How each ‘lockdown’ affect our mental health?

Published as a commentary by CNA on 29 May 2021, see published article

Below is the unedited draft.

“It feels like deja vu, definitely triggered a series of emotions. I was scrambling last night”, shared a young changemaker working with vulnerable communities when asked how he was doing a day after the heightened alert measures for Phase 2 came into effect on 16 May 2021.

He’s not alone in being ‘triggered’. Two dear friends, both home-based business owners, experienced heart palpitations, acute anxiety and low moods over the weekend following the announcement of the two-person cap on Friday which came barely 10 days after the Ministry of Health issued a directive to revert to Phase 2 on 4 May 2021.

A social worker friend who was a senior executive in a family service centre, but no longer works there, shared how she too “was hit by a “familiar surge of terror creeping up from my gut to my throat” during her morning run on the second day of the new control measures.

Calls to a few mental health hotlines also saw an abnormal spike on Sunday, the ‘first’ day of the latest phase of Covid-19 restrictions, according to a quick check with the executives I know.

One might ask: aren’t we more ‘mentally prepared’ after last year’s circuit breaker measures?

Further and frequent tightened measures could trigger trauma symptoms

Experts agree that the Covid-19 crisis qualifies as a traumatic experience because of the extreme physical and emotional toll it exerted, and continues to exert on us.

Last year during circuit breaker alone, the Caregivers’ Alliance supported 11 caregivers, six of whom unfortunately lost their loved ones to suicide and the other five had to deal with their care recipients attempting suicide. In the same period, the Samaritans of Singapore received over 10,000 calls in distress, a 36% increase.

The mental fallout from the trauma that we experienced — collectively and individually — from the outbreak of Covid-19 and last year’s circuit breaker, gets repeated in varying degrees each time we are subjected to a new round of tougher control measures to curb the spread of new clusters.

A “series of emotions” which the body remembers from the traumatic experience gets triggered, like the young changemaker did. The social worker friend “literally felt the same anxiety and terror in my body, my bones” even though she no longer shoulders the grave responsibility of leading her team to manage the ‘lockdown’ measures for the low income families they are responsible for.

In the recent #AreWeOkay public consultation by SG Mental Health Matters (a community initiative by mental health researchers and advocates) conducted between March and April 2021, 51.2% of participants agreed that the restrictions on social activities and interactions, whereas 44.3% agreed that changes to work and school have negatively impacted their mental health. This survey, done during a calmer Phase 3 period, saw 561 contributions which included responses to a series of 21 poll questions, where contributors could add on further feedback and insights in varying areas of mental health.

Layering on top of the traumatic triggers are the new threats we have to navigate with each wave of infections and control measures. When the circuit breaker was imposed last April, the community cases were in the low single digits and we were looking forward to the vaccination. A year later, we are now slapped with a mini version of circuit breaker to curb an alarming wave of community infections with a new variant of the virus. This with increasing cases of those fully vaccinated have all but smashed the promise of the end of this pandemic that was to be with the vaccination. This is a new trauma, each time.

The mental health implications of a second circuit breaker

Many of us expect that a second full-on circuit breaker is imminent, given the three rapid rounds of tightening measures within a space of less than two weeks and the unabating rise in community infections.

Are we now better placed to deal with a second circuit breaker? The last circuit breaker may have shaved off 2.22% from our annual GDP but we are still paying the hefty mental health cost of loneliness and social withdrawal, domestic violence, interpersonal conflicts, unresolved grief, work from home stress, helplessness of an uncertain volatile future etc.

According to IMDA, 100,000 seniors would have been taught the necessary digital skills by the end of March 2021 to allow them to participate digitally in a lockdown. A National Care Hotline was set up in April last year manned by Duty Care Officers (DCOs) who are trained to provide mental health first aid and make the appropriate referrals either to public healthcare institutions or community service providers to follow up if necessary — 30,000 calls were managed as of October 2020. The Ministry of Social & Family Development recently launched a 24-hour National Anti-Violence Helpline for victims and the public to report family violence and cases of abuse and neglect. More employers, like the CEOs and leaders I work with at the WorkWell Leaders Workgroup, have escalated their plans for employee mental wellbeing including work from home support programmes in the last year. Many government-led and community mental health initiatives have also sprung up within the past 12 months.

Are these enough to mitigate the mental health consequences of a second circuit breaker? Not quite.

We might be heading into a second circuit breaker with less shock than we did the last time, but we are carrying way more mental baggage picked up from a year of economic uncertainty, pandemic fatigue and the emotional roller coaster of in-out restriction measures. More than 9 in 10 Singaporeans (91%) have said that their mental health has declined in the last year, according to a study by AIA last month.

The mental health divide has widened further in the last year. We might be in the same storm but we are not in the same boat. The pandemic and control measures are felt differently, and more deeply in certain groups.

Blue-collar workers and low-income individuals were the hardest hit by the Covid-19 circuit breaker. The #AreWeOkay poll found that as income levels increased, a greater proportion of participants disagreed with the statement that changes to work and school had negatively impacted their mental health. In other words, the impact of control measures on mental health is felt less by those with more means. The majority of participants also agreed that vulnerable groups such as individuals from low-income households (81.8%) and people living with disabilities (89.6%) may experience greater risks of mental health challenges. Less than one in three (29.7%) of poll participants knew how to seek out subsidised mental healthcare which may prevent them from seeking help and further exacerbate their mental distress.

Victims of family violence are most at risk of further mental distress and abuse with social isolation measures because they would be trapped with their abusers. Unemployment and economic hardships are triggers for more or even new abuse in a relationship.

Our migrant workers have been confined to their dormitories since 7 April 2020 when the circuit breaker measures kicked in. Foreign domestic workers face increased surveillance and workload from employers in lockdown.

These all point to deepening divides and the urgent need for equitable mental health policies as part of our ongoing pandemic strategies.

Reframing the pandemic and control measures for better mental health outcomes

“What you can name, you can manage” is the golden rationalisation that brings attention, therefore priority and resources, to address problems.

Updates given by the COVID-19 Multi-Ministry Taskforce (MTF) have rightly been focused on the number and breakdown of infections, the ensuing control measures and economic relief support for those affected. Can we also acknowledge and address the collective trauma and personal mental challenge that we are facing?

For many in our midst, these updates bring about a sense of terror and fear that reflect exacerbated uncertainties around home-based learning, employment, healthcare, and family care — even if others, especially those in higher-income vocations, may just merely let out another collective sigh, and a rush to the supermarkets.

With this trauma-informed sensitivity, perhaps we can also be more cognisant of the ways in which we communicate policies. For example, “heightened alert” heightens anxiety and creates new uncertainties. Would “circuit breaker-lite” generate some familiarity to what is to come and therefore tune down the triggers yet has the advantage of preparing us all mentally for the imminence of another circuit breaker? Studies have shown that mere words, particularly affective words, can dampen emotional responses. A new Cornell-led study also revealed that some sound combinations, like those in the word ‘virus,’ elicit more emotionally intense responses than others, even before “corona” was added to it.

“What gets measured gets done” is another maxim that should apply to the rate of infections as much as rates of anxiety, depression, self-harm, suicide and other mental-health issues from this pandemic, an urgent call also made by psychiatrists and psychologists in The Lancet Psychiatry.

The Government had promised a whole-of-government review of all mental health policies in the 2020 Budget debates, an inter-agency mental health task force has been set up last October and three new priorities were announced during the Budget this year. More needs to be done, urgently.

The Covid-19 crisis is equally, if not more, a mental health crisis; not all of us get infected by the virus but all of us are affected by the mental health impact of the pandemic. Mental health strategies must, therefore, be integrated into every aspect of our pandemic management strategies and beyond, starting with calling out this priority at every MTF update with a compassionate acknowledgement and clear reminder to the mental health support resources available, beyond economic ones.

Like my friends, I was not spared. This strange tightness in my chest and the front part of my head have lingered since Sunday night when the full home-based learning (HBL) directive was announced. I don’t have children but my body may be remembering, amongst so much hardship and struggles I witnessed last year, the tragic death of the 16 year old boy in the block next to mine immediately after HBL ended, followed by his single mother who also leapt to her death from the 18th floor less than two months later.

So I’ve been going back to basics, what I call my “ABCs of Covid”: acknowledge the impact of the pandemic and each ‘lockdown’ on my life, and the lives of others through daily journaling in long hand and talking about it in safe and supported spaces; build my reality and gratitude in the present with a peace-giving routine of walks/runs, meditation/yoga and current resources I have in family, friends and community instead of focusing on what I don’t have or can’t do anymore; and commit to meaning-making activities, especially given the privileged position that I am in, to affirm my usefulness even if the meaning of life might get questioned every time I hear a new update of the COVID-19 situation.

We might be locked but we don’t have to be down in a ‘lockdown’ when we know we are looking out for each other.

Anthea Ong is a former Nominated Member of Parliament, a professional certified coach, a social entrepreneur (SG Mental Health Matters, A Good Space, WorkWell Leaders Workgroup, Hush TeaBar) and the author of 50 Shades of Love. www.antheaong.com