When we talk about disasters or a crisis, we often focus on the disruption and stress caused by the index event or occurrence itself. In the case of Covid-19, it’s the health impact of the virus on people and communities. However, secondary stressors are circumstances, events or policies that are indirectly related to or are a consequence of an emergency event, which result in emotional strain among affected individuals and make it more difficult for them to return to what is perceived as normality. Examples of secondary stressors include ongoing financial strain, conflict in families and couple relationships, job insecurity and/or loss.
In this case, policies designed to contain the outbreak may have larger social and psychological consequences than the virus itself – at least at this stage.
In his psychosocial recovery briefing paper following the earthquakes the (then) NZ Chief Science Advisor to the Prime Minister recognised that the population had been exposed to multiple acute stressors of the four damage-causing earthquakes, in addition to the chronic and cumulative stress of the numerous aftershocks that were generated by them.
“there is an inherent threat in the continuing aftershocks that can last for many months, exposing people to recurrent acute stress, while at the same time chronic stress is imposed by the on-going human, economic and social costs” (Gluckman, 2011)
Looking internationally, a research review in 2012 identified 11 categories of secondary stressors including: economic stressors such as problems with compensation, recovery of and rebuilding homes; loss of physical possessions and resources; health-related stressors; stress relating to education and schooling; stress arising from media reporting; family and social stressors; stress arising from loss of leisure and recreation; and stress related to changes in people’s views of the world or themselves.
In the case of the Canterbury earthquakes here in New Zealand, for many (but not all), the impact of the secondary stressors, especially the EQC quagmire, were more pervasive and more distressing than the earthquakes themselves.
And we also know that the effects of disaster on the already disenfranchised gets magnified in times of emergency – we can predict that those that have less of a voice or influence may also not do so well in this Covid19 outbreak and its consequences too.
Redeveloped in 2016, the New Zealand Ministry of Health’s ‘Framework for Psychosocial Support in Emergencies’, says this about secondary stressors:
Examples of secondary stressors include ongoing financial strain, conflict in families and couple relationships, job insecurity and/or loss, difficulties in insurance claim settlement, repeated relocations, and having to give up pets when moving to other accommodation.
For some people, the secondary stressors that follow from the disruption and dislocation an emergency creates may have a greater impact than the primary event. These ongoing, unresolved factors may result in emotional distress and hinder people as they try to reconstruct their lives, livelihoods, families, social attachments and communities. Research indicates that the role of secondary stressors in developing and maintaining significant distress may have been underestimated and may significantly delay and complicate people’s adaptation after an emergency. It is critical to understand secondary stressors as a significant risk factor and to take steps to learn about their nature in each emergency so that they can be reduced effectively.”
Up until now, the most prominent lens through which this Covid-19 event has been viewed is through ‘Health Impact’ and ‘Economic Impact’. Now these policies of border control have been enacted (amongst others), it is important to view these through the lens of ‘Problems of Living’. For many, it is not mental distress they will experience directly. It is much more likely that they will be worried about paying bills, rent, mortgages, other outstanding debt, and having enough food to eat, clothes to wear, and money for transport, power and heating. The basics.
Front-line services may be dealing with an upsurge in people requiring help with anxiety, but it’s important to understand the cause of that anxiety. As well as fears about the health impact of the Covid-19 virus and what it might mean, the very real pressures on daily living will become acute for many workers in the tourism, hospitality and service industries, and as well those working as freelancers and self-employed in the ‘gig economy’. These people have no access to sick pay, holiday pay, or many other other benefits. If they’re not working, they have no income, and it’s unlikely that they have much in the way of savings to call upon. This is just to start with. It will ripple through.
When the Government unveils its support package today, it will be critical for them to track who is affected, how they are affected, and how they are responding to the unfolding events, and how the Government’s support package is being taken up, including where it is helping, where it is missing the target, and also where it may be getting in the way.
So, yes, prepare to upscale support services – and prepare to work in a different way, maintaining physical distancing and increasing access. But don’t make the mistake of expecting a massive influx of people needing mental health services. That may happen, but past experience tells us that it’s not likely in the immediate future. Far more likely will be a large number of anxious people trying to figure out how they are going to get by in the short term when it’s all too clear that the sums do not add up. Focus your support on dealing with the ‘Problems of Living’, and you’ve a good chance of helping people with their very real concerns about how they will deal with their living circumstances as well as how to prepare for possible health impacts.
It’s not an either / or choice. Both ‘health impacts’ and ‘problems of living’ need to be addressed.