The Covid-19 pandemic triggered a mental health crisis in the UK, with many people feeling increasingly fragile after a year of lockdowns. Experts warn of a tsunami of mental health troubles sweeping the globe.
Doctors who spoke to The National revealed the worrying toll felt by people struggling with chronic stress, anxiety and depression over the past year.
For Lubna Jasim, panic gripped her early in the crisis. Her pre-existing mental conditions sparked instant worry about how she would cope in the months of isolation that lay ahead.
"As someone who has suffered from complex PTSD, I cannot afford to compromise on self-care, or receiving therapy and support," Ms Jasim, whose real name is not being used, at her request, told The National.
“Still, there were so many days I lost to overwhelming emotions, which were hard to share or discuss with friends and family, as so many are going through difficult times and one does not want to add to the load.”
Although she kept up her therapy digitally, Ms Jasim sad the online interactions did not address the other needs necessary to maintain her well-being.
“I don’t think I realised how much the buzz and hubbub of a city and crowds provided so much positive background noise in my day-to-day life. The pandemic silenced a lot of those sounds and the comforts of human interactions in real time, which was a real loss that I felt physically and emotionally.”
Studies suggest that women, particularly single mothers, and people from ethnic minority backgrounds, particularly men, are disproportionately affected, although no one is immune to the perils of psychological imbalance.
Dr Hana Abu-Hassan, a native of Jordan, is well positioned to relate to these more susceptible people who present in her offices in London.
"There is a vulnerability that is exposed when they know that one is an Arabic-speaking doctor. Maybe because I am part of a minority group, they feel like I can relate to them. Cultural barriers diminish and their stories seem to flow with ease," she told The National.
Working at a private GP practice in Chelsea, London and for the NHS Imperial Trust, Dr Abu-Hassan sees a wide range of patients, some of whom are specifically drawn to her because of her culture and language.
She specialises in humanitarian medicine including refugee health, torture survivors and global mental health.
Although not a trained therapist, her role as a GP often makes her the first point of contact for people with psychological distress – whether they realise it or not.
"It is not very common for a patient to call and say 'I'm depressed' or 'I'm anxious', or even 'I'm going through grief,'" Dr Abu-Hassan said.
"They tend to discuss other symptoms instead. And then I say: ‘Hold on, I sense some anxiety here. What do you think of that? Or how would you feel if I told you I think you have depression or low mood?’ and I wait for the patient to tell all, and they usually do.”
Regardless of what patients tell her, she tries not to medicalise their problems.
“As much as possible, I try to destigmatise mental health; to create an open door or an open pathway for patients to come back and feel comfortable to talk to me again. This helps create a safe space where they can reliably express themselves."
Danah Saadawi, a British Lebanese psychoanalytic psychotherapist working in private practice in the UK for the past 12 years, has seen her client number double in the past year.
While she does have a few Arabic-speaking and Muslim clients, they are a small minority.
"In the Arab world, therapy is a new and secretive concept still. People still go first to their friends, elders or religious community for advice and help," Ms Saadawi said. "Therapy is seen as niche and for the rich western intellectual. Although that is changing, it may be changing less among certain ethnic communities," Ms Saadawi said.
She thinks the onslaught of challenges brought on by the pandemic forced some of the traditionally reluctant to embrace psychological assistance.
“It has removed the stigma around mental health for everybody, perhaps particularly more for our community where the word client, or patient, translates into the ‘sick one’ with a certain connotation. One doesn't have to be sick to come to therapy, it's a different space altogether.”
“I think hearing about what people have been through and their mental health challenges will ultimately help us reconnect and rebuild relatability again after a year spent in increased isolation,” she said. Of Arab origin herself, Ms Jasim would like to see new spaces created in communities for people to talk safely.
Instead of seeing the usual chronic disease cases, Dr Abu-Hassan has found a new set of patients citing "personal problems" asking to see her.
Young people are badly affected by the pandemic and lockdown and NHS research suggests that one in six may now have a mental health problem, up from one in nine in 2017.
Earlier in the year, the UK government announced that £79 million ($108.6m) of a £500m investment in mental health would be allocated to support children and young people's mental health. It also appointed the former Love Island contestant Dr Alex George as a youth mental health ambassador.
Dr Abu-Hassan told The National she witnessed an increase in calls from the "worried well" in the young adult age-group, complaining of what she calls "health-related anxieties".
“At the very early stages of the pandemic, I used to go to my colleagues and say: ‘What is it with the millennials? They're all healthy, they're absolutely fine. Why are they calling us?’
"But then, you step back and think it is them who are worried about their future, and this is probably their main trigger. Their sense of security is vanishing and future planning became almost impossible.”
While the prevalence of mental health issues is troubling, Dr Abu-Hassan said it is not at all surprising given the circumstances.
"What we are going through is a normal reaction to abnormal – or far from normal – circumstances. It is normal to have a bit of anxiety. We all have a bit of anxiety sometimes, but when anxiety causes dysfunctionality, it is then that you have to address it," Dr Abu-Hassan said.
While there have been great strides in removing the stigma of mental health issues in recent years, she said governments are not making it enough of a priority. She recently advised the Ethiopian government on its mental health plan for healthcare professionals during the Covid-19 pandemic.
“At the moment, public health globally has become a priority and mental health has been put, yet again, on the shelf. It has been deprioritised. [But] it is still ongoing with an upsurge of affected individuals. It could even become the next pandemic. Learning from other epidemics, mental health usually hits hard during the public health crisis and afterwards,” Dr Abu-Hassan said.
She said she worries about vulnerable people hiding their problems behind closed doors or feeling unable to seek help. She said we need to be better prepared for what lies ahead. Raising mental health awareness during all stages of the pandemic is not to be underestimated.
“One day, this pandemic will be in the history books, but will we have the capacity to deal with the aftermath on global mental health?”
Finding an outlet to ease Covid-induced anxiety
For Ms Jasim, who considers herself fortunate to be able to afford private therapy, expression and connection are key components to recovery. "There is so much need for extra care right now for our collective mental health, and that comes from so many sources – therapeutic support, our friends and family, and even from the small gestures of strangers."
As a professional, Ms Saadawi knows the long-term and wide-ranging shifts proper treatment can have on people’s lives and hopes that attention on mental health needs will not dissipate once the pandemic ends.
Without wanting to preach, she encourages people to address issues without feelings of shame or selfishness.
"In our communities, we're very big on the community, perhaps less on the individual. And maybe the awareness needs to also begin there. Yes, the individual needs to start therapy, but this is not selfish. This is not just about them, this is potentially a benefit to everyone," Ms Saadawi said.
As professionals globally sound the mental health alarm, its increasingly clear that having access to the right help and support is both crucial and kind.