Photo courtesy of The Culture Trip
These are difficult times for many of us in Sri Lanka. After two years of a pandemic that disrupted nearly every aspect of daily living, we are now going through a serious economic crisis with widening consequences. Many of the challenges from rising cost of basics, failing public utilities and the impending uncertainty are starting to feel very close, if they are not affecting our lives already.
Mental health professionals, public health specialists and social workers anticipate significant impacts of the current socio-economic situation on individuals and families across all economic strata and communities. They recognize that these additional stressors do not only present difficulties in themselves, but they will add to the challenges that many people are already dealing with in their lives such as chronic illness or disability, relationship problems, COVID-19 infections, precarious finances, grief and loss, domestic violence, evictions, issues at work or pre-existing mental health issues. Some groups or individuals are already in particularly vulnerable positions but even for people who don’t already have specific problems, added stress can make it harder to cope with the day to day. It is not only the current conditions that can place us under stress but also the sense of insecurity and worry about possible risks and other hardships down the road.
In this article, we hope to do three things: 1. remind ourselves to be aware of the signs of additional stress in our lives and those of others; 2. reflect on some of the actions we can all take to increase our psychosocial resilience in the face of increased stress; and 3. share some resources that are available for additional support whenever we might need it.
Watch out for stress reactions
Increased stress can stretch or overwhelm the social, mental and emotional resources that we use to cope with difficulties in our lives. This happens to all of us, but the signs that our ability to cope is compromised may vary from person to person or situation to situation. Sometimes the signs of increased stress may be more visible at a collective level with more frequent or heated conflicts or arguments in the household or workplace or even on the street or in the neighbourhood.
The type or severity of our reactions may vary across a wide spectrum but it is important to remember that experiencing such responses to increased stress is completely natural and can affect any of us regardless of age, gender, socio-economic status or background. Even those of us who are very good at coping with stressful situations can exhaust our resources at times and indeed those who usually shoulder extra responsibilities in either our work or personal lives are not immune to the risks of ‘burnout’. By being aware of and monitoring our own reactions and responses to stress, we can take measures to manage our stress levels and protect ourselves from crashing or even more lasting impacts. We can also be mindful of others around us, in our families and networks of friends and colleagues who may be experiencing increased stress. Recognition and acknowledgement that we can all experience difficulties with increased stress can help us to be more supportive and avoid stigmatizing those whose struggles are most visible.
Becoming aware of these signs is key to managing stress well. Panel 1 below provides some common examples of stress signs, and Panel 2 describes simple actions that we can take to manage stress in our own lives.
Panel 1: Common signs of stress
| Common signs of stress |
| · Difficulty sleeping, or find ourselves thinking constantly about the problems we face
· Lack of patience with colleagues at work or get upset with family at home. · Be more prone to aggressive behaviour, physical violence or verbal abuse, directed even at our loved ones* · Disproportionately strong reactions to relatively minor inconveniences or issues · Withdrawing from activities or avoiding social situations we used to enjoy · Changes in our own behaviour – like increased eating, drinking or smoking · New physical symptoms – chest pains or body aches, frequent headaches, chronic tiredness, digestive problems or dizziness · Difficulties with going about our daily lives or caring for ourselves or those who depend on us* · Drastic actions like self-harm, contemplating suicide or taking huge personal risks* *When our reactions to stress mean we are unable to care for ourselves or others, it is crucial that we reach out for help as soon as possible (see Section 3 below). |
Panel 2: Do it Yourself (DIY) Steps to manage stress
| Accessible Steps for Stress Reduction |
| · Make a list of things in life that are currently our main sources of increased stress. Proactively try to manage these or remain aware of changes that can affect our stress levels.
· Make a list of the most common ways in which we show or know that we are under increased stress. Awareness of increased stress can help us proactively try to manage our situation or our responses. · Make a list of useful actions that help you to cope with stress (leave out those that might be counter-productive). Draw from those that have helped you in the past, and also add new ideas you have not tried before (for examples, see Sections 2 and 3 below). · Mindfully applying strategies to manage your stress and responses can increase a sense of control over these, which itself will contribute to reducing stress. · Make a list of the people in your life who may be dealing with additional stress at this time. Consider how you might avoid contributing further to their stress or do something simple that might be supportive. |
Table 1: Accessible resources to better understand stress
| Resources to better understand and deal with stress | |
| Resource | Accessible link |
| Explore your Stress (Worksheet) by Therapist Aid | https://www.therapistaid.com/therapy-worksheet/stress-exploration/stress/none |
| Understanding Stress Reactions in COVID-19 (Video) by WHO | https://www.youtube.com/watch?v=E3Cts45FNrk |
| Understand your emotional reaction to stress (Shareable Posts) by CAFS, Sri Lanka | https://www.instagram.com/p/B_QDhQAhaY6/ |
| 8 Tips for Relaxation to Deal with Stress (Video) by Mind, the mental health charity | https://youtu.be/cyEdZ23Cp1E |
| Illustrated guide to stress management, with audio files (Book and Audio) by WHO | https://www.who.int/publications/i/item/9789240003927 |
Invest in building psychosocial resilience
We don’t always have control over the circumstances of our lives or the sources of our increased stress. For instance, the power to address the drivers of the current economic crisis or shape national agricultural policy may not be in our hands. However, even as we call for those in positions of responsibility to take action to address the problem and provide solutions to reduce the negative effects on citizens, we must also consider how to bolster our own capacity to best get through these hard times. Strengthening our psychosocial resilience to manage increased stress will contribute to our better coping with the various challenges we may be experiencing in life.
Being psychosocially resilient does not mean we will not be practically, emotionally or socially affected by difficulties such as job loss or violence but rather that we have the (psychological) resources within ourselves and also (social) supports around us that enable us to endure such hardships and recover our sense of wellbeing in their aftermath. The composite term “psychosocial” is used to indicate that psychological and social resources are not independent but rather that they constantly interact and influence each other.
Just as our circumstances and problems will be different, the resources that we possess internally and externally to be resilient to life challenges will also vary. While it’s best to begin building resources before we feel overwhelmed or find ourselves really struggling to cope, it’s never too late to start. Here are some common things that we can all do proactively to bolster our resilience:
Monitor and manage our own thoughts, feelings, behaviour and bodily sensations: as we acknowledge our own responses to stress and become more aware of how or when these are affecting us, we can proactively adapt to cope better with sources of stress or difficulty or moderate our reactions. Regular practices like deep breathing, meditation, prayer or other calming activities can also help us manage our responses when we feel we may be coming under stress. Reflecting on what has worked for us in the past may be a good guide to strategies for the present, and we can also consider trying out new approaches.
Strengthen our social supports: we can take extra effort to stay connected to people who are important to us and who care about us. This can also include people who are compassionate and reliable, as well as those who are capable and resourceful. Participation in collective spaces, whether these are community meetings or religious congregations, can also be helpful – especially if these are kind and inclusive.
Proactively engage with our problems: we can try to access up to date information and connect with useful services that are relevant to the challenges we are dealing with. Making contacts within these or establishing good rapport with service providers can help ensure better access to available supports and may help us get support when we need it. Learning more about the problems we are facing from credible people or other sources can help us to respond better to these.
Identify when we are feeling overwhelmed and reach out: we can contact a trusted friend, social worker, or mental health professional who can assist us through that period of difficulty or can help us get the support we need (see Section 3 below).
Play our part in supporting others: we can also support others in our families and networks by extending social support and acknowledging the importance of managing increased stress at this time. With people who may benefit from our assistance financially, materially or practically, providing these forms of support appropriately and with dignity can also help buffer them from being overwhelmed.
Table 2: Resources for building resilience
| Free resources on proactively building our resilience and capacity to cope with stress | ||
| Resource for building resilience | Accessible link | |
| 6 Strategies for Improving Your Emotional Health (Website) by National Health Institute, USA | https://www.nih.gov/health-information/emotional-wellness-toolkit | |
| Building personal resilience (Video) by Black Dog Institute | https://www.youtube.com/watch?v=pS5H7VfkuPk | |
| Understanding what contributes to resilience (Video) by Glasgow Centre for Population Health | https://www.youtube.com/watch?v=eHyv_LFXkVU | |
| Practical ways of helping others/ourselves to solve problems (Video) from www.psychosocialskills.org | https://youtu.be/VA21qBy_Q2o | |
Getting help from informal and formal supports
Many of us are not accustomed to asking for support from others and especially from formal service providers. The reasons can be embarrassment, the feeling of not wanting to trouble others, shame or being considered weak due to prevailing social norms. However, it is important to note that strongest and most practical action that you can take is to seek assistance. Additional support can really make a difference in being able to endure or overcome problems. There are many sources of support to draw from including the following:
Use our own networks: think of people among our family, friends circles, colleagues, teachers and other circles whom we know to be kind, sensible, trustworthy and who might be willing to listen to our difficulties and help you think through how to deal with it. Go through our phone contact lists to review our contacts if it’s hard to think of someone off the top of our heads. Consider speaking to them, at least as someone who would be able to understand what we are going through, who could explore options we might not have thought of yet or who might be able to provide some moral or practical support to us.
Use the services that are available: Sri Lanka now has a range of mental health and social work supports that can be accessed for free or for a fee.
The state sector has a range of officers providing support to the public through the Divisional Secretariat and District Secretariat offices – including those who deal with child protection, violence against women, economic problems amongst others. We can speak with one of the counsellors about our problem, and they can help connect us with other relevant state service providers. Every district now has a general hospital with a mental health unit, and most Medical Officer of Health (MOH) areas have a regular clinic at which we can meet a mental health professional. The Legal Aid Commission also provides free advice and assistance to those who have problems that may require legal assistance.
There are many different not-for-profit organisations that provide support for economic, psychosocial, legal and other social problems. There are also many private mental health services provided through hospitals and counselling centres. Panel 3 below provides a summary of services available; this list is not exhaustive.
Not all services and providers will give us the same type or quality of care. It can be useful to speak with someone we know who has received services previously to understand what to expect and if the support sounds suitable for us. Note that all mental health providers should follow ethical guidelines and practices and if you feel uncomfortable or worry they may be violating these you should immediately seek support on how to respond to this from another unrelated mental health professional or someone you trust.
Panel 3: Key support services in Sri Lanka
| Key Support Services in Sri Lanka: Governmental, Non-Governmental & Private |
| Mental health and crisis support helplines
National Mental Health Helpline: 1926 Availability: 24 hours 7 days a week Language: Sinhala, Tamil and English Shanthi Maargam Helpline (especially for youth): 071-763-9898 Availability: Everyday from 8.00 am – 10.00 pm Languages: Sinhala, Tamil and English (varies according to a roster – if hotline counsellor is unable to communicate in the caller’s preferred language, an appointment will be provided with the next available hotline counsellor fluent in that language). Sri Lanka Sumithrayo Helpline (for crisis support): 011-2682570 / 011-2674436 Availability: Monday – Friday from 9.00 am – 4.30 pm, Saturday & Sunday from 9.00 am – 1.00 pm Languages: Sinhala and English. Tamil speaking counsellor available every Saturday until 12.00 pm. Mobile/WhatsApp: 076-752-0620, 077-772-3696 Availability: Every day from 10.00 am – 8.00 pm Languages: Sinhala and English. Tamil speaking counsellor available every Saturday until 12.00 pm. CCC Helpline (for crisis support): 1333 Availability: 24 hours 7 days a week Language: Sinhala, Tamil and English Family Planning Association Counselling (especially for family, relationship and sexual/reproductive health related issues): 077-989-5252 Availability: 8.30 am – 4.30 pm Language: Sinhala and English (Support can be provided in Tamil when necessary) Befriender Helpline (for LGBTIQA+ persons): 071-963-8877 Availability: 8.00 am – 10.00 pm (for befriending support), 24 hours 7 days a week (for emergency support) Language: Sinhala, Tamil and English (depending on who is available but if befriender does not speak the caller’s preferred language, another befriender will reach out to provide support ASAP) *Note that this list is not exhaustive, and that there are also district-level helplines established by state Mental Health Units and Divisional/District-Secretariat counselling officers. |
| Support for violence against women and children
National Commission on Women Helpline: 1938 Availability: Monday-Friday from 8.30am to 4.15pm (except on public holidays) National Child Protection Authority Helpline: 1929 Availability: 24 hours 7 days a week Language: Sinhala, Tamil and English Women In Need Helpline: 077-567-6555 (Sinhala & English), 077-018-8444 (Tamil) Availability: 24 hours 7 days a week Language: Sinhala, Tamil and English Women in Need Legal Support Helpline: 076-868-6555 (Sinhala & English), 076-465-6555 (Tamil) Availability: 24 hours 7 days a week Language: Sinhala, Tamil and English *Contact the nearest Divisional/District-Secretariat to contact Dept of Probation and Child Care officers, NCPA officers and Women Development Officers. Mithuru Piyasa (linked to District Hospitals) also provides support for victims of gender based violence, as do many local women’s organisations. |
| Mental health services
National Institute for Mental Health (Colombo) ‘Kalyana’ directory of private mental health providers (mostly Western Province to date) ‘Kalyana’ map of mental health facilities (mostly Western Province to date): https://kalyanasl.org/resource-map/ *Contact the nearest hospital to learn about available mental health clinics or out-patient services, and the Divisional or District Secretariat to contact a counsellor. |
| Legal support
Legal Aid Commission Human Rights Commission |
Beyond coping
Of course, the burden of coping with these multiple crises and stressors should not fall on individuals and families to bear alone. It is the role and responsibility of government and its institutions to address the national economic crisis and other systemic problems that are beyond the scope of private citizens’ actions. The government must take special policy and programmatic measures to buffer the most vulnerable groups in our society against the unfolding effects of the crisis on their economic, social and psychological well-being. There is also a need to ramp up services for those who are worse affected including in ensuring access to support for those of us who are struggling with social and mental health impacts.
However, as we face increasing socio-economic, political and public health related challenges, we may not always receive the timely or effective support that we hope for. Therefore, as groups of neighbours, co-workers, friends or business people, it may be necessary for us to mobilise the resources we have available and promote a culture among ourselves of supporting each other, and especially those at greater risk. Through community structures such as local religious institutions, societies, workplaces or schools, we can contribute to ensuring that vulnerable families have food, clothing, jobs and other basic requirements for their wellbeing. We can stay in touch to share information and encourage each other to get through the crisis. Coming together to respond to this crisis will help us personally and may also help us to grow as a community in which we value and care for one another. That will surely be a resource that would help protect us in hard times.
Shashika Bandara, is a doctoral student in global health policy at McGill University. He is formerly a Policy Associate at the Center for Policy Impact in Global Health at the Duke Global Health Institute. Ananda Galappatti is a medical anthropologist and practitioner in the field of mental health and psychosocial support.
