Mental Health and the Coronavirus in Pakistan

Hanniah Tariq considers what options we have in dealing with anxiety in the time of Corona

Mental Health and the Coronavirus in Pakistan
In addition to people, the Coronavirus has been infecting headlines, social media newsfeeds and personal conversations at an alarming rate. Physical isolation and lockdowns (although necessary) are leaving the public with nothing to talk about and little else to distract them. In this time, Pakistan, and indeed, the world, is experiencing unprecedented levels of anxiety and stress. No one in our generation has faced anything like this before. Neither have our parents. And Pakistani grandparents can only very loosely compare it to the fear existing in society at large during the 1947 Partition.

With most of the country in a collective panic attack Dr. Kinza Naeem, CEO and Co-Founder at the Umang Mental Health Helpline, reveals that in the last two weeks, “a lot of people, especially those who have underlying OCD or anxiety, have been calling. There is a state of panic, and a lot of people are scared. But everything is being especially exaggerated in the minds of people who have an underlying condition.”

Overall, she feels that the number of people calling has doubled in the past weeks.

Dr. Kinza Naeem is CEO and co-founder of Umang, a mental health helpline. She says the number of people reaching out to her organization for help has doubled in the past two weeks

Throughout this rapidly evolving ordeal, we have been advised to take special care of vulnerable segments of the population. However, in addition to those over 60 and the immunocompromised, an invisible and extremely vulnerable group is also struggling in the post-COVID-19 world. These are the people with pre-existing anxiety disorders like Generalized Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Hypochondria and panic disorder. And, it is no insignificant group with an estimated 24 million people in need of mental health support in Pakistan (according to the World Health Organization).

Right now people from various walks of life linked by these common disorders are experiencing the perfect storm of all their fears and triggers coming to life. People with anxiety are convinced the world is coming to an end. They are going into spirals of ‘what if?’ - which many have trouble breaking out of. The ones with OCD can’t stop washing their hands or using hand sanitizer.

“A lot of people with OCD are calling us since it is obviously overwhelming for them. And they are also affecting the people around them, like families and their close ones. If previously they had an urge of cleaning doorknobs say ten times in three hours, now it has doubled,” says Dr. Naeem. People suffering from hypochondria are distressed because they can’t get tested even if they are absolutely convinced that they are infected. The ones with social anxiety disorder who have made it part of their recovery to ensure lots of healthy social contact now find themselves choosing between their mental and physical health.

We are not alone in this boat. NBC, for example, reports that the U.S. is experiencing a “wave of anxiety sweeping mental health patients unlike anything counselors have seen before”. Support helplines are racing to make sure they respond to this crisis. The Crisis Text Line (a free 24/7 support hotline in the country) for example, has acted by changing the first heading to ‘Coronavirus’ on their website. They connect the user with a Crisis Counselor and provide information on ‘How to Deal with Isolation’, ‘financial stress’ and provide specific information for students, parents and healthcare workers. The website reports that people in crisis referring to COVID-19 has increased 49 times from February till March. The organization further reveals that “the pace is increasing. On March 13, Coronavirus was mentioned in 15% of all conversations.”

A cursory search for helplines for anxiety that may be able to support vulnerable groups as well as people currently having a hard time coping wasn’t very promising in Pakistan.

There is no official organization that you can visit for consolidated information about trusted and working helplines for support. Given that “mental health services are not well organized, such as catchment/service areas like National Health Service, United Kingdom” (Pakistan Journal of Neurological Sciences) the unavailability of such information is inevitable. But what else can be expected in a country with only 0.19 psychiatrists per 100,000 population, “one of the lowest numbers in WHO Eastern Mediterranean Region, and in the whole world” (according to the WHO)?

The Pakistan Association for Mental Health has not had any updates on their website since 2017. On calling their number to find out if any helplines or online support groups have been set up in these trying times, the phone remained unanswered. By contrast, on the homepage of the Anxiety and Depression Association of America (ADAA), the first things you see are Coronavirus-related tips and information on managing related anxiety effectively. NHS 111 online allows the user to check if they have Coronavirus symptoms and advises them not to go to a doctor, pharmacy, or hospital until the test is complete. India has a Central Helpline Number for Coronavirus, with separate ones for each state.

When looking for ‘Talk2Us’, lauded as Pakistan’s First Free 24/7 Mental Health helpline I found only a website that seems to be under construction with no information or contact number. Telephoning the Rozan Counselling Helpline also yielded no answer. The phone was attended at the Punjab Institute of Medical Health, Lahore; however, I was informed that no adapted service had been instated under the changing circumstances. For people stuck at home suffering from these unprecedented levels of triggers, the suggestion is for a “relative to come and take care of them”. In case of an emergency, people are advised to come in for an evaluation with no more than one attendant. No offsite support is offered even as the country goes into lockdown in several areas.

The Umang Mental Health Helpline, which I managed to get on the phone, raised my hopes a little. The CEO and co-Founder Dr. Naeem personally attended the phone and informed me about the circumstances of the patients calling and the new measures in place to deal with COVID-19 related anxiety. She assured me that their counselors have been trying to cater to such clients and offering appropriate therapy and support on this new issue. Since the outbreak of this disease, Umang has also taken medical practitioners on board to help provide more guidance about the virus.

Clearly, whether suffering from a pre-existing condition or not, people are in dire need of support remotely. It is understood that non-essential travel is not in the best interest of the individual or the nation. In a country with our current stigmas, extreme anxiety or panic attacks do not even count as an emergency, which is just as well. If all of us with Coronavirus related anxiety come out of our homes to see counselors or attended support groups physically, we are done for. People need to have current information about hotlines and online support and to be mindful of those around them suffering from invisible disorders.

Can someone please step up and lead the country on how to cope and stay positive when no one knows how or when this disaster will be averted?