However, although the ambulance came twice, they couldn’t provide help as none of the medical services in Sofia agreed hospitalized her, referring to the fact that she was lice-ridden and could pose a sanitation problem to others. All attention is now focused on potential COVID-19 victims and that means there is no place for those who have other health issues, especially when they are poor, belong to socially disadvantaged groups and are on top of that considered potential bearers of infection. After trying for several days, unsuccessfully, one of the mental health teams found her one morning lying on the floor: she passed away, in complete social isolation.

To most of us, “social distancing” is difficult. It creates anxiety about the future and results in emotional stress and tension between people who are not used to being locked up together for long periods of time. Domestic violence is on the rise (in France 30% more since the country went into lockdown on March 17), and so is divorce (30% more in affected areas in China). The uncertainty about our economic well-being intensifies the stress, and if one looks at the economic prognoses there is ample reason for this. The numbers vary, but the longer the lock down lasts – and there is no end in sight – the worse the predictions. In Lithuania it is expected that the economy might shrink up to 20 percent, figures in other countries are maybe a bit less shocking but still suggesting a recession that will be much deeper than the 2008-2009 one. One thing is clear: most of those who are rich will survive relatively unscathed and might even become richer because of sudden opportunities. Those who are living in poverty will become even poorer, when the few possibilities to remain afloat will also disappear.

The truth is that we are in fact entering uncharted territory, because a global lock-down is an absolute novelty, never experienced before. Thanks to modern technology, we are living in a global world, where everything is interconnected and most boundaries have disappeared, save a few places such as North Korea and a few native tribes in the Amazon who so far have remained untouched by “modern” civilization.

Crises invariably have a global effect, as we can now see every minute of the day on our computer and telephone screens. Modern technology also provides us with the means to work from home and keep some businesses afloat through virtual operations, but it also has a severely damaging effect because of the barrage of often contradicting information. We are overwhelmed by emotional, sometimes inflammatory messages on social media, resulting in increased anxiety, panic and depression. We fear the world we knew is lost, we have lost all sense of security because there seems to be no exit strategy, at least not for the short- or medium term, and all our plans are on hold because of these apocalyptic feelings. This in turn sabotages the whole idea of continuing business virtually, because people stop doing things altogether, paralyzed by this dark tunnel in front of us.

But how is it for the more disadvantaged in our societies, who were always experiencing “social distancing” because of stigma? Even in the more affluent societies persons with mental illness were disadvantaged, usually in need of special programs to remain part of society, and often living in social isolation in special housing programs, making use of programs that offered supported employment and visiting day centers to fight isolation, depression and suicidal thoughts. We now see that they are the immediate victims of the current crisis. For us social distancing is hard, for them it is murderous, and we can expect many more situations such as the one in Bulgaria where a client was left to die.

In most countries, even those that could have afforded good mental health care services,
mental health care has been structurally under-financed and under-developed, making clients dependent on the goodwill and support of non-governmental organizations and volunteers. The economic crisis that is now heading towards us like a life-threatening thunderstorm, will threaten the existence of many of these NGOs and will severely reduce the number of people who have time, energy and sufficient economic strength to continue volunteering (not to mention the effect of fear of becoming infected due to unsanitary conditions). And even where good mental health care services exist, these will be overwhelmed by waves of clients who suffer from depression, anxiety and other mental health issues.

In the discussions about COVID-19 there is often a lack of understanding how this focusing on the immediate victims of the pandemic will result in deaths elsewhere down the line. Surgical operations are postponed everywhere, health care staff is redirected to meet the COVID-19 challenge and becomes overwhelmed, people are afraid to report to health care services either out of fear of being in the way or because they fear they will get infected. Dutch research shows that at this moment about 50% of normal health care services have come to a standstill. In the longer term, the economic crisis will result in less investments in good health care, which as a result will be even less able to meet the needs of the population. All in all there is a fair chance that more people will die because of this fallout than those who will succumb to the COVID-19 pandemic itself. In Greece, the mortality rate went up considerably as a result of the economic crisis of 2008-2009 and the subsequent imposed austerity program that slashed the GDP with almost 30%. The increase was particularly painful because most of the deaths were caused by well-treatable illnesses. However, the combination of a 30% reduction of health care financing and a large increase in the number of people without health care insurance, turned out to be lethal. There is no reason why the same should not be waiting us in the near future.

But again, like before, those with mental illness will pay the highest price, because for them “social distancing” was already a daily reality, and it will now be combined with more stigma, less interest and a much smaller support system. Furthermore, while those who have no mental health issue might have bouts of anxiety, or feelings of panic or depression, for persons with mental health problems these feels are infinitely stronger, increasing the need to a professional response and a well-developed support network. The combination of the absence of such and the image of a dark period ahead will have enormous repercussions.

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