The number of calls made to the mental health support line 1770 increased again at the end of summer, with concern about family issues and general queries related to COVID-19 taking centre stage.

These concerns should guide the implementation of any coronavirus mitigation measures, Josianne Scerri, from the University of Malta, told a conference on Thursday.

According to data she presented at the annual Richmond Foundation conference, there were 2,659 calls for help between December of 2019 and last month.

A total of 1,033 calls were made in April when Malta registered a spike in COVID-19 cases and reported the first deaths. In fact, more than half the calls in April were related to the pandemic.

Giving a rundown of the nature of calls over the months, Scerri said that when life drastically changed in March – as the country started shutting down – many of them were related to anxiety, depression and psychological distress.

Some callers were afraid the pandemic could trigger previous conditions such as depression while others believed the end of the world was approaching.

Some, who were in quarantine, had no support or spent more time with abusive family members.

Others were scared they would infect the vulnerable while some reported obsessions: one person believed a car could carry the virus, making them prone to catching COVID-19 since they lived in the garage.

By April, callers were expressing fear of a national lockdown or a permanent pandemic. Others reported issues like not being able to support a relative with mental health issues, lack of routine, financial difficulties or distress over a hospitalised family member.

Towards the end of summer – in August and September – people were asking for information about their mental illness or about COVID-19. Family issues peaked and a significant number of people expressed suicidal thoughts. Others mentioned a physical ailment that they had not brought up before – weight gain or fatigue.

Scerri insisted that any COVID-19 interventions should be sensitive to the current pulse of the population, reflecting, among others, concerns over family issues and request for basic information, such as how they could get swabbed or how to deal with a fine.

Impact on migrants

For migrants, the pandemic brought about an increase in attempted self-harm, including swallowing soap, cutting and attempts at hanging, the conference heard.

This could partly be to seek attention, Tanya Melillo, the head of Infection Prevention and Disease Control Unit, said at the conference.

COVID-19, she said, had a disproportionate impact on migrants and asylum seekers, often in a disadvantaged position due to their lower socio-economic status, communication barriers, cultural differences and lower educational levels.

“When they were being told to stay home, many would say I have no home.

“We’d tell them wash your hands regularly and they would say I have no water facilities. We used to tell them stay aware of what is happening around you and many had no idea what the guidelines were as they were not in their own language.”

A further complication was overcrowding, whether at migration centres or rented flatlets. This meant that while, for the rest of society, quarantine could be lifted after 14 days in isolation, migrants had to quarantine for longer as the spread was much harder to contain.

Lack of contact with NGOs because of COVID-19 measures also meant asylum seekers suffered loneliness, while those under quarantine felt they were letting their families down as they could no longer work and send them money.

During the first wave, 50 cases of COVID-19 were detected at Ħal Far detention centre, making up around 6.3 per cent of the residents there, who were consequently put in quarantine for 41 days.

During the second wave, there have already been 93 cases, or 4.5 per cent of migrants in reception centres.

Psychiatry challenges

During August and September, 29 female psychogeriatric patients tested positive for the virus, prompting the setting up of a medical response team.

Psychiatric patients are at a higher risk of medical comorbidities, which, in turn, increases the risk of COVID-19 complications.

Sean Warwicker, who formed part of the team, told the conference that one of the challenges was the need for close contact with patients to administer medicine, wash the patient or help them move.

At the same time, it was difficult for those with behavioural issues to follow social distancing and infection control measures.