• Emergence and worsening of mental health issues on the rise due to economic, social crises
• People being vigilant, authorities being strengthened, and media acting responsibly can change the situation
• Psych community highlights link between economic crisis and mental health

BY Sumudu Chamara   The economic crisis has affected people of all backgrounds to different degrees. Even though how these issues have affected people financially is often discussed, their impact on people, especially on their mental health, does not receive adequate attention. However, in a context where mental health issues – in the current context, caused or exacerbated by economic and other crises – can have far-reaching impacts on people’s lives and can even lead to unforeseen newer issues, there is a lot that the people, the health care sector, and the authorities should do. The impacts of the prevailing crises on people’s mental health were discussed by Dr. Lahiru Yasas Akuratiyage of the National Institute of Mental Health in Angoda, during an online discussion organised by the Sri Lanka Medical Association (SLMA).   Mental health amidst national crises    He stressed that the present situation is a breeding ground for mental health issues and the worsening of the same and that this situation affects people not only mentally, but also physically. He added that there are multiple risk factors in the present Sri Lankan context, including high inflation, plummeting purchasing power, continuing fuel crisis, the crisis in the provision of health care services, increase in Covid-19 cases, poor food security and the risk of malnutrition, disrupted education, and prolonged political instability. “Quality of life keeps reducing due to the prevailing crises, and it has a direct impact on the people’s mental health.” Citing a study conducted by Save the Children in June, Dr. Akuratiyage pointed out that people reported feeling tired, having trouble falling asleep, experiencing anxiety, and having trouble concentrating have become more prevalent, which he said could be symptoms of mental health issues, even though it does not necessarily constitute mental illnesses. This situation, he said, may increase in the future, and therefore, more data is required in order to assess the situation properly. Describing the process of mental health issues increasing, he said that it happens in stages and that the prevailing situation can not only worsen but prolong mental health issues. Speaking of the nature of the connection between the economic crisis and mental health issues, he said: “Sometimes, economic downturns can be a cause of mental illnesses, and that is common. At the same time, there is a situation where the social situation of those who have mental illnesses deteriorates. We call these two situations social causation and social drift.” Dr. Akuratiyage also pointed out that the prevailing dire economic situation can negatively affect the quality of interpersonal relationships and the people’s movement, and how the people on medication may reduce their medicine intake due to medicine shortages and increased prices of medicines.   Mental health issues    According to Dr. Akuratiyage, among the mental health issues that people are more likely to be exposed to during and due to the economic crisis are stress and depression. He said that while the two situations may share more or less similar symptoms, it is important to differentiate the two whenever possible and that doing so will make it possible to take steps to address them on time. He described stress as a mental health issue that may arise when a person’s ability to cope with a negative feeling exceeds the limits of his/her coping mechanisms. The result, he said, is the inability to control stressful feelings. Describing the symptoms of depression, he said that depression, on the other hand, results in more long-term impacts and could affect a person’s lifestyle to a greater degree than stress. According to Dr. Akuratiyage, external factors such as economic hardships can change the hormonal balance in people’s brains and that has a direct connection to mental illnesses or mental health issues. “Amidst the prevailing crises, these situations can worsen, and hence require great attention,” he emphasised. In addition, mental health issues such as burnout were highlighted by Dr. Akuratiyage, who also pointed out how healthcare workers faced a mental state called burnout during the peak of the Covid-19 pandemic. Adding that this is not a mental illness, he added that this situation is majorly linked to job stress, which may be prevalent during the economic crisis. Furthermore, he mentioned the five stages of stress leading to burnout. They are, the honeymoon phase with high job satisfaction, commitment, energy and creativity being prevalent; the onset of stress with waning optimism and common stress symptoms affecting the person; chronic stress with a marked change in the stress levels and experiencing more intense symptoms; burnout with the symptoms becoming critical and increasingly difficult to cope with; and habitual burnout with significant, ongoing mental, physical, or emotional problems. “When such experiences are noticed, it is important to be vigilant and to help when needed,” he emphasised. Adding that suicides could also be an issue that may increase due to the prevailing crisis situation, Dr. Akuratiyage said that in the context of the economic crisis, such incidents have already been reported. Anxiety was another issue he highlighted as having the chance of becoming more prevalent. Noting that anxiety is the irrational fear about the future, he said that the country’s present situation is likely to trigger more cases of anxiety. In addition, citing the same reasons, he pointed out the likely increase or prevalence of phobias and panic attacks. In addition, the likely increase in drug use and domestic violence were also highlighted. Dr. Akuratiyage said that these are also issues that may become more prevalent due to the prevailing economic hardships. He also highlighted that these issues or the causes of these issues may sometimes be interconnected.   Impacts on the healthcare sector and treatment   During the discussion, Dr. Akuratiyage also paid attention to how the impacts of the economic crisis affect the country’s healthcare sector which may in turn affect the treatments obtained by people living with mental health issues. He said that this matter too should receive attention, in addition to the likelihood of an increase in new cases of mental health issues. “There are a lot of people who are on medications, especially in hospitals. At present, there is a severe shortage of medicines in Sri Lanka. Many live with the help of medication, and this shortage may put them in a difficult situation,” he explained. In addition, difficulties faced by patients as well as healthcare workers when travelling to treatment centres due to the fuel shortage were also pointed out as another issue that worsens the situation in the healthcare sector. Even though some patients are treated outside hospitals in general society, according to Dr. Akuratiyage, that too has become a challenge due to transport issues caused by the fuel shortage. “Treatment gaps existed before too. However, we have a reasonable fear as to whether it will worsen due to the prevailing crises,” he expressed concerns, adding that this overall situation may even prolong patients’ stay in hospitals and worsen their mental health situation.   Violence    In a context where political and social instability has led to social unrest to a great degree, Dr. Akuratiyage said that violence has become more prevalent as a result. He added that violence, however, may not necessarily be a mental health issue or a sign of a mental health issue. “This instability changes the people’s way of thinking and how they respond to these situations,” he stressed, adding that the nature of the expression of violence, too, has changed in the recent past with the rapidly evolving political and social situations. Speaking of the process of how stressful factors such as the crisis situation can turn into violence in people, he pointed out that frustration leads to negative effects, which leads to aggressive inclinations, which in turn leads to aggressive behaviour. This process, according to Dr. Akuratiyage, is dependent on various internal and external factors, some of which have a link to economic and other crises.   Migration and at-risk groups   During the discussion, how the economic situation renders people vulnerable to risky acts such as migrating without a proper and safe plan was also highlighted. Adding that many, especially those who are from underprivileged backgrounds, tend to migrate to another country with the sole intention of surviving the economic situation, Dr. Akuratiyage said that migrating can cause stress. He added: “Many people go abroad when they cannot survive here anymore, and they are largely selective migrations. They use risky and stressful ways of migrating. There are practical challenges associated with migrating as far as mental health is concerned where, in addition to the process of migration, having to be in an alien environment can be stressful. These challenges have been found to trigger mental health issues such as depression.” Speaking of at-risk groups, he said that certain groups are more at risk of being exposed to economic hardships and also mental health issues related to those hardships than others. Among the group he pointed out are, children, whose education has been disrupted for years, and also elders, who are sensitive to crisis-related developments. “One of the main issues I see is that in today’s context, adolescents are greatly disappointed as to what will happen to them, whether they should stay in the country and what they should do if they are going to stay in the country.” Dr. Akuratiyage added that most of the time, these concerns may become visible as behavioural issues in children and that therefore, such requires more vigilance. In regard to pregnant women, he noted that depression among them may increase due to economic challenges and domestic violence. With regard to elders, he noted that in a context where they are largely dependent on their children, their mental health may also be affected due to economic challenges. To change this situation, Dr. Akuratiyage said that there are steps that need to be taken at the national, patients’, health sector, and individual levels, even though the overall solution, however, lies largely in economic revival. Some of the recommendations he mentioned are raising awareness on mental health and stress management; being vigilant about fellow citizens; using the media especially social media to spread correct information, and the media acting responsibly when discussing mental health-related matters. Even though some of these measures may require considerable effort and resources, everyone can contribute at some level, and this contribution can be as simple as being careful enough to share only reliable information on social media.   ============BOX==================== If you feel that you or someone you know may be dealing with mental health issues and/or suicidal thoughts, the following institutions could assist you to deal with them. Sri Lanka Sumithrayo: 0112682535 The National Institute of Mental Health: 1926 Shanthi Maargam: 0717639 898 Courage Compassion Commitment (CCC) Foundation: 1333 =======================