The prolonged Covid-19 pandemic is likely to have a long-term effect on mental health, as stress levels rise with the uncertainty of the outbreak as well as the economic downturn it brings, experts have warned.
Dr Cornelia Chee, head of the department of psychological medicine at the National University of Singapore and the National University Hospital, said that when it comes to Singapore's response to the Covid-19 pandemic, the "honeymoon" phase is long over.
That was from January to end-March, when the various task forces and healthcare services were activated, and community and imported case transmission appeared to be well contained by robust public health measures, she said.
"In the hospitals, morale was relatively high because we could see that healthcare workers were not getting infected, unlike during the Sars outbreak," said Dr Chee, referring to the severe acute respiratory syndrome.
Singapore is now in the disillusionment phase, and more cases of anxiety and depression can be expected in the coming months, Dr Chee said.
"We certainly entered it in March as the dorm workers' cases increased and it was becoming obvious that our overall economic recovery was dependent not only on our ability to contain our imported and locally transmitted cases, but on how well other countries managed their outbreaks and responses too," said Dr Chee.
Singapore has had more than 56,000 coronavirus cases and 27 deaths from Covid-19 complications.
Dr Chee said Singapore's recovery phase - which comes after the disillusionment phase - will get under way here when there is pandemic control and economic recovery.
At the moment, this phase seems to hinge on the availability of a safe, effective and well-distributed vaccine, she said.
These phases were originally described in a manual by the Substance Abuse And Mental Health Services Administration in the United States for health workers helping victims during a disaster, such as a hurricane or terrorist attack.
The Samaritans of Singapore (SOS) chief executive Gasper Tan said: "Without a clear indication of when the situation will improve, the prolonged exposure to these stressors and the impact of the pandemic may take a toll on one's mental health."
These may then lead to pronounced feelings of worthlessness and helplessness, he said.
SOS started a text messaging-based service last month, some three months ahead of its planned launch, to help address some of the mental health needs in the community.
Data on increased mental health cases due to the pandemic may not be available yet, but calls to help hotlines have risen.
During the circuit breaker period, calls to the SOS hotline rose from 3,826 in March to 4,319 in April and 4,265 in May.
The April and May figures are about 30 per cent to 35 per cent higher than a year ago.
June saw fewer calls logged - 3,831 - but this is still higher than the 2,863 calls in the same month a year ago.
The National Care Hotline, which was launched in April to provide emotional and psychological support to those facing difficulties during the pandemic, has received 26,000 calls.
A spokesman for the Ministry of Social and Family Development (MSF), which operates the hotline that is manned by trained volunteers, said the majority of the callers are above age 21.
Their top concerns include "mental health, marital and family issues, emotional support needed and financial or employment worries".
Samaritans of Singapore 1800-221-4444
National Care Hotline 1800-202-6868
Institute of Mental Health's Mental Health Helpline 6389-2222
Silver Ribbon Singapore 6385-3714
Singapore Association for Mental Health 1800-283-7019
Tinkle Friend 1800-274-4788
SOS Care Text service available through Facebook Messenger on the SOS official Facebook page
Dr Goh Kah Hong, head and senior consultant of psychological medicine at Khoo Teck Puat Hospital, said his department is seeing higher demand for its services.
"People are seeking help now because what they would have usually put up with has become too overwhelming to just bottle up."
He expects the pandemic to have a "long tail" because of the ramifications of prolonged stress and social isolation.
"With so much uncertainty surrounding the pandemic, it is hard to predict how long people will continue to struggle when it wraps up," he said.
MSF chief psychologist Vivienne Ng said that apart from some people who may experience psychological distress, there are also vulnerable groups such as those with disabilities, people with mental health needs and the elderly, who may be isolated at home and need additional emotional support and access to specialised services.
"Individuals with financial problems and/or who are experiencing unemployment, as well as those with caring responsibilities for young children, the elderly or individuals with special needs may also feel additional stress during this period."
She advises people to talk to friends or family if they feel distressed.
"If you find yourself not able to function daily - having a poor appetite or being unable to sleep properly or concentrate, in low mood, for instance - please seek help early from a mental health practitioner," she said.