The Tribune

THE Bahamas, as a society, has come a long way in addressing the issue of mental health.

Just about two decades ago, no one wanted to admit they had any kind of mental health issue. They would have been met with negative labels that could follow them the rest of their lives.

Many did not even want to admit if they were depressed and needed help. These were things you are supposed to “deal with” and “get over”.

People from every socio-economic background suffered in silence due to the stigma that family and friends might put on them if the truth were revealed.

That time of stigma and discrimination about mental health is being replaced in these times with awareness and understanding.

Society is beginning to accept that mental health issues can affect anyone; even more so, because the COVID-19 pandemic has created a new set of circumstances that have taken a toll on most of us.

On Sunday, October 10, World Mental Health Day was officially celebrated under the theme: “Mental Health in an Unequal World” with the mission: “Mental Healthcare for All - Let’s Make it a Reality”. The day is organised by the World Federation for Mental Health and endorsed by the World Health Organization (WHO). The Pan American Health Organisation (PAHO) has organised a series of campaigns to bring light to the issue, which is critical now more than ever.

PAHO/WHO The Bahamas & Turks and Caicos Islands, the Ministry of Health, the Bahamas Psychological Association and the Healthy Bahamas Coalition are joining in the worldwide campaign for mental health awareness. In such a small population, COVID has hit The Bahamas hard and grief levels are high.

Latest reports indicate that 600 people have died from COVID-19. That troubling fact is met with concerns that another wave is expected. Most Bahamians know someone who has died because of the virus. The obituaries have gotten thicker. They are filled with announcements from families that have lost multiple members. Parents and their adult children are being buried together. Siblings are sharing one obituary column.

In the southernmost island of Inagua, residents are in shock as the fifth member of one family has already succumbed to COVID.

Breadwinners are gone from families. Students have lost their teachers. Pastors have left their flocks. Community leaders have passed on. These deaths are shocking, often because the victims are people who were otherwise healthy or not showing any indication of the possibility of dying.

What makes it worse is that due to the contagious nature of the virus, the victims die alone. Their loved ones had to face the agony of not being able to hold their hand, hug them, sing to them… not being able to rally around them in their final moments. While praying for the best, family members have gotten the devastating news that their loved one has died because of the COVID-19 virus… at least 600 times in The Bahamas alone, and at least 4.55 million times worldwide. This makes the burden of grief even heavier. In our nation, it’s a grief we all share.

PAHO gives this advice on how to help someone who is grieving during COVID-19:

• listen carefully, but don’t oblige them to talk

• ask them about their needs and concerns

• help them to take care of their basic needs

• help them to connect with family and other sources of social support

• encourage them to resume their daily activities at home, school, work and social relationships.

Recovering and adapting is a process that takes time. Finding a moment for closure can help the process, PAHO advises, and “it’s important to say goodbye”.

If the restrictions don’t allow for the usual rituals, there are some alternatives. When at home, you can host a virtual memorial with others. Light a candle and display a photo of the person who died. Share special memories or thoughts about them, or what each person would like to say to them.

You could organise a meal with family and friends and leave a chair or empty space where you can leave a photo or drawing of the deceased. Give everyone an opportunity to express meaningful feelings about them. You could also write a letter to the person who died, telling them everything you still want to say to them. You could also bury an object of the person who died, following a ritual similar to a funeral service.

It is normal to go through a grieving process, and the reaction will be different for each person. They will need all the support they can get. If the person has difficulty performing daily activities or resorts to harmful behaviour, they may be in need of professional help.

Throughout the pandemic, hospitals have been overrun with COVID- 19 cases, Intensive Care Units have been overfilled with COVID-19 patients, and health care services had been disrupted.

Faced with these challenges, frontline health workers around the world have felt the mental health consequences of the pandemic over them and the people they care for.

When PAHO Caribbean made this statement its Facebook page this weekend, with a clarion call for doctors, nurses, medical students, and all healthcare workers to join a #MENTALHEALTHNOW campaign and be bold enough to share their story on social media.

Such a call could be a rallying point for this shift to an awareness about mental health that could push society in a new direction. If those we trust to take care of our medical needs are willing to be vulnerable enough to share their stories, it may give us all the courage to accept and share that we are all feeling the sting of the pandemic in some way.

“The COVID-19 pandemic has exacerbated the mental health situation in the region, increasing new cases of mental health conditions, and worsening pre-existing ones,” PAHO states.

“The pandemic has also produced significant disruptions to services for mental, neurological and substance use disorders. Populations that have historically faced a higher burden of mental health conditions and reduced access to treatment are being disproportionately affected by mental health impacts of COVID-19.

This World Mental Health Day, the WHO is calling for increased investment in mental health - a sector it says is chronically underfunded - at all levels of society, from individuals, businesses and countries.

“COVID-19 has interrupted essential mental health services around the world just when they’re needed most,” said Tedros Adhanom Ghebreyesus, WHO Director General.

“World leaders must move fast and decisively to invest more in life-saving mental health programmes – during the pandemic and beyond.”

Tanya McFall-Major, PAHO/WHO consultant for The Bahamas & Turks and Caicos led a regional panel discussion on the issue this weekend. She spoke with experts who shed light on the issue.

“We all have been going through a lot during this pandemic,” Dr Renato Oliveira said. “There’s a deterioration in the mental health of the populations of the Americas. It’s a cause for concern.”

PAHO studies, he said, point to an increase in depression and anxiety in the pandemic. Children and adolescents are more vulnerable.

“Children have been out of school. They have not been able to socialise. They have not been able to play as before. This has an impact on their mental health.”

Another vulnerable group, health workers, are being exposed to the virus daily, he said. They are isolated from family members. In many places, they don’t have the proper personal protective equipment. These things just “add layers to their stress”. Dr Oliveira said PAHO will shortly launch a virtual course on self-help for healthcare workers.

Sahar Vasquez of Mind Health connect in Belize pointed to some of the things not to do to try and cope during the pandemic: “Don’t overindulge in things that are pleasurable; they’re quick fixes, not long-term fixes… whether it’s drinking or overeating.”

The stigma of having a mental health issue is still a major concern, as well as violence and discrimination, according to Franco Mascayano of Columbia University. So while the impact of the pandemic remains huge, at risk groups, he said, have to be considered and assisted.

“It is normal for people to experience stress and emotional distress during periods of great challenge in their personal life,” says Camille Smith, a University of the Bahamas representative.

“However, when that challenge also occurs in the wider local community, and then extends to a global pandemic, it is considered a compounded situation in which it becomes more likely that many will experience stress, emotional distress and even experience possible negative impact on their mental health.”

In The Bahamas, mental, neurological, substance use disorders and suicide (MNSS) cause 15 percent of all disability-adjusted life years (DALYs) and 32 percent of all years lived with disability (YLDs), according to the latest PAHO Caribbean report. While men are mostly affected by alcohol use disorders, headaches, and Alzheimer’s disease and other dementias, women are mostly affected by headaches, depressive and anxiety disorders. PAHO advises that primary care providers receive training and tools to prioritize detection and treatment or referral for the common disorders for each age-group and sex. When members of the public get involved with campaigns like those underway for Mental Health Day, they improve the chances for increased awareness, and help to make for changes in their society. In this case, all healthcare professionals are encouraged to join the #MENTALHEALTHNOW campaign. To reach the Mental Health Hotline, call, text or WhatsApp - 819-7652, 816-3799.