Surviving stay-at-home: Looking after your mental health during the coronavirus crisis

The coronavirus pandemic is an unprecedented crisis affecting everyone around the world. Belgium followed other European countries in introducing a raft of measures aimed at curbing its spread, including strict rules about staying at home, as well as social distancing.

We have all experienced disruption to our lives and for many, this means heightened anxiety and social isolation. It’s a particularly difficult period for people with existing mental health concerns and for those who may be facing problems for the first time.

To address some of these concerns, The Bulletin talks to clinical psychologists Lisa Classen and Marie-Thérèse Kastl at the Community Help Service (CHS) in Brussels, a mental health centre, educational testing service and 24-hour crisis helpline. The non-profit operates in English and also offers therapy in other languages.

How has CHS adapted to this period?
Lisa Classen: We are all working online; we do Zoom, Skype, Whatsapp. We have gone through a shift where we were feeling really daunted last Monday, and although face-to-face consultations are much nicer, working this way has a different intensity and a nice quality. Our volunteers are super motivated and go into the building one by one from 10.00 to 13.00. The helpline is still running and volunteers at the mental health centre are taking telephone calls.
Marie-Thérèse Kastl: Many of our clients have wanted to continue therapy on the phone, despite the change, it’s really interesting to observe that.

How have your clients been reacting to the situation?
MTK: Some people are more in denial, others are getting super anxious and some strangely are so wrapped up in their personal issues that they are not apparently affected by it. There are some poor mothers who have to cope with home-working and children and housework and are finding it hard to have five minutes to take care of themselves. Having time for yourself is one of the big challenges.
LC: For those who were already suffering from anxiety, this is exacerbated. It is also bringing up other incidents like 9/11 and old traumas. One common theme is that employers can still be demanding when people have to juggle work with looking after their kids and organising school work. So there’s a need for some kind of rhythm and continuity. In other households, there’s a special kind of isolation for people living alone. A common symptom is that sleep is impacted.
MTK: In the beginning, we all thought we could read all the books we’d never read, but it doesn’t work that way. People are really exhausted. There are less social commitments and it may feel wonderful to begin with, but there’s the commitment to watch the news, the commitment to the family, to be on social media… And then there’s the financial aspect, with many people facing uncertainty. Some clients have said they can now better understand the generation who experienced World War Two.

What are the current and longer-term mental health challenges?
LC: We have had a boy who was hospitalised as an emergency after a suicide attempt. In the adult team, it has also happened twice this past week and it was hard to find facilities. It is difficult to create a safe support system at the moment, so we are having to be very flexible.
MTK: There is an unknown element over the period of confinement. If it is extended, it may be difficult for some people to adapt to. We deal with the possible future anxieties.

Are there any particular difficulties for expats and the international community?
LC: I think it’s more on the feeling side, as this is a time when we want to connect to our close ones. I think even people in Brussels who have been here forever have the same problem, as people can only connect online. It’s important to get good advice on the local context of the corona crisis.
MTK: When expats are ill, they find it much harder to trust and rely on the local hospital system and doctors, because they don’t know it very well. It feels less reassuring. They can also get confused between the news they get from their families abroad compared to the information here. So it’s really important to follow at least one Belgian news channel, otherwise the disconnection adds to more confusion and complications. It’s important to be connected to what is going on locally.
LC: English-speaking sources in Brussels matter a lot. We can help with our helpline and the Brussels Childbirth Trust is also a good source. Some young mothers are not wanting to go to the hospital if their child has a problem. There’s a lot of disinformation, but they can still go to the Queen Fabiola children’s hospital.

What are your recommendations for families?
MTK: Different age groups have challenges in different ways, so it’s about finding the right balance of time with them and respecting their privacy. Some teenagers feel that if they’re stuck at home with their parents, they have to share activities together. Adolescence is already a challenging period for parents. They need space and most of them have their own rooms, so it can be useful to put up ‘do not disturb’ signs on doors. With children and adolescents, we recommend doing things together so they have space to express themselves and their feelings.
LC:  For younger children, it’s really about staying as calm as possible as an adult and for that you may have to get support from someone else. Keep a good rhythm between occupying them and letting them play. You can be a bit more flexible at times, for example, about watching TV.
MKT: Perhaps with children, you can find a way to explain to them what is happening for their level of understanding, for example, about social distancing. The Anna Freud organisation in London has some good suggestions on how to talk to children.
LC: Another useful organisation is childmind.org in New York.
MTK: It’s important for children to know they can trust adults and the doctors who are in charge, and that they are doing their best to take care of the situation.

What are the additional stresses of juggling home-working with childcare?
LC: What has come up in several sessions is that families with kids who are also expected to work from home feel very stressed. Of course, they will work less, but if their employers can give them authorisation for that, the stress is decreased. We can work then on realistic expectations in this new situation about a possible work/family scheme and how that could be communicated to the employer.
MTK:  A little word for the mothers who don’t work, but who may have partners working from home and they need to have some alone time, so they can do something to nourish themselves. One mother introduced one hour after lunch when everyone went to their rooms for quiet time with no conversation.

What are your recommendations for looking after your mental health?
LC: For social media, what makes a lot of sense generally is to choose your sources, those which you really trust, government or otherwise, and to reduce your consumption. It is good to do things that are separate from corona. It makes sense to structure your day and also incorporate things from before, like a nice book. I had one patient who has just arrived in Brussels for her job and she doesn’t know many people. We were talking about what nice things she could do and she is going to order a musical  instrument and join an online class as music has always soothed her.
LC: Several patients have already joined various initiatives in Brussels and this is also a way to stay healthy.
MTK: It can give you a good feeling when you are the one who can help. We also feel that as therapists, it’s nice to be able to offer help.
LC: I advise my patients to turn this unmanageable big chunk of time into more manageable units. A structure is important: How do I start the morning and how do I organise my day? It’s helpful to get dressed, prepare regular meals, cook nice things together, do many hands-on things together, try out online yoga, go for walks, and you can still meet with another person for the time being if you keep a social distance.
Sense of safety and security are key words for everything. With very vulnerable clients you go through with them, with whom is it safe to have contact right now? How can they be aware of their supportive online network and where do they feel safe?

General advice on coping with the coronavirus restrictions:

• Control how much news and social media you follow and use reliable sources. Regularly switch off.

• Maintain online or telephone contact with colleagues, friends and family, whether for work or social get-togethers. Consider reaching out to people who live alone or risk being vulnerable.

• Establish a daily routine that includes self-care and regular exercise, whether outdoors or indoors.

• If you have free time, consider learning a new skill or enjoying your favourite hobby.

• Anxiety is normal, but try and maintain a long-term and positive perspective. There may be many people in a more precarious situation than you.

• Get involved in neighbourhood and citizen initiatives, from volunteering to joining in the applause for frontline workers every evening.

• Seek professional support if you have difficulty coping. Many support organisations offer remote consultations.

• If you are home schooling your children, set a routine, but factor in time for play and relaxation for all the family.

• If you are juggling working from home and childcare, set boundaries within the family and with your employer if necessary 

Useful links

Association Belge de Psychothérapie/Belgische Vereniging voor Psychotherapie
Belgian association of psychotherapists (Fr & Dutch)

ADHD – ASC – Dyslexia Family Resources Belgium
Multidisciplinary network providing support to English-speaking families

ANBN
Online and phone advice from Leuven centre on eating disorders (Dutch)
016.89.89.89

Alcoholics Anonymous
English-language meetings in Continental European Region

Brussels Childbirth Trust (BCT)
Support for families and parents-to-be (in English)

Brussels Mindfulness Institute
Anti-stress therapy plus courses for mindful parenting

Buddywerking
Flemish support project for people with mental health conditions

Community Help Service (CHS)
24/7 telephone hotline offering support and advice in English. Plus mental health services centre for adults, children, adolescents and families, consisting of a multidisciplinary and multilingual team.
Helpline: 02.648.40.14
Mental Health Centre: 02.647.67.80

Le Chien Vert
Mental health support for children, adults and families

CRéSaM
Reference centre for mental health professionals and services in Wallonia.

Fédération Belge des Psychologues/Belgische Federatie van Psychologen
Belgian federation of psychologists (Fr & Dutch)

Ligue Bruxelloise Francophone pour la Santé Mentale
Alliance of mental health professionals.

Mens Sana
Online information for chronic mental health conditions, in particular schizophrenia (French)

Mental Health Europe
Umbrella organisation representing mental health associations in Europe

Plateforme de Concertation pour la Santé Mentale
The mental health association serves French- and Dutch-speaking people

Psygroup
Multilingual centre in Etterbeek run by association of independent psychologists. Offers therapy and coaching

Similes
Support for families and friends of people suffering from psychiatric and psychic problems. Associations in Brussels and Wallonia (French) and Flanders (Dutch)

Schizophrenia 24x7
Support for sufferers of schizophrenia and psychosis (French/Dutch). Platform provided by Janssen pharmaceutical company

Ups & Downs
Self-help for people with bipolar disorder and chronic depression

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