- Teresa Costa & Carmen Critelli
‘Forced loneliness’: new challenges for the WHO Mental Health Plan in light of the pandemic
‘Imagine yourself closed for months in a cage. You can only communicate with others through the cage’s bars and you are not able to free yourself. You can try to talk and ask for help, but you cannot escape.’
The current Covid-19 pandemic has forced most of us to introduce new and unprecedented social distancing and isolation guidelines. These ‘social’ rules have substantially changed the way most people live and perceive their own day-to-day reality. In fact, the current pandemic is not only threatening people’s physical health, but it is also putting their mental and psychological well-being at stake. Despite individual differences and other risk factors, extended periods of social isolation and loneliness generally have a pejorative effect on individuals. Especially in the case of mental health, long-term loneliness can lead to sleep disturbance, increased depressive symptoms, neglecting of one’s health, higher risk for suicide as well as dementia.
The current situation is even more peculiar because it forces people to face a new type of loneliness which does not only depend on personal circumstances. In fact, there is a difference between ‘feeling alone’ or loneliness and ‘being alone’ or isolated. ‘Loneliness’ refers to a subjective feeling (Even though I see my friends every day, I still feel lonely) which can or cannot be influenced by the level and quality of one’s social interactions. ‘Isolation’, instead, is an objective state which refers to actually being alone, without social contact and/or interactions (I am alone, I am isolated). Loneliness was a mental health concern also before the pandemic, being already considered a serious epidemic - especially in the United States. At the same time, though, it was also easier for most people to manage it by engaging more often in social activities or looking for more satisfying interpersonal relationships. Instead, the current pandemic has introduced a new type of ‘forced loneliness’ which does not solely depend on subjective experiences and where the usual remedies do not and cannot work anymore. For this reason, new solutions need to be found and awareness on the pejorative psychological effects of isolation needs to be addressed.
Loneliness is not the only running sore that quarantine flared up. Other variables enforced by the pandemic worsened people's mental health. Changes in the daily routine, anxiety and the impossibility for some people to exercise due to the gym' closures led to an escalation of eating disorders (EDs) cases and aggravated the condition of people already suffering from them. Several psychotherapists noticed the rising of an alarming number of people experiencing a troubled relation with eating due to lockdown's restrictions, which consequently led to mental health instability and worsening already existing disorders.
The Journal of Eating Disorders estimates that 83.1% of the patients interviewed reported that their ED’s symptoms had worsened since the outbreak of the pandemic. This is probably connected to the general condition of uncertainty and heightened anxiety. In fact, one of the principal causes that influence the presence of an anxiety disorder is environmental change. As the Covid-19 has altered all the aspects of everyday life, anxiety has become a recurrent mental health follow-up factor that has led to different illnesses such as EDs. Indeed, there is a closed relationship between anxiety and EDs. Often, anxiety precedes them. The patient, struggling with anxiety, cannot manage certain aspects of his/her life. Eating habits, weight, and exercise spin out of control of the patient's sight or reversely, the patient believes to have a false sense of control, which is unhealthy.
One significant factor that characterizes some of the most common eating disorders (anorexia, bulimia and binge-eating) is the obsessing relation with food. As people are stuck at home all day long, without any distraction or motivation, anxiety and uncertainty led some of them to focus too much time on their bodies' image or exacerbate eating habits and addictions. Also, the excessive use of social media created a breeding ground for the development of eating disorders, especially adolescents faced constant pressure from social media interaction such as TikTok and Instagram, where many users inundated the feed with posts about “how to lose weight" and the importance of exercise to not gain weight during such crises. As Dr Agnes Ayton, the Eating Disorder Faculty Director at the Royal College of Psychiatrists, stresses, certain messages were particularly "unhelpful" to people who suffer from obesity and orthorexia.
Considering what it has been said about the current situation and the challenges every individual is facing and will have to face; and considering that the effects of social isolation and loneliness pose a serious challenge on people’s well-being; it seems therefore necessary to look at these problems as pressing mental and public health concerns and to properly address them. Dr Margaret Chan, Director-General of WHO from 2007 to 2017, presents the Mental Health Action Plan 2013-2020 (MHAP) as an essential tool to achieve mental health that is crucial in ensuring well-being for all people. The plan, therefore, aims to grant equity through universal health coverage by stressing the importance of prevention. However, the effects of isolation on mental health are not discussed sufficiently in the MHAP. Specifically, the circumstances of ‘forced loneliness’ brought by the pandemic need to be taken into consideration.
One element that stands out from the MHAP is the idea of ‘community-based’ support and services. The plan aims at providing mental health and social care services in a community-based fashion, emphasizing the idea of community and support groups. However, given the current circumstances, the idea of community is fading and the extent of interconnectivity between individuals has drastically decreased. Since the effects of the global pandemic will probably shape and change the way we socially organize and interact, an alternative network of care should be provided. Perhaps, this health care network should be based on a different conceptualization of community and support groups which is not centred on physical collectives and traditional programmes of social participation. Instead, a new type of social support could be provided which focuses especially on the role of loneliness and its impact on mental health. Thus, ‘special’ mental health care programmes should look at how to re-connect individuals after a global pandemic, how to support them in nurturing healthy and enriching relationships and creating new services such as more ‘individualised’ or ‘home-based’ support to improve emotional health. Although socially interacting online is not equal to physically meeting, the plan should also integrate ‘online’ health care programmes and services, as they will probably be needed in the future.
In regard to EDs, as many of the behaviours associated with the different diagnoses can have fatal impacts on both physical and psychological well-being, it is crucial that the patients can fight those disorders from different fronts. Indeed, anyone living with an eating disorder should receive care from a multidisciplinary team of professionals including a therapist, doctor, dietist and/or a prescriber if necessary. Therefore, the MHAP needs to address the new challenges brought by the forced isolation and give more relevance to people affected by EDs giving them a multidisciplinary support which can help them in their process of rehabilitation. Indeed, as most of the bed spots in the hospital were reserved to COVID-19 patients, people suffering from EDs were left behind. The international community must recognise the importance of fighting mental health issues as it has been highlighted during the pandemic, and only thanks to that, we will be able to get out of the tunnel.
This article was written for the MD x EuroMUN Printed Edition.