‘Look, listen and link’ to help people mentally cope with Covid-19

A 30-year-old woman suddenly broke into tears. She was breathing rapidly as her heart was pounding in her chest. Her hands were trembling and cramp. Her face was numb and her legs were stiff. She felt dizziness, anxiety and panic. She could listen but could not speak. Fortunately, a mobile health team was nearby to calm her down.

A week before, three of her family members were admitted to the hospital because of Covid-19. Since then, she had difficulty sleeping, loss of appetite and lack of interest in daily activities. She also received phone calls and messages from distant relatives and neighbours, especially when an ambulance came to her house before this. Her family members who were staying with her wish they could do more to help.

Indeed, like most disasters and infectious diseases outbreak, Covid-19 is causing immense disruption to the emotion and social behaviour. The patient, their close contacts and healthcare workers are especially vulnerable to enormous stress.

A research article published by The Lancet showed a wide range of psychological impacts including depression, feelings of confusion, fear, anger, post-traumatic stress symptoms and even substance misuse.

On March 12, the World Health Organisation (WHO) released a statement on mental health and psychosocial consideration during Covid-19

It puts an emphasis on the Covid-19 responders such as healthcare workers and community leaders to be familiar with basic emotional and practical support to the affected people by using psychological first aid (PFA). WHO had previously published a PFA guideline during the Ebola outbreak and a PFA manual for field workers to facilitate efficient application of PFA.

PFA is not a replacement for professional counselling by psychologist or medication prescribed by psychiatrists. Instead, PFA has been described as a humane, supportive response to someone who is suffering and may need support. It intends to help people to feel safe, connected, calm and hopeful. It entails networking and collaboration, to guide victims and their family members towards access to social, physical and emotional support. It empowers people to be resilient, that they are able to help themselves, as individuals and communities, during this turbulent time.

Respecting safety is paramount to PFA. Since Covid-19 is highly infectious, every precaution is needed to reduce risk and avoid harm when delivering PFA. Recently, the International Federation of Red Cross and Red Crescent Societies advocates remote PFA

The communication between helpers and affected persons should take place using phones or emails, except for the frontline workers.

Dignity and the rights of the affected persons are crucial elements in PFA. As stigma and prejudice grow, it is of utmost importance to communicate with persons in distress with respect and empathy.

This is because every single person has a different coping mechanism and ability to adapt to the evolving environment. Anyone who wants to help should allow time to take its due course, to give victims space to ventilate and channel their problems voluntarily. Sometimes, it is sufficient to just let them know that help is always available when they need, without intruding into their private space.

The principles of PFA are “look, listen and link”.

The initial step involves assessment of the person, their surroundings and safety risks, their urgent basic needs and emotional cues for distress reactions. Take time to observe before offering help. It will allow calmness and time to think before offering support. Listening takes more practice as it takes more than just a set of ears to truly appreciate one’s feelings and concerns. Listen with the eyes and facial expression to give undivided attention. Listen with the heart and voice to show care and respect.

Always begin a conversation with introduction and use general questions before going into the details, as needed. Pay attention to immediate emotional reaction and identify the emotion to acknowledge it. Use touch and pause as appropriate.

People who are quarantined and healthcare workers who work tirelessly are exposed to disconnectedness and loneliness. Thus, “link” is an essential step to PFA. Helpers should be equipped with information and skills to tackle practical problems and access services for daily living under the movement restriction order.

A breadwinner will be worried about getting food on the table. Thus, information on various aid and available support from the government or non-governmental organisation is valuable.

There are times when healthcare personnel may feel burned out or stressful but do not feel comfortable to admit them to a colleague or superior. It is the role of PFA to act as a bridge between an employer and an employee to manage and alleviate workplace-related issues.

However, people with severe or prolonged distress may need more than PFA. People with pre-existing mental health conditions too may experience heightened anxious thoughts and compulsive behaviours leading to acute stress reaction during this pandemic. Hence, it is vital to recognise these, support their needs and offer appointments with medical personnel as soon as symptoms flare-up.

Ultimately, things might get worse before they get better. Lingering uncertainties surrounding a dynamic pandemic like Covid-19 may exacerbate anxiety and stress. Covid-19 may define a new normal for Malaysians in the face of socio-economic challenges. Worry not, PFA is one of the tools to help everyone get through.

The health ministry and MERCY Malaysia are providing psychosocial support via phone (011-63996482, 011-63994236, 03-29359935). The Mental Health and Psychological Support Services (MHPSS) are in coordination with the Covid-19’s Crisis Preparedness and Response Centre (CPRC) on day to day basis. Various agencies, local authorities and organisations are working together to contribute as much as they can.

As long as Malaysians hold their hands together, the tough get going.

Dr Ariff Fahmi Ahmad Zawawi is a family medicine specialist. - FMT