Tele-counselling support can help tackle Covid-19 mental health issues

Thirty-year-old Ahmed woke up shaking in the middle of the night. He felt choked as he reached for the glass of water beside his bed. He kept gasping for breath, a heavy weight pushing down on his chest.

Ahmed forced himself out of bed and turned the lights on—an effort to challenge the darkness consuming him every night. He feels a crippling sadness as the room lights up. Is there a way out?

Covid-19 has forced us to confine ourselves in our homes, resulting in a range of harmful emotions for many people. Ahmed, for example, experienced difficulties in breathing, irritation, sleep disturbances and an incapacitating fear of being infected.

He had been living in fear of being trapped since he was 15, when his friend accidentally locked Ahmed in his room. Being in enclosed spaces for long periods was particularly suffocating for him; the lockdown triggered the trauma that Ahmed constantly tried to run away from.

Ahmed called a mental health helpline in desperation. He had no idea how it was going to help him, but he knew he had to say something out loud.

The counselling psychologist on the phone was able to make Ahmed feel safe and express himself. He was given an empathetic ear and his words were taken seriously. He was suggested breathing exercises and given tips for getting a good night's sleep, to start with. Ahmed ended the call saying, "Thank you for listening. I feel relieved knowing that I won't die from this. I think I will be okay."

More than 1,300 people have called the same helpline since April 2020. Two out of five called to report such symptoms. Understandably, Covid-19 has changed the world for all of us. The pandemic could be likened to a wartime situation causing deep uncertainty and panic among millions of people.

The many faces of a pandemic

Many people fear either catching Covid-19 themselves or being asymptomatic carriers who unknowingly transmit the disease to family and friends. This fear is particularly intense in homes with elderly relatives or young children.

Since April, almost 200 callers have expressed worries concerning their current and future financial state, their health and their family's health, according to data collected from Moner Jotno Mobile E (MJM), a tele-counselling platform by BRAC, in collaboration with the Psychological Health and Wellness Clinic and Kaan Pete Roi, an emotional support hotline.

Drastic changes in daily life have caused shifts in routines and schedules, resulting in insomnia, claustrophobia, restlessness, panic, loneliness and isolation. Since April, 195 callers have reported mental health concerns. 80 people have called regarding an immediate emotional crisis. Other callers have acknowledged sleeping problems, self-harm and abuse.

A deep, deadly void

Bangladesh is not prepared for the devastating long-term impact of the pandemic on people's mental health. Mental health is a topic rarely discussed and even more rarely understood. There is only one psychiatrist for every 2,00,000 patients with reported mental health issues in Bangladesh.

There are approximately 200 psychiatrists and 600 psychologists and psychotherapists in total in the country. Few universities offer applied psychology courses, and these are not accessible for many because of lengthy enrolment processes and high course fees. Working in mental health often attracts stigma; a common belief is that those who work in the field become "crazy". Mental health is not prioritised in social, political or national policy discussions. Consequently, there is a lack of secure job prospects.

At least 11,000 people take their own lives each year in Bangladesh, most of whom suffer from psychiatric disorders such as depression. In 2019, 32 people took their own lives every day. 

The real numbers are arguably much higher. There is no national surveillance system for suicide. Suicides are under-reported because of shame. Those who attempt suicide and survive it often suffer intense humiliation.

There is one government-run mental health facility, in Pabna, with 500 beds. Its patients are reportedly highly neglected. Mental health services are concentrated around tertiary hospitals in big cities, but non-existent at the level of primary healthcare. The level of awareness of mental health needs and access to support services in rural areas in Bangladesh paints an even bleaker picture.

Covid-19 has hit low-income families the hardest, leading to tensions within households as families struggle with little to no income.

For instance, 26-year-old Shila's husband lost his job in Saudi Arabia soon after the outbreak. He planned to start a small business after coming back to Bangladesh. He was furious and abusive when he realised that they did not have enough money to do so.

Shila had never spent the money he sent back on anything, for herself or her son, without his permission. She was devastated by her husband's behaviour.

Unable to take it after weeks, at 11pm on April 5, Shila attempted to escape her life. Her mother screamed for help when she spotted her in the cowshed. Their neighbours rushed in and saved her. She was admitted to the nearby hospital by Rehana, the leader of the local polli shomaj (women-led institution).

Shila's incident is one of 693 incidents reported through BRAC's community empowerment programme in the first 20 days of the lockdown. A number of these incidents have been directly linked to the social and economic consequences of the lockdown. Shila is among many others who have turned to suicide as a way out of the challenges posed by the pandemic.

Just a call away

Moner Jotno Mobile E was initiated in order to address the void of mental health services in Bangladesh, seeking to provide tele-counselling support to people feeling isolated, lost and/or frustrated.

The platform is for anyone seeking a space to be heard, valued and respected. It is hoped that every caller will leave with a more positive experience and a more optimistic outlook for the future. If counsellors sense a risk of self-harm, conflicting thoughts or a need for further support, callers are referred through specific pathways to psychologists.

How can we understand if our loved ones need help?

Here are some symptoms to look out for: loss of desire to participate in any activity, even their favourite hobbies; difficulties in concentration; lapses in memory; difficulty falling asleep and, alternately, sleeping for prolonged periods of time; heightened nervousness and/or a strong fear of other people; rapid changes in moods and emotions; withdrawing from daily life, family and friends. A person may also seem to be hyper-excited one moment and very depressed the next.

Seek immediate support if you know anyone who is displaying one or more of these symptoms.

The trained psychologists at MJM are available from 8am to 12am, seven days a week, at 01709817179.

Dr Erum Mariam is Executive Director of BRAC Institute of Educational Development, BRAC University, and Zaian F Chowdhury is a communication specialist at BRAC.