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Dr. Joanne Paul- MBBS (UWI), FRCPCH (UK), FRCP (Edin)

Last time we discussed points from Professor Gerard Hutchison on our declined mental health post pandemic and the reasons for the increased violence and aggressive behaviour. Professor Hutchison is a professor in psychiatry with the University of the West Indies. He also works in the psychiatry department at the Eric Williams Medical Sciences Complex. I had written that mental health is a state of well-being and balance and is the ability to cope with the normal stressors. We discussed that being cooped up caused our mental health to decrease. Now that we have opened up and are now freer to move around, there is a resultant mixture of emotions. We feel all over the place, antsy, hyped up, uncontrolled, wild, like how anyone feels after being cooped up then let out. Yet with our mental health balance decreased we have less buffer, less space, less of a gap, between daily routine behaviour and being triggered, where we either want to cry or beat up someone. It is like when you are under serious pressure whether at home or at work. Every little thing can trigger you off and your emotions and anger are harder to control. In comparison to when you are on holiday and chilling and relaxed. Any issue that comes up seems less important and easily swatted away


Prof:

‘Another issue is the lack of social cohesion and low levels of interpersonal trust which have become intensified by the pandemic and all the measures devised to contain it. That the covid 19 pandemic has revealed and amplified the fault lines and divisions in the society is to state the obvious but what it has also done is to amplify the social and systemic flaws and exacerbate the weaknesses of societies. Again, multiple studies have confirmed that the disadvantaged, those who earn less income and are less well educated, are faring the worst. Fragile family structures have also been adversely affected by the pandemic with implications for reduced parental supervision, higher dropout rates and greater opportunities for illicit activities. We are seeing increased homelessness, increases in reports of domestic violence and childhood abuse and neglect. In this kind of environment, crime and specifically violent crime is likely to flourish and we must prepare ourselves to meet this challenge. Childhood abuse, childhood neglect, social and economic inequities leave a toxic mess. There is an accumulation of anger and resentment in the society among abused groups who feel that not enough has been done to protect them as well as those who feel that the inequities protect and indeed serve some while denying and punishing others. Violent crime is an outlet for these negative emotional states which may also express themselves as greater hedonism and a lowered appreciation for delayed gratification and indeed value for life itself.’

Prof:

‘We have always experienced higher than average rates of violent crime and suicide at least in the recent past century so it is no surprise that the mix of pandemic induced social and mental distress will add to the factors that have predisposed us to these realities. Where there are guns, they will be more utilised to resolve problems. Where there are drugs there will be more use and greater demand. Where there are gangs there will be more rivalry and greater recruitment to gain relative advantage. Where there is increased violence there is social breakdown and a sense of hopelessness.’

JP:

We often forget though that our essential services are also part of our general society, experiencing the same issues and exposures. One would think they are also at similar risk. But in fact, they may be instead more vulnerable

Prof:

‘Another factor to consider is that members of the protective services particularly the police are not exempt from these social and mental issues and are a group that is especially vulnerable. They also must deal with the policing of the public health regulations as well as their normal duties and their own personal issues. In addition, here we have an ambivalent low trust relationship with the Police so making the stress of their work during a pandemic even more demanding and likely to result in further fraught relations with the wider society.

Another interesting finding is that while the greatest risk for physical health has been with the elderly, it is the adolescents and young adults who seem to be struggling more emotionally and psychologically. This has consequences for education, long term productivity and risks for social destabilizing and perhaps deviant behaviour.

What might be needed is greater mental health penetration of communities, greater support for education access and supervision, greater investment in arts and culture and sports within those communities and the wider society. There must also be greater empathy from and easier access to support structures inclusive of social and mental health services. We also need something more from our leaders, more honest and sensitive communication, and a greater acknowledgment of what the less advantaged in the society experience. The pandemic and its effects must not be allowed to facilitate our end but inspire us to new beginnings.’ 

JP:

Sometimes, when talking to Prof, there is just nothing more to say.


Dr Joanne F Paul is a Lecturer, a Paediatric Emergency Specialist, and a member of TEL institute

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