By: Simren Sekhon, Rishita Sadh & Ramya Chaturvedi
As of April 2020, 3.9 billion people in the world (more than half the global population) have been impacted by lockdown and social distancing measures (Sandford, 2020). The impact COVID continues to have on mental health across the international community is no doubt significant. In this Singapore-India collaboration, each of us unpack one of three critical themes herein: gender, age and stigmas associated with mental health. This is but one of the conversations that need to happen on mental health during and post the COVID era. We can’t wait to hear your insights on the matter.
Gender
COVID-19 has “set back efforts toward gender parity” in a number of realms (Cox, 2020). Primarily, the current global health crisis has seen a worsening of a global mental health crisis – and particularly so for women. Although data shows that men are at greater risk to die from the virus, “the emotional impact of the pandemic is disproportionately falling on women’s shoulders” (UN Women & Women Count, 2020, p. 20). The following figure illustrates the state of such within Asia Pacific:
(UN Women & Women Count, 2020, p. 2)
It is imperative here that we understand the intimate correlation this has with women’s positionality in the global economy. Primarily, “women’s economic resources are being hit hardest” (UN Women & Women Count, 2020, p. 4). According to USC’s coronavirus survey, job losses along with additional childcare duties and mental distress disproportionately affect women – particularly those without a college degree (Miller, 2020). 44% of women reported being the only household members providing care, compared to 14% of men. Furthermore, 67% of the global health workforce is female (Lowy Institute, 2020). Therefore, women likely bear an unequal load of negative psychological outcomes that emerge as a result of their work in a health emergency. This is of growing concern given that current data shows that women report higher instances of posttraumatic stress symptoms (Liu et al., 2020).
Illnesses like unipolar depression occur twice as often in women than men (Department of Mental Health & Substance Dependance, 2020). Complexity here is great both in the gender differentiation of illnesses and the gender bias that persists in its treatment. For instance, doctors are more likely to diagnose depression in women, even when they exhibit identical symptoms to men. Dependent on one’s gender, socioeconomic position, and social status, access to resources, exposure to risk and susceptibility varies.
Violence-related mental health problems are currently of particular concern. While they remain poorly identified (World Health Organisation, 2020), pandemic-induced lockdowns have meant that victims are often confined with their abusers. This undermines their options for confidential support, further disabled by overburdened health systems. In Singapore, a 22% increase in family-violence related offences were reported (Cheon, 2020). Similar realities are evident across Asia Pacific, as evidenced below:
(UN Women & Women Count, 2020, p. 20)
It is key we recognise that the above data is only a reflection of the exacerbated realities that were true prior to the pandemic. In India, 70-92% of affected individuals have not received any care of any kind in this time, particularly concerning given that India already accounted for more than a third of female suicides and nearly a fourth of male suicides globally (Balaji & Patel, 2020). Suicide rates in Singapore were reported as 11.1 deaths as of 2016, 0.6 deaths greater than the global average at the time (Global Health Observatory, 2016). Although research and commentary in Singapore in regard to mental health is increasing, the enunciation of gender differentials are greatly missing. Furthermore, gaps in our mental healthcare system were identified in the spheres of accessibility, affordability and inclusiveness during the Parliamentary debate on the Ministry of Health’s (MOH) budget in March 2020. Evidence base to support state action and intervention herein is fundamental and currently lacking, reflected in the state’s “mistake” of not identifying psychological treatment as part of “essential services”, rectified only three weeks after the start of circuit breaker (Choo, 2020). Positive steps are noted in the government’s recent launch of the National Care Hotline for individuals to access support via telephone. However, this should be but one step that needs to occur to holistically understand and address the gendered mental health crisis that beckons.
Age
The impact of COVID on mental health is not only differentiated by gender, but age too. In addition to fear and anxiety that may arise about the virus itself, reports suggest that “older women are more likely than older men to live alone or in residential care, meaning they are more likely to be isolated due to social distancing measures” (Tank, 2020). Furthermore, family violence response services do suggest an increased number of calls from older people experiencing violence, including those inflicted by adult children struggling with job loss (Tank, 2020). As we work to understand the complex realities of mental health across the global population, it is also important to further nuance this by exploring the significant impact COVID has had on children.
Education, often seen to provide a sense of structure in a child’s day, has seen major disruption due to the pandemic. Concerns here go beyond academic learning. Rampant impact is also noted on the physical and mental health of children. Anxiety, for example, has reportedly spiked amongst children. According to CDC, 7.1 % of kids between age groups 7-13 have been diagnosed with depression and this pandemic has spiked up that rate. (Data and Statistics on Children's Mental Health, 2020). “The Singapore Children's Society (SCS), which runs Tinkle Friend (an online chat and call center that provides support and advice for lonely children), said it received 564 calls and online chat requests last month, compared with 356 in March” (Han, 2020). Lockdown has meant that children have been unable to engage with their peers in manners they are used to in school: loneliness is therefore attributed as a key cause herein.
Furthermore, physical activity is known to be important for children’s development. However, lockdown has meant a restriction on physical mobility. This is reiterated by reports which indicate that children are “experiencing fears about the virus, worries over access to online classes, and stress and irritability from being unable to go out” (Balaji & Patel, 2020). The importance of play in a child’s life is contrasted with new social distancing measures: the means through which this will continue to impact how children are able to play with one another and what that means for their psychological outcomes needs to be researched further.
Kids with preexisting mental health issues or learning disabilities are likely at an even bigger loss given further strain to accessing the professional support they require. Furthermore, as alluded to above, parents continue to struggle to balance their child’s complex needs as well as their own work, exacerbating their own stressors. The cause for concern, however, is greatest for the most vulnerable kids like those who are homeless and/or live in slums, whose life circumstance is embroiled with increased exposure to the virus and financial depravity. The concern for young girls is great herein: 40% of adolescent girls between the age of 15-18 were not attending school prior to the pandemic and 30% of girls from the poorest families had never even set foot in a classroom before (Gohain, 2020). Given that corona has been cause for their continued disenfranchisement from the education systems, concerns persist that they may never resume their education even after the lockdown eases.
Stigma
Rampant stigmatisation of mental health has led to a general reluctance in people reaching out for help. Currently, mental health disorders continue to escalate at an alarming rate, with a treatment gap of 50-70% and more than 20 million youth experiencing such. Despite this consequential setback, only 0.06% of the Indian budget is devoted to the development of mental health care, severely limiting options for necessary support (Surge et al., 2013).
Fundamentally, the causes and realities of mental health issues continue to be areas that members of our community are oblivious to or ignorant about. One survey by the National Council of Social Service (NCSS) in Singapore found that 60% of people believe mental conditions are caused by a lack of self-discipline and will-power; evidence also indicates stigma has an impact on seeking help and recovery, with up to 78.4% of patients never seeking help (Lim, 2020). Further studies suggest that 56% of the general population perceive that a patient with a mental disorder is dangerous, while 70% that believe mental illness is a sign of personal failure (Surge et al., 2013). The tables below depicts these realities of stigma evidenced in India and its impact on the personal and professional lives of an individual:
To improve such, we must work to raise awareness around mental health and normalise conversations on such. To do so, it is important to understand what terms like ‘stigma’ mean. According to Surge et al. (2013), stigma comes in different forms such as community rejection, friendship refusal, and uncaring parents is the most common type of stigma. This can lead to community rejection, defined as the non-acceptance among the community where families with a mentally ill member are frowned upon. The social isolation here is arguably exacerbated in COVID, as a result of social distancing measures that ironically, is advised for the protection of our physical health.
The impact of the pandemic on mental health is not just in regard to the disease itself: but as has been evidenced, far more amplified given social and economic realities. Nevertheless, the impact of the disease in itself should not go unnoticed. Herein, the thread of morbidity, confronting mortality and lack of control over one’s ailment is worsened by little knowledge about the virus, given its recent surgence. Furthermore, patients with preexisting mental health conditions who contract the virus are likely to face a disproportionate level of stigma resulting from both. This can manifest into a wide range of mental health issues, starting from mild anxiety and depression to experiencing a major post-traumatic stress disorder, especially for vulnerable populations (ChannelNewsAsia, 2018). According to the Samaritans of Singapore (SOS), for example, suicidal risk increases when there are predisposing vulnerabilities such as mental health issues like depression and external stressors arising from the home and environment of youths.
Most importantly, major barriers remain in regard to the availability, access and infrastructure created for mental health care. Workers are often overburdened with the lack of supervision and support. Inadequate training of the general health work-force tends to further undermine the lacking infrastructure necessary for the community (Kumar, 2011). Be it in a demographic as large as India or one as small as Singapore, attention must be placed on reaching the underprivileged community, who otherwise are least able to access necessary support.
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