[Q&A] MCO and mental health

Photo by Jeremy Perkins on Unsplash

It has been over 2-weeks since Malaysians have been staying home during the Movement Control Order (MCO). We would like to find out more about potential issues that could crop up especially in regards to their mental health (MH). We speak to Universiti Malaya Specialist Centre consultant psychiatrist Associate Professor Dr Amer Siddiq Amer Nordin on this subject matter.

This is probably the first time Malaysian been cooped up at home for so long. How does this affect their MH? What kind of issues may arise?

“This is correct. However, a pandemic such as this is no different from a respond to disaster. The response is akin to grief – a sense of loss. In this case, the loss is more likely to be autonomy or a sense of control. With an MCO, some might feel that they are not in control of their time, activities, life in general and will have emotional responses akin to losing a loved one. If we use the Kubler Ross model:

  1. Shock
  2. Anger
  3. Bargaining
  4. Despair
  5. Acceptance

What is the current depression rate in Malaysia? Do you see a rise during this period?

“The rate of depression is between 8-12% according to a review of all studies on depression in Malaysia by my colleague, Dr Ng Chong Guan from Universiti Malaya. We are seeing a rise in people complaining of mental health problems including depressed mood but a diagnosis of depression is not seen to be out of the ordinary

We are however seeing a rise in people relating symptoms of anxiety where some of them are having adjustment disorder requiring medical support (anti-anxiety treatment) but a diagnosis for a disorder of anxiety needs longer than the 2 – 4 months of the present MCO.”

Because of the MCO, many people have lost jobs or temporarily experienced loss of income. How are they coping mentally? What goes through their minds? 

“This is true – loss of income/jobs. The main feeling is anger, frustration, and anxiety. Without a clear picture of how long will this MCO go and or how many people will be affected and eventually die, many are worried about falling ill, having loved ones getting ill or losing their jobs permanently as a result of COVID-19.

I have been out there stating that we started with a health issue but will end up with an economic issue. Both are extremely important to consider and address. People cope differently to these situations, however, collectively it appears that people are responding according to the (Kubler Ross) model.”

It has been reported since the MCO, Talian Kasih hotline has seen an increase of 57% calls from women in distress. Why is this happening? 

“There could be many reasons:

  1. It is a widely publicised hotline which is from the government addressing a variety of issues: – mental health, domestic abuse, child abuse, sexual related issues, distress
  2. With the MCO, victims of domestic violence might have a harder time due to increase exposure to their perpetrators
  3. People could be calling in to seek help in general – mental health, abuse, and possibly even financial support.”

How about families who are ‘stuck’ together during MCO, how does it impact them, as some are forced living closely due to the size of home etc. 

“This will surely affect them negatively in particular if your house is not a livable space. By this I mean, overcrowding, small area, the lack of personal spaces or green spaces which can make it hard on a normal day but harder when you’re not allowed to go out at all.

This poor livable spaces might also be precipitating causes for all sorts of emotional distresses, potential abuses – physical, verbal and sexual. Once this MCO is over, a national discussion on this might be needed to relook into future homes as some are extremely challenged.”

What about the mental health of front liners especially medical personnel who tirelessly work round the clock. How are they coping? 

“From previous experience, they were found, just like all of us need support. Many hospitals and organisations have from the early onset developed “Psychological First Aid” teams for all front liners. NGOs have also supported these initiatives.

Some have gone further and provide psychosocial activities and assistance to front-liners who might be in need. Lately, the assurance of adequate Personal Protective Equipments (PPE) have been helpful in reassuring staff on the frontline and frequent Continued Medical Education (CME) has improved our understanding and intervention of the “enemy”

Clear SOPs developed also reduce risk and empower staff and this assists in their mental health. The main challenge was fear and anxiety as we had in the initial stages, little knowledge of what we are really dealing with. This is seen in all countries facing COVID19.”

Two weeks have passed since people are working from home. How does this impact their level of stress as some say they experience increased workload during MCO? 

“People are getting emotionally tired and angry with the situation. This is an expected response. Especially since there is not a clear set outlook in this matter both locally and globally. People are also having to juggle everything from being a parent, teacher, nanny, chef and also employee or employer. Some have more support than others, others have very little support.”

MCO may be here to stay. At least social distancing, for some time. How will people adjust to this new normal?

“People will adjust to this new norm adequately. We have now experienced what it feels like if we don’t do just this, ie the MCO. The threat will be here for some time and therefore we will all need to adjust to this new normal starting by having no Ramadan Bazaar and possibly a more quiet Hari Raya.”

MCO means people are staying connected through the internet and phone lines. How does this impact their relationship in terms of being emotionally ‘connected’. 

“If done well there are little implications for the short term and possibly midterm. It is harder however to make new connections through this medium moving forward. Emotional connection is key and needs to be encouraged to reduce loneliness or emotional isolation.”

MCO also sees excessive smartphone and social media use during this period, what are the implications of these habits to their mental health?

“We know that excessive use is detrimental to health. Studies have found excessive use of the internet and social media to be possible risk factors to depression and anxiety. Some with poor control might also develop an addiction problem. Moreover, excessive use has been associated with an increased risk of cyberbullying and the implications of this are also concerning – depression, anxiety among them.”

Another 12 more days more to go, how do one care/continue to care for their mental health? 

“It’s important we develop and maintain a routine. It’s also important that we have a plan during the coming month (in case it gets extended). Doing the 4Ms – mindfulness, movement (exercise), mastery (self-care) and meaningful engagement activities will surely help. Making sure we have adequate sleep. Ensuring we eat healthily and are adequately hydrated will also help.

Now more than ever, we also need to be financially healthy and learning new skills like financial literacy and other possible opportunities protect our financial health and thus mental health.”

Bionotes of expert

Dr Amer Siddiq is a consultant psychiatrist with Universiti Malaya. His doctorate work was on the effects that depression had on smoking and weight gain. His sub-speciality is in addiction where he is a local and international expert in methods to quit smoking. Dr Amer Siddiq is a consultant to the World Health Organisation and also the Ministry of Health, Malaysia for smoking cessation and mental health. He is a committee member of the Taskforce for Mental Health Promotion in Malaysia which is chaired by the Minister of Health.

In the community, he is the consultant for the Subang Jaya Care Warriors, a local group assisting in suicide prevention and is also consultant to Befrienders Kuala Lumpur. He is the primary lead for an LRGS and also the Grand Challenge grants on tobacco control. His research output includes patents on a training program which is adopted by the Ministry of Health to train all healthcare professionals to assist people to quit smoking. This training program is licensed to Johnson & Johnson and is expected to be expanded in SEA. His best publication is in Lancet Oncology IF 35.286.

**All previous posts about COVID-19 here: https://sciencemediacentremalaysia.com/tag/covid-19/

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