In 2015, a never-before-seen coronavirus called Middle East Respiratory Syndrome, or MERS, made its way to South Korea. The outbreak ultimately infected nearly 200 people in the country, most of whom worked in the health care sector. About three dozen died.
"People were so shocked at the time," recalled Dr. Sun Jae Jung, a preventive medicine specialist and psychiatric epidemiologist who was working at a hospital in Seoul during the outbreak. "It didn't have any vaccines. It didn't have a treatment."
Fear of the virus ripped through Korean society, Jung recalled. The mental health repercussions of the contagious disease weren't widely acknowledged. Health workers and people in quarantine lacked psychosocial support and suffered from conditions such as post-traumatic stress disorder, PTSD.
"People were so frustrated that I think they didn't even recognize it's a mental health issue. So they were mostly focused on the biology of the virus and your fatality and how to prevent [it], but not about the mental health issues or of the frustrations or anxiety," Jung said. "They did not talk about it at that time."
Five years later, it is clear the new coronavirus pandemic is causing a worldwide crisis in mental health as it makes its way around the globe, destroying lives and livelihoods. The United Nations has urged governments to take mental health consequences seriously. Previous infectious disease outbreaks, from Ebola to SARS, are now informing present-day virus responses. It helps that the global spotlight on mental health has grown in recent years.
In South Korea, Jung said, she and others in the medical field wanted to prevent the mistakes made during the MERS outbreak. When COVID-19 emerged in the country in late January, they were keenly aware of the serious mental health challenges that could follow. Jung, who specializes in psychiatric epidemiology at Yonsei University College of Medicine in Seoul, began conducting surveys on the mental health of the general population. The results have yet to be published.
"People were more anxious and [had] more acute stress symptoms," Jung said. "A lot of people reported they have issues in sleep, and also they have issues in anxiety symptoms — like they have a palpitation — they have some kind of panic symptoms."
Lessons from MERS
After the MERS outbreak, Jung and other health professionals came to realize that working on the medical front lines, or being infected and put in quarantine, could lead to acute stress, anxiety, and PTSD. Those mental health issues were on top of broader anxiety people often felt about the possibility of getting sick and having their lives disrupted.
Health professionals, who were likeliest to be infected, faced an additional layer of stress during the MERS outbreak: They went from being a highly regarded sector to being almost vilified, with the stigma of the disease casting blame on those who were infected or at risk of spreading it.
This time around, teams of psychologists in South Korea have been working with patients who are in quarantine for COVID-19, and more psychosocial support has been set up for hospital workers.
But perhaps most notable, Jung said, is the shift she has observed in Korean society: People are talking about mental health. They even devised a term for pandemic-related emotional problems, especially after everyday life came to a halt.
"We don't say corona depression, but we say 'corona blue'," Jung said. "I mean, like, everyone was depressed."
South Korea has experienced less than 300 COVID-19 deaths and had some 11,500 reported cases. The growing acknowledgment of "corona blue" has spread to other countries, too. Singapore, for its part, elevated mental health awareness in the wake of coronavirus.
Early on in the coronavirus pandemic, Silver Ribbon, a group mental health agency in Singapore, set up virtual counseling services and tried to raise awareness about the emotional impact of disruptions to everyday life — such as social distancing, loss of physical connections, and staying home.
"We started receiving more calls," said the group's director, Porsche Poh, who is also a board member of the World Federation for Mental Health. "And many people are sharing that they were experiencing anxiety."
In response, her group has been reaching out to the elderly, who might not be as tech-savvy. They are also organizing virtual events and concerts to encourage people to connect with one another, come forward to get help, and find ways to cope.
Musician Eugene Yip Goh Mingwei joined one recent virtual concert hosted by the group.
"I've been through mental health issues in the past, and this really kept me going," Mingwei said. He then sang a cover of "A Little Braver" by New Empire to participants on the call.
Increased global awareness
The last decade has seen a shift in mental health. Awareness has increased worldwide.
A turning point came in the late 2000s, when The Lancet, a leading medical journal, established a major commission on global mental health. The United Nations and the World Health Organization have made mental health a priority on their global agenda, and they've issued guidelines on recognizing and treating psychological distress from COVID-19.
A growing body of research shows mental health interventions can be effective around the globe in a variety of settings, from refugee camps to urban centers.
Dr. Vikram Patel, a psychiatrist at Harvard Medical School, has spent the past few decades spreading awareness of and access to mental health services worldwide.
"It turns out that psychological pain, just like physical pain, is a fundamental universal human experience," he told The World last year. "And I think this is a very powerful piece of science because it suggests to us that knowledge around how you can help people with mental health problems recover that has been generated in one context, can have great application in other contexts."
Expensive specialists and formal therapy are not the only ways people can build coping skills. Community members can receive training in counseling, and there are some core methods that people can adopt to manage anxiety and depression. That includes identifying and doing activities that bring people purpose and enjoyment, and can help break cycles of destructive thought and behavior. Other simple techniques that all kinds of mental health specialists recommend include breathing exercises.
Still, Patel worries that even while the psychological toll of this pandemic is just beginning, mental health is "being shoved back into the shadows."
Though there is now more awareness about mental health, he said, it is unclear whether governments and health care systems will innovate and invest resources to better respond to the long-term psychological repercussions from COVID-19.
"The widening of inequalities in countries, the continuing uncertainties about future waves of the epidemic, and the physical distancing policies begin to bite deeper into our mental health," Patel told The World in an email. "Mental health care systems in most countries will be ill-equipped to deal with this surge, not only because of the paucity of skilled providers but also because of the narrow biomedical models which dominate mental health care."