Mind your head: experts talk about looking after your mental health

One in five people has experienced increased psychological distress during the pandemic. Experts tell Sharon Ní Chonchúir what we can do to keep our mental health in check
Mind your head: experts talk about looking after your mental health

Picture; iStock 

HOW well are you coping with lockdown number three? In these dark days of winter, as Covid-19 case numbers remain stubbornly high and the pandemic looks likely to restrict our lives for months to come, it would be no wonder if your mental health was suffering.

Many of us are feeling the pressure. According to evidence compiled by Trinity College Dublin's Department of Psychiatry in November, approximately one person in five has experienced significantly increased psychological distress during the pandemic.

Last April, a study of 1,000 people conducted by Maynooth University and Trinity College Dublin found that 23% reported depression, 20% reported anxiety, and 18% reported post-traumatic stress, all at ‘clinically meaningful’ levels.

In a survey of 195 psychiatrists by the College of Psychiatrists of Ireland in May and June 2020, 79% reported seeing an increase in generalised anxiety, 72% an increase in health anxiety, 57% an increase in depression and 54% an increase in panic symptoms.

RISING DEMAND

Aware, the national mental health organisation, has seen a significant increase in demand for its services. “There has been a 36% increase in calls to our support line compared with the same period last year, with peaks of over 80% at various points during the year," says Dr Claire Hayes, the organisation's clinical director.

Some sectors of society are suffering more mental distress than others. Cocooning is having a detrimental effect on the elderly, with a study by Trinity College Dublin and St James Hospital finding that 40% reported that their mental health was worse or much worse since the start of the pandemic.

At the other end of the spectrum, the young are struggling too. In a national online survey of 1,000 Leaving Cert students carried out by Maynooth University in June 2020, 61% said their levels of overall wellbeing were low or sub-optimal and 46% reported high levels of anxiety and/or depression.

In many ways, this is to be expected. "There is a life-threatening risk so being anxious is appropriate," says Dr Eric Kelleher, a consultant liaison psychiatrist at Cork University Hospital and Mercy University Hospital and spokesperson for the College of Psychiatrists of Ireland.

Martin Rogan, CEO of Mental Health Ireland, compares the mental health impact of Covid-19 to a wave, with ever-changing peaks and troughs. "This time last year, there was a building sense of anticipatory anxiety," he says. "We couldn't switch ourselves off and this led to problems with insomnia for many."

"The uncertainty at the outset was frightening,” says Dr Kelleher. “Particularly as images of Italian patients and healthcare workers were being broadcast all over the news."

IN THIS TOGETHER

During the first lockdown, there was a sense of pulling together for the common good. “A collective scare can bind communities together,” says Rogan. “In the UK, there were two periods of history when rates of self-harm and suicide fell dramatically and those were the two world wars. During lockdown, our mood shifted as people looked after each other. Sports organisations offered to do our shopping and everyone checked in on their neighbours.”

But this effect was short-lived as many found it difficult to sustain the huge effort involved. “By summer, we were like the coyote in Roadrunner,” says Rogan. “We had run out of road and many of us fell into anxiety, isolation, and a sense of loss of control.”

Most of us were and still are struggling with a range of different stress factors, says Dr Damien Lowry, a chartered counselling psychologist with the Psychological Society of Ireland. "There is the pandemic itself and the fear of infection and transmitting it to others," he says. "There are also the mental health effects of restrictions that have been imposed upon us."

Social distancing may be the most harmful of those. “Social connectedness is the lifeblood of being human," says Dr Lowry. "It has been identified as one of the strongest predictors of life satisfaction and it is the very thing that is being attacked and eroded by this virus."

The constant deferral of hope is another factor. Vaccines may have heralded a return to our pre-pandemic lives but there are no guarantees.

"The situation is relentless," says Dr Lowry. "We bought into the first lockdown because we believed short-term pain would allow life to return to normal. Since then, we have discovered that 'normal life' brings another wave of the virus, swiftly followed by restrictions and the removal of things we enjoy."

CHRONIC STRESS

 Dr Harry Barry.  Picture: Gareth Chaney Collins
 Dr Harry Barry.  Picture: Gareth Chaney Collins

Dr Harry Barry, a GP and author of bestselling books on mental health, believes this relentlessness has resulted in many of us living in a state of chronic stress.

"We are working from home, homeschooling, under financial pressure, and panicking about contracting the virus," he says. "Our internal stress system is overwhelmed."

You may well recognise some of the symptoms. They include sleep problems. “We are tired but wired and unable to sleep,” says Dr Barry.

A loss of motivation is another symptom. “I have heard of lots of houses where nobody gets out of their pyjamas all day,” he says.

There are physical symptoms such as mouth ulcers and irritable bowels.

Then there are the effects on mood. "We are anxious and down," he says. "We are so frustrated we feel as if we could tear our hair out. All of this is putting enormous strain on our mental health."

However, it is possible to counter this ongoing stress. There are steps we can take to bolster our mental health.

"The key is to acknowledge our feelings, manage our thoughts, and deliberately focus on actions that are helpful," says Dr Hayes.

Start with acknowledgement. "Tell yourself it is normal to feel stressed and to find this time overwhelming," says Dr Kelleher.

Then differentiate between what you can and cannot control. "Draw two concentric circles like the yolk and white of an egg," says Rogan. "Write what you can control in the yolk and what you cannot in the white. Don't surrender to the hopelessness of focusing on the white. Instead, focus on what you can control, one small thing at a time. Each success will increase your motivation."

FIVE A DAY

Rogan also recommends the Five Ways to Wellbeing, a set of actions developed by the New Economics Foundation in 2008 to help maintain or improve mental wellbeing. "Think of them as the mental health equivalent of your five a day," he says.

The first step is staying connected to others. "Covid-19 makes this challenging but it is still possible," says Rogan.

Step two is being active. "The World Health Organisation advises 30 minutes of vigorous exercise every day, ideally outdoors in a natural setting," says Rogan.

Step three is to pay attention to your surroundings. "This grounds you in the moment and is the basis of mindfulness," says Rogan. "Stop what you are doing and look around and listen. Plan moments like this throughout the day. Don't leave it all until the end. Otherwise, you will accumulate stress.”

The fourth step is to stay curious and nourish your creativity. "Whether it is talking to an older person about their life experience or baking banana bread, it will give you a sense of satisfaction," says Rogan.

The last step is to give to others. "Doing something for someone else always boosts your sense of wellbeing," says Rogan.

SLEEP TIME

Dr Barry urges everyone to prioritise sleep. "It is the most important preventative factor in all mental health conditions," he says. "We should all aim for eight hours a night."

Having a regular routine is also important. "Try to mimic your normal life as best you can," says Dr Barry. "Get up and start work at the usual times. Take regular breaks throughout the day and shut down on time. No checking emails."

Controlling your use of social media is crucial too. "While you should keep up to date with developments and guidelines, checking a constant news food is not helpful," says Dr Hayes. "Choose one or two news sources you find reliable and stick with those. Otherwise, limit your use of social media. Studies indicate a link between excessive use of social media and anxiety and depression."

SILVER LINING

This pandemic is taking its toll on all of us but there may be one silver lining. We might emerge having learned the importance of tending to our mental health.

"We take our health for granted when we are well, but the changes Covid-19 has forced upon us has shown how rapidly that can change," says Dr Kelleher. "The pandemic has made us stop and ask ourselves what we can do to keep ourselves mentally well."

Most of us have the resilience required to withstand whatever Covid-19 throws at us in the months ahead if we learn to harness it in the right ways. "We have it in us to get through this," says Dr Barry. "Following simple steps will carry most of us through to what we all hope will be an eventual end to this pandemic."

ONGOING SUPPORT

There is help out there for everyone who is experiencing mental distress. Your GP can advise you on the best supports for you.

Aware runs a support line from 10am to 10pm 365 days a year as well as a support mail service and self-care groups.

Mental Health Ireland lists tips for promoting positive mental health, wellbeing and recovery during this time on its website.

The College of Psychiatrists has advice for families and young people with mental illness on their website.

The HSE runs a free text message support line. Text Hello to 508508 for help.

Visit www.yourmentalhealth.ie for a nationwide listing of support services.

REAL PEOPLE, REAL EXPERIENCES

Jess McCaul has struggled with anxiety and anorexia since her teens.

"This time last year, I was just out of hospital and trying to get on top of things," says the 28 year old from Longford. "I had fought hard to establish a routine of working and socialising and suddenly that went out the window. My work in hospitality stopped. I couldn't see my friends. All my structures were gone and it was hard to keep myself on the straight and narrow."

Her therapy sessions moving online was another problem. "I live with my mother and brother and didn't always have privacy," says McCaul.

She ended up back in hospital where, with support from staff, she developed new strategies for staying mentally well. "The most important thing was getting some structure back into my life," she says.

She now makes sure she gets up at the same time every day and takes regular exercise. "Even if it's just five minutes walking outside, it helps," she says.

Online yoga helps to calm her mind as does embroidery and painting.

McCaul also posts on Instagram as @JesskaDenise and has her own blog, www.jesskadenise.ie, where she writes about beauty, fashion, lifestyle, and her mental health experience.

"Having the blog and Instagram gives me the motivation to get up, get dressed, and put on some makeup," she says.

What McCaul misses most about pre-pandemic life is having a sense of control and certainty about the future. "We are all struggling with not knowing what is going to happen next," she says. "I've learned that focussing on routine helps. Get some exercise. Take a breather by listening to music. You will feel a little better."

Talking is beneficial too. "There are so many groups out there," she says. "BodyWhys is one that really helps me."

Abigail McDonnell works in HR and hosts a weekly mental health podcast called See Change Sessions.

Having been diagnosed with anxiety and depression aged 17, she thought she knew how to control her condition. Living through a pandemic made her realise that she didn't.

"I was in my final year at college this time last year. I had just started a new job. I was volunteering. Life was hectic and looking back on it, I was keeping busy as a way of distracting myself from my mental health issues," says the 23 year old from Dublin.

Lockdown changed that instantly. "I spent the first two weeks in tears, terrified by how I had suddenly lost control," she says.

She was worried about her parents contracting Covid-19 and found living online stressful. "Work, studying and socialising all moved online and the idea of opening the laptop seemed overwhelming at times."

Two strategies helped her to cope. One was establishing a routine. "I forced myself to work regular hours, take regular breaks and switch off after spending the day online," she says.

The second was to accept her feelings. "For too long in my life, I tried to push my emotions away and that doesn't work," she says. "During lockdown all I could do was get up, work, and go back to bed. I had no energy. But I had to be kind to myself and tell myself that I needed that rest and time to adjust."

The advice McDonnell gives to others is the same she gives herself. "Your feelings are valid," she says. "We are all dealing with so much now. While I can't control some aspects of my mental health and none of us can control this pandemic, we can control how we manage it. We should accept our feelings, be compassionate to ourselves, and do what we can to get through. It's OK to take a nap or have a down day. Just let your emotions out."

She also reassures people that help is available. "My family is a huge support to me and I sometimes text 508508, the HSE's free 24-hour text message support line, just to have a chat. It's anonymous and always there."

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