.