3 Insights about mental health during COVID-19

6 stories, 3 insights, and 3 opportunities within the landscape of challenges related to mental health in the era of COVID-19.

“I felt paranoid every time I had to touch the handle bars as I alighted from the bus. I would wash my hands every time I touched something. I hated the fact that we had to travel to work when everybody else could work from home.” Jane is a 28 year old kindergarten teacher living in Singapore, and one of billions of individuals facing the impacts of the COVID-19 pandemic. Her reflection is a glimpse into how, in spite of our shared global realities, all individuals are living through uniquely different contexts.

Over the past few months, the COVID-19 pandemic has fragmented the structures of life as we knew it. Individuals everywhere have pieced these fragments together in new, unique patterns that affect their mental health in various ways.

At the Emergency Design Collective, we are investigating the mental health impacts of the COVID-19 pandemic. Over the past month, our team of mental health specialists, designers, and innovators has conducted over 20 in-depth interviews with individuals all over the world who shared their unique mental health experiences during the COVID-19 pandemic.

While conducting exploratory interviews, our Emergency Design Collective team crystallized insights about feeling out of control, developing coping strategies, and supporting vulnerable communities. In this article, we share these three insights illustrated by interviewee stories and discuss three key opportunities for progress.

1 | When risks are invisible and largely outside of individuals’ control, anything can feel like a threat.

“This pandemic has flipped my life on its head.”

— Charlotte

Charlotte is a 30-year-old living in a small city in New Zealand. She started self-isolating in early March, two weeks before her colleagues due to concerns about her immunity, and she began feeling the effects of isolation early on in the pandemic.

“My bubble consists of my fiancé and three cats,” Charlotte shared. “I miss hanging out with my friends. I haven’t had many since I moved here and was starting to have a bit of a social life before the lockdown.”

Reflecting on her situation, Charlotte remarked, “I have enough room and am in a safe environment. Our house is large enough for my fiancé and I to have our own offices to work from home.” While her quarantined work-from-home setup is helpful, it takes a toll on work-life balance and mental health. For example, Charlotte noted, “I am spending more time in my office as I try to have voice chats with friends to help boost my social meter.”

The pandemic has affected the cadence of her life in an especially severe way due to her experience with depression and anxiety. Charlotte explained, “I have depression and anxiety, so being in lockdown has amplified those thoughts and feelings… I’m a worrier normally, but between the stress and anxiety, most nights I struggle to get more than 3 hours of sleep [with] insomnia and eventually [end up] oversleeping 14+ hours. I have had a lot of mental breakdowns over the past 6 weeks. I don’t think two days have passed where I haven’t bawled my eyes out.”

Often, Charlotte feels trapped in isolation and uncertainty about the momentous ways the COVID-19 pandemic has impacted her future, but she also misses the small, charming details of pre-pandemic life just as much. She shared, “I was planning on moving to another country before the pandemic and I have to delay that plan… until the situation improves. I also miss having control over my life — this pandemic has flipped my life on it’s head. I want to go to the pet store. I want a dog and I miss petting dogs. However, I probably won’t be doing that for a long time.”

“I want this to be over… I want the uncertainty to be gone. ”

— Anne

Based in Denver, Colorado, Anne is 32 years old, newlywed, pregnant with her first child, and facing the dangers of being an essential warehouse worker during the pandemic.

While some of us can occasionally grasp at a pre-pandemic sense of normalcy for comfort, for Anne, not much has stayed the same. “It’s hard to get people to follow the rules in the warehouse,” Anne said about her workplace in Denver, Colorado. “There is so much pushback […] We had to send people home because they’re not following the rules.”

Not able to properly protect herself because of work, not able to feel safe at her pregnancy-related doctor appointments, and not able to openly share her struggles with others, Anne reported feeling helpless and concerned about her situation.

“I have to go to the doctor and it’s a really serious thing. I’m even less willing to tell people that I’m pregnant. I’m in the first trimester and we don’t know how COVID-19 affects pregnancy. It’s a little hard to celebrate as much as we would want to. It makes me sad.”

Anne’s sentiments might resonate especially strongly with those of us going through major life changes, experiencing precarity in different forms, or just craving some clarity about the future. There’s a raw emotion captured in Anne’s emphatic words, “I want this to be over. May I have some answers, maybe a plan? I want the uncertainty to be gone.”

Stories like these help illustrate that when risks are invisible and largely outside of individuals’ control, anything can feel like a threat. Some common key stress factors include feeling isolated, observing others violate social distancing guidelines, worrying about how loved ones are protecting themselves, and experiencing extreme, abusive, or violent living conditions.

2 | New realities require completely new habits and routines.

“I was angry today at COVID. Not at anyone, just at the situation.”

— Frederick

Frederick is a New York-based professor in his 40s, living with his spouse and three young children. Amidst the pandemic, Frederick is grieving the loss of his father after a long illness unrelated to COVID-19, while simultaneously struggling to cope with his overwhelming additional responsibilities due to the pandemic.

“The world is changed,” said Frederick. “We are being conditioned into distancing and being somewhat nervous. I don’t know what post-pandemic will bring, but my guess is that it won’t be the same.”

Speculating about what is next, Frederick wonders if the ‘new normal’ is the future we should expect. “I’m not sure how I will approach shaking hands and hugging people. I guess I can’t even say that I look forward to picking up a pizza without being worried about it, and it’s hard. You will never know if there will be a surge or not.”

A more immediate concern for Frederick was the heaviness of loss and how to cope with grief while supporting those who rely on him. “I’m unable to deal with the parent I lost because I have three kids under the age of 6, and it’s a full-time job,” Frederick shared. “I was angry today at COVID. Not at anyone, just at the situation. I feel I have five people [to take care of]. That’s a lot of people, and my mom is just one person.”

There is a pressing need for humans to have relevant coping strategies that help them deal with extreme emotional states affected by the COVID-19 pandemic. Like Frederick, many individuals may be learning the ways in which uncertainty about the future can affect their ability to cope with issues of the present.

“I can’t go and give them a hug. The normal human thing is to be physically present.”

— Gail

Gail is a software company CEO in her 40s, based in Portland, Oregon. During the pandemic, she is grieving the loss of a friend’s teenage son, who died by suicide.

“He was just a kid, he felt that alone, he died at home, under the shelter in place.” Gail reflects, as she processes her own grief and helplessness. She said, “It is very hard to not be there to support a loved one when they are grieving. I can’t go and give them a hug. In a normal world, I would fly and rent a hotel room, and now I don’t feel comfortable doing that. The normal human thing is to be physically present.”

Gail’s distress poses the question of how one might cope with a loss that is already so painful, when our usual ways of coping are unacceptable during the pandemic. Given the imminent uncertainty about the future, and the increasing occasions of grief during the pandemic, more and more individuals are encountering Gail’s dilemma of wanting to be there for loved ones, without the luxury of truly “being there”.

The insight that became clear throughout these interviews is that new realities require completely new habits and routines. Our survey results of coping strategies include mindful self-care activities to combat exhaustion and failing work-life balances, as well as trends of increasing honesty and comfort in individual interactions. At the same time, paranoia about the pandemic, widespread misinformation, and the emotional toll of losing loved ones weighs heavy on people everywhere.

3 | Increased risks and stress have disproportionately impacted vulnerable populations.

“I hope this opens the door to more minorities caring for other minorities.”

— JP

JP is an Asian American in his mid-20s working in the tech industry in California. In his pre-pandemic life, JP describes regularly confronting the pressures of the model minority myth. Now, those struggles seem like “innocent pressures” to JP, compared to the exacerbated experience of being perpetually perceived as a foreigner during the pandemic.

JP shared how his experience, along with those of countless Asian Americans during the pandemic serve as a reminder that xenophobia and white supremacy are still prolific and current issues in America. According to JP, the COVID-19 crisis has created a new context for people to voice, display, and project their internalized fears and biases.

In spite of being more scared about his personal safety than ever before, JP noted that the heightened racial tensions during the pandemic can be a productive opportunity for Asian Americans to empathize with and support other people of color. On the topic of supporting BIPOC in America, JP commented that “Asian Americans and Pacific Islanders should be even more attuned to [other ‘minority’ groups’] struggles given highlighted experiences due to Corona. Not quite apples to apples, but I hope this opens the door to more minorities caring for other minorities.”

More broadly, JP posed the question of how we might find ways to care for those whose struggles are different from our own and not necessarily personally relatable.

“We need better facilities to reach vulnerable communities.”

— J

J is a social worker living in the Bronx in New York City, where he cares for patients at the lower end of the income spectrum. The pandemic shifted his in-person care patients to telemedicine, which is only a viable option for those with resources like reliable internet and a level of tech literacy.

“Everyone has a different environment at home, and [adjusting] has been a learning process for patients,” J said. “Telemedicine companies haven’t really been helping us with this transition. We need better facilities to reach vulnerable communities.”

Healthcare equity and support for low-income individuals in under-resourced neighborhoods is an imminent issue that the pandemic is magnifying. “The fact that we’re not physically going to these communities could be bad,” J expressed, “We need to […] engage and find communities in need and supply them with resources.

The issue of access to healthcare is one that is “even more exacerbated with the homeless population,” according to J. His firsthand experience and empathy with low-income patients in the Bronx sheds light on how our existing systems are not adequate for those communities, and how individuals in power must invest more time and resources into communities that are most vulnerable during the pandemic.

Illustration by Dorothy Estelle Monares

Perspectives shared by JP and J help demonstrate that, especially in America, increased risks and stress have disproportionately impacted vulnerable populations. Contributing further to mental stress and anxiety is the fact that racism targeting BIPOC is rampant in all dimensions of society, and access to critical healthcare resources during the pandemic is inequitable across socioeconomic groups.

At the Emergency Design Collective, we used our insights about mental health during COVID-19 to extract the following three questions:

What are the ways in which individuals are feeling out of control and anxious about their situations?
How might we enable people to discover and develop coping strategies that are culturally competent and adequately sensitive to their internal and external states?
How might we support vulnerable communities and help them feel heard and seen through their unique challenges in this time?

Based on these open questions, our team identified the following three key opportunity areas.

1. Co-design protocols that can flex as public sentiment shifts.

Dealing with the unknowns of COVID-19 and the fears it surfaces requires our protocols to remain flexible as new information and new behaviors emerge.

2. Empower people to explore and iterate new ways of coping.

Periods of transition are always opportunities to examine and create new behaviors, which often leads to lasting change by habit-formation.

3. Co-design for the greatest needs first, to everyone’s benefit.

By prioritizing the highest, most urgent needs, we will lead by creating safe conditions for the most vulnerable communities, which simultaneously benefits all groups. Engaging those at risk to participate as they can in the co-creation of solutions ensures relevancy. Engaging those with more resources ensures reach.

Like Charlotte, Anne, Frederick, Gail, JP, and J, our team is navigating our new contexts one step at a time. We hope that together, we might empower our communities to nurture and support their mental health throughout the pandemic and beyond.

Equipped with design opportunities, our Emergency Design Collective team recently wrapped up an ideation phase, during which we developed an initial low-fidelity prototype to demonstrate our thinking. We are actively looking for collaboration partners focused on initiatives that support people’s mental health and wellbeing during COVID-19, and are particularly interested in projects that serve our most vulnerable community members.

If you’re interested in getting involved with the Emergency Design Collective, get in touch with us here: https://emergencydesigncollective.com/get-involved

Emergency Design Collective Team members: Tracy DeLuca (Design Lead), Natasha Fong (Project Management Lead), Erika Johnson (Designer), Elena Vasconi (Contributor), Hannah Lael Martin (UX Researcher/Designer), Whitley Kemble-Williams (Researcher/ Designer), Marina Terteryan (Service Designer), John Park (Researcher/Product Strategist), Sherylene Chan (Service Designer/Researcher), Alison Sizer (Market Strategist), Komal Trivedi (Contributor/Researcher)