Stress, anxiety and a sense of isolation amid the global COVID-19 pandemic and South Africa’s current 21-day lockdown can add to psychological distress, and for those already struggling with mental health disorders it is now more important than ever to keep up with treatment.

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The psychiatric profession, represented by the South African Society of Psychiatrists (SASOP), has urged mental healthcare users to be aware of early relapse signs, continue with prescribed medication and to keep therapy appointments.

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Mental healthcare is considered an essential service during lockdown, and SASOP has assured patients that public and private health sector mental health services remain open for both scheduled appointments and emergencies, and where possible some practitioners have shifted to online consultations.

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Prof Renata Schoeman, board member of the Psychiatry Management Group (PsychMG), said mental wellbeing is vital in this time of crisis, whether or not one is suffering from a mental illness, as lockdown can aggravate feelings of isolation – even more so for those already struggling with mental health issues.

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“Now is the time to re-focus one’s energy on improving your mental health and resilience. It is crucial to stay socially connected while practising physical distancing, to stay informed via credible sources of information, and to keep to generally healthy habits.

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“A strong individual and communal mental health status are key to remaining physically strong and socially cohesive during this crisis,” she said.

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For those with mental health conditions, she said, it was vital to remain well and stable by keeping up with treatment, avoiding the need for hospitalisation when healthcare resources are already stretched by the impact of COVID-19.

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Prof Schoeman said this was not only to limit possible exposure to the coronavirus if patients need to be hospitalised for a psychiatric condition, but also because medications such as mood stabilisers and anti-psychotics “cannot easily, if at all, be continued should they require admission to ICU and especially should they require ventilation”.

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Dr Kagisho Maaroganye, SASOP board member and public sector national convenor said as an essential service, mental healthcare providers including psychiatrists, psychologists, mental health nurses and occupational therapists are on duty and pharmacies, depots and suppliers are open to ensure continued availability of medication.

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“Hospitals and clinics will be available throughout this period to assist mental healthcare users in case they have an emergency or crisis during the lockdown and beyond. Both private and public hospitals and clinics are taking well-considered, best practice measures to ensure that mental healthcare is delivered in the safest possible way during this public health crisis,” he said.

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Some practitioners have switched to “telehealth” as a contingency plan during lockdown, offering remote consultations via telephone or online platforms such as Zoom, in line with guidelines issued by the Health Professions Council of South Africa (HPCSA).

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“Tele- or video-consulting is a means of delivering high quality treatment to vulnerable patients, while protecting both them and clinicians from unnecessary risk of exposure to the virus,” Prof Schoeman said.

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Early relapse signs for mental healthcare users to be aware of include lack of sleep or irritability and SASOP advises patients to get advice by phone from doctors or clinic nurses on what steps to take to manage their vulnerability and fears around the risks of COVID-19 and isolation.

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“Avoid self-medicating or trying to heal yourselves with alcohol, illicit drugs or taking your medication in a manner not advised by your psychiatrists or general practitioners. It is important that we can manage any potential relapse early on, so as to avoid hospitalisation,” Dr Maaroganye said.

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He said the public at large may also experience emergencies or crises due to steadily increasing mental distress or illness and they are able to contact community health care workers, social workers and doctors/nurses/psychologists at clinics for assistance.

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While staying home, staying safe by physical distancing when going out to access essential goods or services, and frequent hand washing and sanitising, SASOP also urges the public to remain both physically and mentally healthy by exercising at home, eating healthy foods (including fresh fruit and vegetables as far as possible), getting enough sleep, and avoiding alcohol abuse and illicit substances.

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“SASOP members are available to offer support to mental healthcare users and their families who may be feeling overwhelmed under the strain that our entire nation is under. At the same time, SASOP will continue to offer its members our total support so that they can feel enabled to continue delivering the high quality of psychiatric management to mental health care users that they have been for many years,” Dr Maaroganye said.

SASOP advises all South Africans to use the communication means they have available to stay connected with families and loved ones and to be aware of those in the community who may be more vulnerable in isolation, such as single parents, the elderly and those with mental health disorders.

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Dr Maaroganye also advised staying informed by accessing credible information sources, such as government’s www.sacoronavirus.co.za site and the World Health Organisation (WHO, www.who.int), and not to seek constant updates but rather twice a day, to avoid feeling overwhelmed and heightening anxiety.

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“Although this challenge is enormous and even overwhelming, it is important to have faith and hope that you and the country will overcome this challenge. Being without hope can add extra burden on one’s mental health to a point that one’s mental condition can relapse or worsen,” Prof Schoeman said.

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Where to get help and information

SA Depression Anxiety Group (SADAG): 0800 21 22 23 / 0800 70 80 90

SADAG WhatsApp support (9am-4pm): 076 882 2775 / or SMS 31393 or 32312 and a counsellor will call you back

Lifeline South Africa: 0861 322 322

Department of Health: 060 012 3456 (WhatsApp “hi” for access to comprehensive COVID-19 information)

National Institute for Communicable Diseases toll-free COVID-19 hotline: 0800 0299 299

Visit www.sacoronavirus.co.za