COVID 19: Its impact on the Mental Health of Workers

Musings on World Labour Day

By Alex Nkosi & Tawonga Gondwe-Nkosi

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Understanding Mental Health

Mental health is a commonly misunderstood subject. People confuse “mental health” with “mental illness”. Mental health “refers to our emotional and psychological state, our social well–being and how we feel about ourselves and interact with others” (Magellan, 2018), while “mental illness” refers to a wide range of disorders that affect mood, thinking, and behavior. Even though mental health is not the same as mental illness, it is an established fact that poor mental health can lead to mental and physical illnesses. Mental illness can affect anyone regardless of age, gender, social standing, religion, or race/ethnicity. People with mental illness often experience distress and have problems functioning at work, home, and in social situations.

The value of mental health and well-being

Mental well-being makes up an integral part of an individual's capacity to lead a fulfilling life, including the ability to form relationships, study, work or pursue leisure interests, as well as to make day-to-day decisions and choices (WHO, 2017). When we have good mental health, we are resilient, can handle life’s challenges and stresses, have meaningful relationships, and make sound decisions. Mental health, like physical health, is important at every stage of life, from childhood to adolescence through adulthood and old age. However, disturbances to an individual's mental well-being can adversely compromise these capacities and choices, leading not only to diminished functioning at the individual level but also broader welfare losses at the household and societal levels.

Determinants of mental health and well-being

Having sound mental health and well-being is not just a matter of will-power and personal choice. Mental well being is to a larger extent influenced not only by individual attributes but also by the social circumstances in which persons find themselves. It is also determined by the environment in which an individual operates and lives. The conflation of these social determinants may threaten or protect an individual’s mental health state. Thus, depending on the local context, certain groups in society may be particularly susceptible to experiencing mental health problems, including “households living in poverty, people with chronic health conditions, minority groups, and persons exposed to and/or displaced by war or conflict” (Ritchie, 2018).

Of COVID 19 and job losses

Three weeks after the International Labour Organization (ILO) predicted that 25 million jobs were threatened by the new coronavirus, the UN labour agency now says that the “economic effects of COVID-19 on the world of work are proving to be far worse than the 2008-9 financial crisis, with cutbacks equivalent to nearly 200 million full-time workers expected in the next three months alone”.

In terms of statistics, the ILO intimates that “Workers in four sectors that have experienced the most “drastic” effects of the disease and falling production are: food and accommodation (144 million workers), retail and wholesale (482 million); business services and administration (157 million); and manufacturing (463 million)”. Cumulatively, they add up to “37.5 percent of global employment and this is where the “sharp-end” of the impact of the pandemic is being felt now”, says Guy Ryder, the ILO chief. It is important to add that behind these figures are people who have families that depend on them.

The stringent public health measures recommended by the World Health Organisation (WHO) which are being implemented in many parts of the world to contain the viral spread are inadvertently affecting the world of work too. Universally, small and medium-sized enterprises in both the formal and informal economies are closing down due to the lockdown effect. In Africa, however, it is the colossal informal economy where the majority of people work, especially women and youth, that is facing the sharpest brunt as a result of lockdowns, with consequential massive job and livelihood losses.

According to the ILO, 85.8 percent of employment in Africa is informal. In practical terms, this means that there are millions of people who have insecure employment, and their lives are defined by precarity. Experientially, it is not uncommon for people living in precarious conditions not to have savings. Lacking in predictability, job security, social protection, the precariat live hand to mouth, and mostly have no idea where their next meal, with which to keep their bodies and souls together will come from. This is why apart from losing a job; people working in the informal sector are innately vulnerable to developing mental health problems, as they are disproportionately impacted by the COVID 19 pandemic. It is underscored that globally around two billion people work informally, most of them in emerging and developing countries, and that “tens of millions” of informal workers have already been affected by COVID-19.

COVID 19 and Mental Health Risks

It is a well-known fact that mental health problems are related to deprivation, poverty, inequality, and other social and economic determinants of health. Economic crises such as the current COVID 19 pandemic is a high risk to the mental well-being of the population and for the people affected and their families. Additionally, the Mental Health department at WHO emphasizes that globally, the number of persons exposed to extreme stressors are large and that exposure to extreme stressors is a risk factor for mental health and social problems. The psychological, social, and economic havoc wreaked by COVID 19 has left the entire world population in shock and distress. Most of the people are currently living in fear, largely exacerbated because of the explosion of fake news about COVID 19 that is easily transmitted through social media platforms.

For people that were already living in poverty, this simply means the crisis will further push them into the rut of destitution. Workers without appropriate policy measures also face a high risk of falling into poverty and will experience greater challenges in regaining their livelihoods during the recovery period post the pandemic. Research has shown time and again that job loss is associated with increased depression, anxiety, distress, and low self-esteem which may lead to higher rates of substance abuse. Already, as unemployment rises and a recession looms, we are already hearing in the news of some cases of individuals committing suicide.

Those with pre-existing mental illness and substance use disorders pre-COVID 19, and those newly affected will likely require mental health and substance abuse recovery services. Thus the pandemic highlights the existing challenges and new barriers to accessing mental health services. For the scope of this article, we shall cast a spotlight on a few mental health issues that are likely to be induced by the pandemic, namely, (a) anxiety, (b) depression, and (c) stress.

Anxiety:

Anxiety is what we feel when we are worried, tense, or afraid, particularly about things that are about to happen, or which we think could happen in the future. Currently, feelings of anxiety are increasingly common, as people are fearful for themselves or their loved ones falling ill and are uncertain of the repercussions of the pandemic. Informal workers that have lost their livelihood are greatly prone to feelings of anxiety as they worry about how they will feed their families in the face of a lockdown and job losses. Equally, the already overwhelmed frontline workers also live in constant fear of contracting the virus; of what will happen to the bed-ridden patients that are in their care. They may be wondering as to when this pandemic will be over. When they get home, they may also be concerned about the risk of infecting their own families.

Depression:

Depression is a common mental health challenge that causes people to experience low mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. Research shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance abuse and suicide. Recent polling by American Institute KFF on “The Implications of COVID-19 for Mental Health and Substance Use” shows that “more than half of the people who lost income or employment reported negative mental health impacts from worry or stress over coronavirus; those in the informal economy and lower-income report higher rates of major negative mental health impacts compared to higher-income people” (Panchal et al, 2020).

Stress:

Bhargava and Trivedi (2018), define stress as “a condition of mental pressure for a particular individual facing problems from environmental and social wellbeing which leads to so many diseases.” Most likely, we all know what it's like to feel stressed. When we say things like "this is stressful" or "I'm stressed", we may be referring to situations or events that we are overwhelmed by. Case in point is the current pandemic where we don't have much control over what happens. As a result of the pandemic, millions of people are likely to be undergoing stress.

Suggestions on supporting workers and frontline staff

• Mitigating the impact of mental health disorders: With COVID 19, it appears that anxiety, depression, and stress disorders may increase. WHO counsels that to reduce health, social and economic burden of mental disorders it is essential that “countries and regions pay greater attention to prevention and promotion of sound mental health at the level of policy formulation, legislation, decision-making, and resource allocation within the overall health care system” (WHO, 2014). In most African countries, for instance, mental health does not feature as a priority even with the ministries of health. This is in spite of the well known debilitating effects that mental health disorders have on people. With COVID 19 pandemic, mental health should be taken as a priority by governments worldwide.
• Job losses and unemployment: The most well-known universal interventions in response to job loss and unemployment tend to be legal policies governing unemployment insurance and welfare assistance or policies associated with improving job security. Their availability varies dramatically across different parts of the world. Governments as duty bears have the constitutional responsibility of caring for their citizens, especially in times of pandemics. According to ITUC-Africa, one of the critical needs to be addressed is to “guarantee the livelihood of workers by upholding their sick leave, wage support, income support, food support, rent, and mortgages relief and accommodation support (ITUC-AFRICA, 2020). In this regard, unions must seek to play clear monitoring roles in the provision of necessary security and protection for workers and in the institution of relief measures for all workers.
• Care for the carers; the frontline staff: In psychology, there is a term called “care of carers”. This means that people in the caring professions also have a need to be cared for. With constant stress and burn-out, it's important to reach out to them. Ask friends or family members that are frontline workers, what you could do to help ease their burden. Some may need you to help with babysitting their children for instance or simply to be listened to.

Conclusion

By way of conclusion, it is our hope that we have demonstrated the inextricable link between COVID 19 and the mental health issues it causes for workers and in the world of work. It is thus critical that while workers are on lockdown or have lost their livelihood, they seek the necessary help that will foster their mental wellbeing. Lockdown and social distancing does not mean emotional distancing. Ensure that you are in touch with your colleagues and loved ones by checking on them constantly and providing them with the atmosphere to express their innermost feelings. Remember, there is no health without mental health!

*The co-author, Tawonga Gondwe-Nkosi is a Psychotherapist who has extensive experience in promoting mental health and psychological wellness for children, adolescents, and families.