Lerato Mahwai argues that mental health was not given the priority it should have been when the country went into lockdown.
The Covid-19 pandemic has had an impact, both physically and psychologically, on people’s lives across the world.
Mental health professionals have, therefore, carried a double burden during this crisis: They have experienced an increased need for their professional services, and they have also had to deal with how the pandemic has touched them personally.
While mental health practitioners working in public institutions continued working during lockdown, those in the private sector had the option to go into lockdown or to continue offering services.
Those that decided to continue working had to adjust to how they provided psychosocial services. Some continued with contact sessions, while others opted for online sessions. Some professionals decided to use both.
Mental health professionals, who opted to use contact sessions, had to take precautionary measures before and during each session, which introduced a level of discomfort during sessions – such as having to talk while wearing a mask, open windows and physical distancing.
This is a challenge as such conditions can make contact sessions feel impersonal and human connectedness is vital for therapy. Contact sessions were described by one registered counsellor as “an anxiety provoking experience, because of precautions needed to be taken for therapy” and its associated risks.
The option for conducting contact sessions was endorsed by medical aid schemes, which initially did not pay for services provided online.
Online therapy challenges
Although online therapy removed all risks associated with Covid-19 transmission between the mental health consultant and client, online sessions had its own set of challenges.
Firstly, some clients lacked resources, such as a device, connectivity, or privacy in their homes, to conduct online sessions, while other clients mistrusted virtual sessions.
Secondly, mental health professionals had challenges with non-verbal clinical observations of clients as well as affording internet access.
One psychologist raised concerns around confidence in their ability to provide effective sessions online, since they were not trained to do so.
The lockdown regulations restricted contact sessions (individual, group and community interventions) which affected access to psychosocial services and delayed some people’s access through the referral system.
One psychologist was concerned that “people no longer received help and care with the same frequency as before”.
Another social worker said that during the lockdown they had limited time and staff available to render services. They could only see clients on an appointment basis, which limited the number of people they could see, and as a result they lost clients.
Public health facilities halted and turned back referrals for psychosocial services (for therapy and medication) because they were not recognised as essentials.
Moreover, the unavailability of mental health professionals with specialised services (such as clinical or psychiatric skills) and other relevant stakeholders (e.g. courts were closed) meant that other professionals could not refer cases for specialised help.
This challenge left general psychosocial support professionals overwhelmed and frustrated because they received more of the psychological cases during the lockdown than they were used to or it was beyond their scope of practice.
Mental health professionals expressed feeling helpless that they could not help people with the same ease and consistency as before the lockdown. They were also concerned about relapses and self-medicating among patients “because of reduction in the consistency of professional care that they needed”.
One psychologist said it could create “long term effects”. Another psychologist was worried about patients’ “difficulty to communicate their mental health challenges with their families or loved ones”, who may therefore not be able to get the necessary support.
Other professionals were worried because they could not go out to check up on families or track and follow up on other clients due to lack of connectivity, lost contact or sessions terminated because people on furlough from their jobs could no longer afford treatment sessions.
Professionals were, therefore, left in the dark over how these clients were managing. There were concerns about cases piling up because some services were halted and would only resume once restrictions were uplifted.
Issues exacerbated
The lockdown exacerbated mental health issues – for example, among those who had challenges relating to family dynamics, child abuse and gender-based violence, and were now confined to one space with their perpetrators, which traumatised them.
Some people experienced depression and anxiety because of financial stress (due to job losses and employment uncertainty) in addition to the unknown effects of Covid-19.
Furthermore, one counsellor specified issues around the “effects on poverty-related communities that lack the necessary resources to cope” during the lockdown.
Some professionals reported an increase in suicide rates (especially among teenage girls).
Although, the lockdown may have attempted to stop the spread of the disease, mental health and psychosocial problems were not given the necessary prominence in the policy-making or in public discussions of the consequences of Covid-19.
It is almost as if this society has learnt little from the Life Esidimeni tragedy, and what it revealed about the consequences of de-prioritising mental health needs.
– Lerato Mahwai is a research associate at the Auwal Socio-Economic Research Institute and a Master of Philosophy student in social policy and development at the University of Johannesburg.
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