By 7am each day, Michelle Williams, 52, would be seated at her desk, her dark hair neatly pinned back and her mind ready to tackle all that lay ahead.
Between that moment and hitting a traffic jam at 4pm, she had mountains to climb. She would oversee services as broad-ranging as immunisations, nurse training, speech therapy programmes and a lot more.
With almost three decades in the private and public health sectors, she took being an assistant nurse manager in public health in the Western Cape in her stride.
Then a global pandemic hit.
Suddenly, Williams found her days starting at 6am and often ending well after 8pm, with difficult tasks added to her schedule, including telling families their loved ones had died.
Her mental health began to suffer as Covid-19 engulfed the country.
In early March she lost her best friend. Then, a few months later, her stepfather died.
“The news around me was all about Covid-19. I wanted to stop the bus, just get off and get back on when I am ready,” she said, adding that her normal stress relievers, such as walking on the beach and seeing family members, were not an option.
“As friends and family members tested positive, it became a lot. There were days when things felt overwhelming. If it was not for the people around me, I think I would have lost it,” she said. “I was exhausted, but you can’t go into that dark space and stay there. I was drained, but I didn’t want to stay there. I spoke to people and moved through.”
Williams is one of several million South Africans whose mental health has taken a huge knock over the course of 2020, and several studies and surveys are emerging to count the true cost of what some are calling “the second pandemic”, fuelled by the virus itself and the psychological fallout of lockdown.
The latest was carried out in Soweto and focused on more than 200 adults who were already enrolled in a long-term study, but the researchers say their findings apply to all low-resource communities in SA.
It looked at “the impact of lockdown on the mental health of people in Soweto” and “found a significant link between symptoms of depression and how likely people felt they were to be infected,” said Dr Andrew Kim of Northwestern University in Illinois, who co-directed the study for a health research unit at Johannesburg’s Wits University.
The results, published in the UK’s Cambridge journal, Psychological Medicine, showed people were two times as likely to experience significant depressive symptoms for every step increase in their perceived risk from the virus.
“We also found that those with a history of childhood trauma were more likely to have a higher perceived risk of contracting the virus,” said Kim.
Fifteen percent were found to be at risk of depression, while 20% indicated that the pandemic “caused them deep worry, anxiety or led to them ‘thinking too much’ about the virus and its impact”.
It also highlighted the stigma of mental health issues, as many of the participants described clear symptoms of anxiety and depression, but were not able to pinpoint the problem.
They also found a higher risk of depression and anxiety “among ... those already suffering the effects of poverty and deprivation”.
Kim said the pressure of the virus and lockdown “has added to the already high levels of mental illness among people in South Africa, where one in three experience some kind of mental disorder in their lifetimes and where only 27% of patients with a severe mental illness receive treatment”.
“Our study re-emphasises the importance of prioritising and provisioning accessible mental health resources for resource-limited communities in Soweto and across South Africa,” he said.
I wanted to stop the bus, just get off and get back on when I am ready.
A recent survey by Pharma Dynamics also showed high levels of mental health issues brought on by the pandemic and lockdown.
The pharmaceutical company polled more than 1,200 adults across the country and found that 56% of them “had higher levels of psychological and emotional distress than before the pandemic”, 49% feel anxious, 31% are depressed and 6% have contemplated suicide.
Abdurahman Kenny, who manages the mental health portfolio at the company, said: “The disruptions in routine and economic activity have had a devastating impact on mental health.” Record-high unemployment levels, social isolation, additional childcare responsibilities and fear of getting sick have all played a role.
According to Kenny, a mental health crisis is looming and “increased psychological support efforts” are sorely needed to avert this.
He said people “who previously coped well are now less able to manage due to multiple stressors”, while those with existing mental health conditions have experienced a worsening of symptoms.
According to Prof Liezl Koen, a psychiatrist in public health in Cape Town, South Africans need to look for signs of mental health fallout in their loved ones
“Changes in mental functioning affect thinking, behaviour and emotions. Be alert for anything that is different from the usual: excessive worries and fears, dramatic changes in eating and sleeping, unusual behaviour, increased sadness or irritability, inability to respond to positive input, social withdrawal, underperformance, decrease in self-care or loss of hope. Don’t be afraid to ask if you are concerned.”
It is also “critical to avoid using substances to self-medicate symptoms” as these can worsen symptoms or bring on new ones.
