Covid-19 and its impact on mental well-being

Tuesday 18 th January 2022

*Dr Ali Moafi (Counselling Psychologist)
**Dr Ali Al Faraj (Consultant Psychiatrist)

***Gulamabbas Lakha (Researcher, Psychology of Religion & Neuroscience)

One area of concern associated with Covid-10 pandemic is its impact on mental health and how this is affecting individuals and families alike. Good mental health is an asset and is also linked to good physical health – both of which support positive social and economic outcomes for individuals and society. Mental health disorders account for almost a quarter of the total burden of ill health in the UK. Specialists participating in this seminar will assess these phenomena, using their first hand experiences with the most affected by the lingering suffering. Also how does religion deal with mental health issues? How much can faith minimize the negative impact and provide cushioning effect against it?

Chairperson: I am working in the Iraqi cultural welfare centre. We ran a self development programme during COVID so I am quite passionate about this topic. The topic itself is called the COVID 19 impact on mental health and how it affects individuals, families, children across the board. You can’t really be healthy without your mental health being alright as well. It accounts for almost a quarter of total ill health in the UK. That is quite a big amount. We are also looking at how religion affects mental health and can help you deal with it in terms of it like religion and faith.

Dr Ali Moufai: It is my pleasure and honour to be in this meeting. Thank you very much for the invitation. Very briefly from the point of COVID 19 let us understand what is normal, healthy, mental functioning so we have a source of comparison.

We are made to have an experience, our brain generates a lot of emotions. It is like a big power station which generates a lot of emotions and chemicals. So we are talking about the  physical self which is the physical being. We will get onto the spiritual later on. Therefore in the world of psychology we are talking about the physical self hence all these emotions which are generated by the brain throughout our development depending  on infancy, childhood adolescence and adulthood and how a family functions.

In  a normal good functioning family situation most of the time you ought to be happy, you ought to functioning, you ought to be having a  normal life style. What has happened in the COVID situation is that normality, the social network, the experience  of a happy expression whether it is verbal expression or interaction with other people in society, meetings environment through a network that has ceased in keeping one’s distance, we are not allowed to socialise. 

Suddenly something has come into the ring and has caused a major social barrier into the whole process of normal function. It impacts on different people in different situations, in different age groups and from different  cultural backgrounds – to some degree the same but to some degree depending on the family network and makeup it can have a different effect.

The basic mechanism is the same but how we regulate our emotions, how we treat them and deal with them, whether we are able to nourish them  – that is where COVID has made a difference.  If one has had a happy childhood, a happy adolescence, a happy adulthood then one should be armed with the maximum   amount of mental health tools to be able to deal with one’s emotions.

It is the same thing with the adults. There is a very big and large assumption  – world events obviously affect us and so on and so forth. As we are talking about COVID 19 bearing in mind that such restrictions are in place we begin to get worried. The anxiety begins to kick in. We can’t express our feelings, we can’t express the sharing of love,  it prevents our love and our emotions from being expressed. If you like the serotonium production which is the fundamental chemical that we are able to express so that we function  also become disrupted.

Bearing in mind that there are huge amounts of isolation and we are not allowed to socialise etc etc and therefore depression develops if  we don’t learn the new rules and new means to be able to  self express or express in the safe family or other situations so that we do not catch COVID 19. If that does not happen there is a basis for depression. We worry about going out, we worry about our children, we worry about the future. All these elements of worry begin to kick in and develop the basis for anxiety. 

It would affect us differently if we are a child or an adolescent. Remember that children and adolescents are hugely socially reliant to be able to develop naturally. If they are prevented from this they rely heavily on social media and social networks, especially gaming therefore that in itself becomes quite addictive. This again formulates the basis for huge amounts of depression in children and adolescents in particular.

And obviously if we do not have a clear understanding of how these things function as adults then we ourselves could develop anxiety, become angry and all sorts of behaviours that are not acceptable for a normal family functioning can take place. 

Hence for adults to have a relative understanding  of a clear well being process is very fundamental. There is some research done and I think my colleague Dr Ali will provide some slides outlining the statistics.  I have come across research which says there is a 50 percent increase in mental health issues before and after during COVID 19. In different populations it varies and there are some differences but they are not huge. 

Going back to what the base is what is healthy what COVID 19 has caused and what we can do about it. Again the first thing to do is to learn to self regulate. The first thing is to have a strong belief that if I do X , Y and Z to protect myself then nothing should happen. Therefore to prevent fear kicking in. The belief about whether I am going to catch COVID or not is extremely important to have a very positive attitude and people do not do what they can like walk in the park or doing sports.  Even basic exercises. And therefore the fear takes over. Rather than having a physical illness we tend to  develop the negative mindset which sets the scene for more negativity and depression and anxiety to take over. Mental health issues will come up. I won’t go into that for the sake of this seminar but there are plenty of u-tube links that you can tap into.

But the key is that you control the key to your self regulation. This is a very fundamental point that I am making. Before you go to any therapist  anyone to be able to seek help you have to start from yourself.

We are the focus, we are basically the centre of well being ourselves. It is not the world outside, it is not the media it is not anyone else so  we have to  start from  ourselves. So as adults we have to learn what that healthy mental health status is to be able to regulate it and then apply it to children.

Obviously children are much more susceptible. In fact  for children and adolescents from the age of 13 and 14 till about 16 or 17 it is a different ball game altogether. So if we do not have clear understanding about what is happening we could actually be part of the problem rather than part of the solution. 

So it is very important to understand that we have to be patient, we have to be proactive, we have to think positive and we have to realise and identify what is   healthy mental health so we can then understand that  COVID and other issues can disturb the process.

This is really just a synopsis of how we can potentially  be affected. This is easier said than done. There is a lot  that can be done but unfortunately people do not abide by that – the sports and the walking for example, the positive thinking and therefore the linguists, what we see what we do, how we feel  often that is left  to the media. That takes over. They say that only bad news makes the media and the other issue is that controlling what news we watch, how much we watch and if any  and if we allow ourselves to be subjected to the social media. There is so much negativity flowing that we need to watch out for that as well.

The other thing I just want to point out is the role spirituality. The essence of any religion for that matter is to be able to communicate with the ultra being and in the case of any religion to be able to  communicate with God whether it is Islam, whether it is Christianity, whether it is Judaism.  Whatever religion it is to be able to communicate with God the super being.

The fact that we recite the Quran, that God is talking to us and we recite the  dua and we communicate with God that in itself is an expression especially for adults because children watch what we do and  learn what we do. The health environment is controlled by that. If through a certain regularity of spiritual practice we achieve a level of peace that peace will be seen in our face, in our house environment.  This is how we develop.  Every religion has its own way of developing spirituality but in a Muslim household this will directly have an effect.

I am not saying this will resolve the situation. I am saying it will bring peace  within the household and will control any temperamental situation issues to a high degree and if it is practised and brought down to a concrete belief level we will see a change in our behaviour at the family level. There is plenty of evidence across the globe that spirituality can have an effect on personality and can bring peace into one’s state of mind and body and behaviour.

Dr Ali Alfaraj: I will try and be focused. This is a big topic and it is difficult to cover everything.  Thank  you brother for making it easy for me and talking about the mechanisms and brain functions and how the pandemic could lead to mental difficulties. 

I have summarised the research findings of studies that have been done in the UK about the impact of COVID on mental health. I  will talk a little bit about the differences of the impact on different groups. I will at the end give some guidelines about how to look after our well being during the lockdown.

We can look at biology,  psychological thinking and social factors. Obviously there are other factors that do affect our mental health, or expectations and the way we have structured our own thoughts. 

So some of the factors in relation to biological factors. We are a whole being. One of the major factors that could contribute to how COVID can affect us is how we were before COVID. Some of us have physical problems or mental problems.  Our baseline might not have been optimum. We  might have had difficulties before COVID.

So starting with a troubled  baseline obviously contributes to how people could cope or not cope at the time of the lockdown. The way the mind is structured. COVID is a shock to psychology, it is a shock to ourselves because when we live our lives we do not think about death or dying. We do not think of a bereavement or losing a loved one or losing a number of people. Death is a fact of live even though many of us live in the delusion that we will never die. Maybe it is a blessing from God that we come into this life without our choice and we leave without our choice. This isa  reality that we have to accept and it is all about how we deal with that reality away from denial and away from living in delusion.

Worries during the pandemic about finances, about our own needs about relatives about jobs – all the worries that were there before COVID do not disappear when COVID arrives. Actually there are more worries when the pandemic occurs. There are factors that are associated with COIVD. One very important factor is loneliness when people realise that they can’t mix with others.  Some people are extroverts and rely a lot for their mental well being on people in social contexts.  Some people are very comfortable with themselves spending time on their own but there are other people who rely on their mental well being by keeping social contacts. It is a good thing to have a mixture of the two – being comfortable with oneself but also having a degree of connection with others. 

During the time of COVID more people get ill, more people die, more people go to  hospital and less  people go to hospital for ordinary complaints because the hospitals are not open  for all services. And then there is worrying about jobs, about income, even about food. We have not had any food shortage but if I ask the question how many of us have thought or worried about the availability of food you will be amazed. Many people worry about the availability of food even though we have not had any problem with food. People rush to buy toilet paper and things like that. Maybe there are shortages in food availability. It may not last long but people still worry about the basics. So all these factors could contribute and could affect welfare.

Studies were started at the beginning of the pandemic from 2020. So about 50 percent of the population was anxious or worried  and this also happened in 2021. With each new wave  of COVID there are more worries and with each lockdown there are  more and more limitations. People who live in a flat alone and do not have a park to walk in feel really isolated. They are not confident about seeing an end to the pandemic. Young people are feeling more lonely, people who are unemployed and single parents are the people most likely to struggle.

 Most worrying 1/10 people in the UK reported having had suicidal thoughts or feelings. 8% in 2020 –13%  in 2021. Feeling of hopelessness at 18%, almost remained the same. Young adults (18-24 year olds), full-time students, people who are unemployed, single parents and those with long-term disabling health problems and pre-existing problems with their mental health continue to be significantly more likely to be feeling distressed, across a range of measures, compared with UK adults generally.

UK adults who have physical and mental health conditions are significantly more anxious about the easing of lockdown restrictions. Adults with pre-existing mental health conditions appear to be at greater risk of death and hospitalisation from COVID-19 than the general population, but at lower risk than some other high-risk groups.  Pakistani and Bangladeshi men have reported larger in MH wellbeing declines than White British men. There is a larger deterioration in MH among women than men: mostly seen within the White British population.

People are also concerned about the easing of lockdown. They may or may not trust the government guidelines. They think they may still get COVID. People are also worried about the new strains of the virus. They also worry that the vaccine may not be effective against new strains of the virus. 

While many adults are still accessing MH services, there is some evidence of a shift from face-to-face to virtual care. Loneliness has become much more common, increasing from 10% of those surveyed in March 2020 to 26 per cent in February 2021. Among 18-24 year-olds:48% Vs 26% among adults. Loneliness is unfortunately rising.

There was an increase in the proportion of parents reporting depressive and anxiety symptoms during the first national lockdown, but prevalence has remained lower than for adults living alone. There were higher levels of psychological distress, anxiety and depressive symptoms among carers than non-carers throughout the pandemic, but they were also more likely to report a greater sense of a purpose of life.

The good thing is that people are still able to access the mental health services. Mental health services are still open and even  there could even be  good access through virtual services. Services are accessible. They are probably more accessible than the general hospitals because the general hospitals are filled with COVID cases.

Loneliness is increasing. Young people are relying on the internet and on play stations. They were isolated before but when COVID happens they become isolated because they can’t socialise and have to limit the socialisation. So loneliness is a big issue. It was a big issue before especially among the older people  or the older adult population. It is a big factor which affects health. More work has to be done on enabling people to have social contacts.

It is good that COVID came after the internet. If COVID came before the internet we would be struggling now. We would not have seen our families for a long time. We are fortunate we can do conferences and video calls. There is a small percentage of older people who are not able to use the internet. Many elderly men and women do not know how to use internet.

I had the experience with some of my patients who were trying to have video conferences with their parents and grandparents and they were not able to do that. They were not able to do that during the pandemic as their grandparents did not have the technology and they did not know how to use it. It is not good for the people who do not know how to sue technology.

Single parents have more anxiety. This has improved a little bit since the first lockdown. It is still better for them than for others living alone.  The studies have also found a higher degree of psychological problems among carers than among non carers during the pandemic because of their responsibility.  They have a greater appreciation of the meaning of life looking after someone else. This indicates how our role as individuals helping others can affect our well being. The studies have found this very clear. Looking after someone else and looking after your neighbour, or looking after friends and relatives is a good thing for you and for them.

The general advice is to look after your existing physical and health issues: treat pain, take your medications, take vaccinations, take vitamin D etc Only 54% had the  booster. People have given many reasons for not taking the COVID vaccine. This is a big topic why people do not want to have the vaccine. I don’t think there has been any cynical trial with vaccines that has been done more than COVID. This vaccine has now been tested on millions and millions of people. And we have a lot of data about safety. Only about 50 percent have received their booster dose.

It would be a good idea to have your Vitamin D level measured. There is a big difference between the risk of hospitalisation and risk of death if you are deficient in Vitamin D.  People who are deficient in Vitamin D are more likely to be admitted as a result of COVID and they are more likely to die as a result of COVID. So take Vitamin D. It is cheap and it is available everywhere –  it is especially important for  people from a black background. We don’t have lots of sun in the UK so we don’t produce a lot of Vitamin D.

Stay active: return to usual activities. Do the things you were doing before in your home or flat and make them structured. 

Maintain your needs: social, spiritual, religious etc  It is all about acceptance of life and the changes.  Deal with any issue with alcohol/drugs/excessive smoking/excessive energy drinks. Make sure you have good sleep.  Practise acceptance. Do not moan all the time about how bad COVID is and how life is  bad and how situations are difficult. Start thinking and talking about positive stuff. We are happy to have the internet, we are happy to maintain contact. So talking positive and talking  to others in a positive way could boost your mood and reduce anxiety.

Do not get into disputes and arguments. Keep in contact with friends either by phone or by video calls. Try to lose weight. There is a connection between people who are overweight and those who get COVID. It will have an effect on boosting your energy and your self esteem. And look after others. Looking after others and having a role is very important.

 Schedule enjoyable activities. Practice being merciful to yourself, acceptance, commitment. Practice living with the pandemic, avoid dwelling on negative news etc Think positively, Speak positively with others. Remember good news are not good news, only bad news come to headlines.  

Gulamabbas Murtaza Lakha: It is a great pleasure to be with you this evening and my thanks to our hosts for their kind invitation.  I would like to pay tribute to our previous esteemed speakers who have provided such a rich back drop with context and detail about mental health during the COVID crisis.

I would like to share some information from my research to build upon some of those insights and specifically to focus on faith communities –  not only the challenges that faith have experienced but critically what faith communities can do about drawing upon the different dimensions of their religious teachings to be able to navigate the mental health landscape.

The academic literature on the psychology of religion has exploded over the last couple of years and the amount of empirical data that we now have on the relationships between religion and spirituality on the one hand and the experience of depression on the other is quite impressive. It is a  global data set.

Here in Oxford we have been looking at all of that. Firstly the experience of the UK Muslim population and how Islamic concepts and practices can be harnessed from a psychotherapeutic perspective for depression. And the second dimension is  engaging with service providers ranging from psychologists and psychiatrists to gp’s and trying to work with service providers in trying to address the needs of faith communities more broadly and the Muslim community specifically.

In terms of why bother? What is the point of this? What we see is that faith communities and the Muslim community in particular have a problem with stigma and the source of that problem ranges from community to family to the self.

And then the second dimension is accessibility. One of the big issues with psychotherapeutic intervention for depression like cognitive behaviour therapy or different forms of counselling is the range of interventions that are offered for depression. One of the big problems we have is accessibility for that. Quite often among members of a larger community there is a higher disease burden there but the problem is exacerbated by a reduced willingness to seek help. So not only is the prevalence of depression increased but the willingness to seek help, particularly psychotherapy is lower. So lowering barriers to access is critical.

And the third issue is adherence. If you have medication make sure you take it. Equally from a psycho therapeutic perspective if you are on a form of behaviour therapy like cognitive behaviour therapy or a whole host of other therapies you need to do your homework. You need to be able to implement those techniques in order to benefit for your mental health.

But adherence to those techniques is really difficult. And yet when we analyse the mechanisms the techniques of the major psychotherapies we find remarkable corelations with faith traditions.

So for my research I was focusing on depression. Different psychotherapies and interventions that are offered for depression on the one hand and well established and well understood cognitive practices from Islam. There are some remarkable corelations I would like to share with you because when we combine this conceptual analysis with the empirical data from Muslims who are suffering from depression as well as the clinicians who are providing services the needs for these points of contact becomes very clear in order to address these three points: stigma, accessibility and adherence.

So one of the things I was doing for my thesis was going through the NICE guidelines for depression. Nice is the National Institute for Health and Caring. It is the body in the UK that determines best clinical practice for a whole range of medical conditions and of course the guideline for depression is prominent in its influence across the clinical community and that provides a whole range for different therapies: CT dimension, mindfulness, problem solving, personal therapy, counselling,  emotive behaviour therapy and one of the first things I had to do was to go through the techniques within those interventions see what is connected to Islamic concepts and practices and  where the congruence may be.

From that there were ten contact points that emerged in two categories.  First it was about self knowledge. Thinking about our thinking. The more aware we are of our thinking the more equipped we are to be able to manage that. It reflects the teaching of Prophet when he says the one who knows oneself knows one’s lord. 

But the critical thing is that when you look at the etymology of  the word ‘arafa’ it is like experiential knowledge. It is  about knowledge  you gain when you walk the path yourself, when you look in the mirror yourself.

So if you look at the NICE guidelines and the interventions for techniques that are reflected in the Islamic concepts and practices, in the realm of self knowledge there are at least five: awareness of thoughts, awareness of emotions, mindfulness practices and we have a range cognitive practices, reflection and contemplation. And there is body awareness. And so much of the Islamic teachings are grounded in the body experience from prayers – the movements of salat, to fasting, the pilgrimage. Haj is so important. 

So if we look at the range of self  knowledge from the body, to the emotions to the mind and to different dimensions are reflected in the Islamic teachings. And will come to that in a moment as to where and how we see that.

Just to come to the second dimension. The second dimension is about resilience and flourishing. And we find five contact points there: optimism and hope  is a principle we see across a range of different interventions. And of course we find this is in Islamic teaching. Motivation in our lives. Gratitude positive psychology has so much empirical data on the benefits from a mental health perspective, maintain a sense of gratitude. We find these practices all over the Islamic tradition.

We have relationships which are so important not just from the point of view of managing anxiety and depression but from a spiritual point of view the ahlak teachings are rich in the importance of maintaining  good relationships. Relationships in a three dimensional sense: the relationship with God, the relationship  with ourselves and the relationship with others.

The final aspect  is  awareness of behaviour patterns such as holding ourselves to account both for the good and for the bad that we have. These are the ten  techniques that we see across a range of psychotherapeutic treatments recommended by the NICE guidelines.

So what do we see when you look on the other side and consider the Islamic teachings. If we look at the Quran just the first seven verses they have so many dimensions that can be used for optimism and hope as well as for relationships. Just to touch upon one concept of rahma where God is clearly introducing himself as the most compassionate, the most merciful.  The question is what difference does that make to one’s experience of oneself.

What I propose and this is very brief is with regard to rumination. Rumination is that process of thinking about events in the past. Like chewing an old piece of chewing gum when the flavour has gone. Or worrying about the future and not being in the present moment.

One of the common experiences of people with depression is that they live in the negative events of the past those that we have caused. Being kind to ourselves is really underestimated. In the duwah tradition the way we self sabotage and the way we deprive ourselves of mercy in is quite important particularly in the context of the daily prayers where we recite this chapter at least ten times a day. 

We can think about the legal framework of Islam like being the skeleton of the body that holds us up. The psychological teaching is like the soft tissue that gives life to  that skeleton. But we need that framework to hold us up so the lungs have the space required to be able to function.  Prayers provide the opportunity to come back regularly and quench the thirst  to stop the rumination, to rejuvenate our sense of hope and our sense of agency. 

Islamic practices are increasingly being  analysed. We brought members of the Muslim community. We took some EEG’s during certain practices and the results of that were really quite encouraging about the way in which the brain responds when the mindfulness practice is based on seyas. Seyas is that matters to you. 

That is reflected in neuroscience  across a range of different faith communities. There have been studies on pain tolerance with people from the Catholic tradition So we can harness our faith to be able to withstand the challenges we face, to be able to bolster our resilience.

In the interests of time I would like to conclude with just a very simple example. I will speak about motivation and agency. Which agency?  In a nutshell this is one of the first casualties of the experience of expression.  This is about being the driver in your own car. All to often people feel they have been shoved into the back seat and other forces are driving their car.  They do not know where to go and they also feel hostage in their own car.

Agency is about taking back control of the steering wheel. Sometimes the car goes of course in a direction we do not want it to go and we need to steer it back.  With the obligatory prayers half a dozen times a time when we are on the ground how do we get up again? That process from going from a position on the ground back to our feet often comes with the recitation that by the strength and through the power of Allah I rise regardless of how I ended up on the ground.

Whether  there is economic injustice that is pushing me into the ground or whether it is through my own folly that I ended up on the ground through the process of renewal and rejuvenation and through the practical application of rahma, compassion, through tapping into  a greater strength when I  may feel broken and powerless I can get back up on my feet once again.

When we discuss these experiences with Muslims experiencing depression as well as clinically the service providers and how clinicians can help Muslims connect with the concepts presented in psychotherapy are well known in the faith tradition.  How can we dispel the stigmas that are out there and spread the ideas of all faiths. 

When we look at the experience of Jacob the Quran says that his eyes had turned white. I would translate this as grief or sadness or depression. He goes on to teach how important it is to use the faith tradition that we have to get back up. To be able to drive through that area of difficulty using every vehicle.

By looking at different contact points in Islamic history we have one participant who was a mother and recently lost her child in the late stage of pregnancy. And her family  said don’t be sad, don’t grieve have patience. But she was a mother who had lost her child. She wanted to grieve and it is only when she reflected on the history of the Prophet Mohamed and how he grieved in his young childhood when he wept and grieved and this enabled her to explore her own emotions and release them.

So  when we reach out to our community in the time of COVID when we face a range of difficulties let us make sure that we do not ignore the tremendous resources that we have in our faith communities and bring them to bear on the challenges we are facing.

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