With everything that is going on as the novel coronavirus disease COVID-19 spreads throughout the world, you may find it difficult to make sense of your rapidly changing situation. Am I safe from infection? Are my children, parents, and grandparents safe? With schools closed, how am I to meet the needs of my children and those in my care, and even my own needs, including when I am at work, if I can (or even try to) work remotely?

This article will address the following topics:

1. How our mental health and overall well-being is affected by COVID-19
2. How to cope as a parent or adult
3. How to support and communicate with children

It makes sense that we experience fear and anxiety in the face of uncertainty; this is what helps us to cope in the short term. The problem, though, is when fear and anxiety turn into a long-term scenario and may become more intense. This then affects our ability to adapt and cope with the situation. In any pandemic, it is common and normal for us and our children to feel stressed and worried, even nervous, upset, afraid, confused, or irritable.

Psychosocial stressors for COVID-19 include the fact that we are not 100 percent certain about how it is transmitted, schools are closed, travel is restricted, health facilities are avoided, and there is the risk of relapse of preexisting health conditions. In addition, there is discrimination towards persons who have been infected and their family members, stigmatization of those who treat and care for patients, and stigmatization of specific ethnic population groups or nationalities. Stigmatizing is not only wrong, it is dangerous because it drives those who may have contracted the disease to avoid detection and treatment, thus increasing the risk of further spread. In a study during the Ebola outbreak, stigma led participants to keep easily treatable, non-Ebola illnesses a secret and avoid seeking help.*1

Stressors in the Ebola context included fear of infection, frustration and boredom, inadequate supplies, inadequate information, and financial stressors and are very similar to those in the current COVID-19 pandemic; they have the potential to have a serious impact on our mental health and well-being unless we do something about it.

So what can we do? For those who have been directly exposed, timely mental health and psychosocial interventions should be developed urgently, especially for those with 2019-nCov pneumonitis, their close contacts, suspected cases who are isolated at home, patients in clinics, families and friends of affected people, health professionals caring for infected patients, and the general public who are in need.*2

What practical actions can we take to improve our mental health and avoid developing mental health problems?

First, we should limit watching, reading, or listening to news that causes us to feel anxious. The near-constant stream of news reports during the outbreak can cause anyone to feel uneasy and stressed. To counter this, we should seek accurate information only from trusted sources and only at specific times of the day, if our work routine allows it. Instead, we should find opportunities to reach beyond our own needs, amplify positive narratives, and honor caregivers and social care staff and health care workers who support people who may otherwise be stigmatized.

Coping strategies in times of stress include staying connected with loved ones, especially vulnerable individuals; practicing physical rather than social distancing; keeping a predictable routine; limiting your exposure to the news to specific times and trusted sources; keeping things in perspective.

Managing your mental health and well-being means taking time to care for yourself. Put in place helpful coping strategies, such as staying connected with loved ones, including through digital media, eating healthy foods, engaging in physical activity, and avoiding unhelpful coping strategies such as the use of tobacco, alcohol, or other drugs. Keep daily routines even in cases of teleworking or self-isolating. Aim for physical rather than social distancing. Try to keep things in perspective.*3

It is normal for children and family members to react strongly and to lose interest in daily life, feeling irritable, sad, and confused, and having trouble sleeping or being fearful about what is happening. Having their predictable routine disrupted, especially with schools closed, can be distressing for children. Parents can support the mental health and psychosocial well-being of children in various ways: making more effort to listen to children and answer questions openly and honestly about the virus and their fears; speaking kindly to them; reassuring them and playing with them; helping them to feel safe and find positive ways to express their feelings such as anger, fear, and sadness; providing opportunities for physical exercise and play (when possible); reestablishing structure and routine, and asking them to help with mundane family tasks, which can give them a sense of security and control over their situation.*4

To help children cope with anxiety and stress, keep a predictable routine; listen as much as you can to them; talk to them kindly; answer their questions about the situation in honest, simple, age-appropriate language; reassure and play with them to make them feel safe; engage them to participate in household tasks; let them move; laugh with them; let them express frustration safely.

One of the greatest ways to cope with stress is to look beyond ourselves and see how we can reach out and support others. Older adults are vulnerable given their limited access to information sources, weaker immune systems, and higher COVID-19 mortality rate. Children with disabilities are particularly vulnerable, facing barriers to access care and essential information. In the context of school closure or home isolation/quarantine, we should seek to provide support to caregivers of children with disabilities, including those with developmental, behavioral, and/or intellectual disabilities, in managing the care and education of their children at home, and in attending to their own mental health and psychosocial well-being. Some practical actions include helping them access accurate information, designing communication that is not solely written (e.g., including images with children and adolescents with disabilities), encouraging family or friends to call regularly, and teaching them to use video tools.*5

Eat healthily, exercise, avoid the consumption of tobacco, alcohol, or other drugs.

Lastly, having personally lived through an Ebola pandemic in Sierra Leone and supporting protection partners as they put in place mental health and psychosocial programs, I found that one of the greatest resilience coping strategies was their sense of humor even in the darkest of times. Laughter is indeed the best medicine, even if in the context of COVID-19, it means laughing at the absurdity of the multiple different scents and brands of sanitizing hand gels!

More information can be found in the links below.

• Global UNICEF, including messaging: https://www.unicef.org/coronavirus/covid-19.
• Palestine WHO: http://www.emro.who.int/countries/pse/index.html.
• WHO global, including messaging: http://www.emro.who.int/pse/palestine-news/landing-page-for-covid19.html.
• Stress coping during COVID-19: https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2.
• For children during COVID-19: https://www.who.int/docs/default-source/coronaviruse/helping-children-cope-with-stress-print.pdf?sfvrsn=f3a063ff_2.
• IASC MHPSS RG document on mental health and psycho-social support (MHPSS).
  Considerations of the COVID: https://interagencystandingcommittee.org/iasc-reference-group-mental-health-and-psychosocial-support-emergency-settings/briefing-note-about.

Stigmatization and blaming do not help. Engage in acts of kindness, express appreciation and gratitude towards healthcare workers and doctors.
Be particularly considerate of the special needs of children with disabilities in these times.

To know more on how to protect yourself and your children, please visit UNICEF State of Palestine’s website https://www.unicef.org/sop/ar/covid19. The information is in Arabic.

*1 The Lancet, “The psychological impact of quarantine and how to reduce it: rapid review of the evidence,” February 26, 2020, Department of Psychological Medicine, King’s College London, London, UK.
*2 Lancet Psychiatry 2020, published online, February 4, 2020, “Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed.”
*3 Adapted from WHO Mental Health and Psychosocial considerations during COVID-19 Outbreak-12th March Version 1.4.
*4 Sourced from Child Protection Sessions for Parents and Caregivers Training Toolkit, Inter-agency publication, 2013. http://resourcecentre.savethechildren.se/library/child-protection-sessions-parents-and-caregivers-training-toolkit.
*5 Source from briefing note on addressing mental health and psychosocial aspects of COVID-19 Outbreak, Version 1.0, Interagency Standing Committee.