Hotel quarantine is an effective way to prevent the spread of viruses and protect the public, but it can be challenging for the mental health of those in isolation. As a certified counsellor, I will provide my best recommendations to stay sane during hotel quarantine.

Introduction

The current Coronavirus (COVID19) pandemic caused by the novel SARSCoV2 strain has brought the entire world to a halt, leaving people fearful and nervous. COVID19 began in Wuhan, China, in December 2019 and has since spread to more than 200 countries. Almost all countries promote the principle of social distancing, quarantine, and isolation as the most efficient methods for containing the COVID19 pandemic. There is substantial evidence to indicate that socialisation and communication are essential in preserving mental health. Both physical and psychological well-being have been linked to social networking, group interaction, and involvement.^[1]Ganesan, B., Al-Jumaily, A., Fong, K., Prasad, P., Meena, S., & Tong, R. (2021). Impact of Coronavirus Disease 2019 (COVID-19) Outbreak Quarantine, Isolation, and Lockdown Policies on Mental … Continue reading

According to studies, those who were quarantined experienced negative psychological effects such as post-traumatic stress symptoms, confusion, and anger. As a result, some problems were identified as driving factors for physical and emotional exhaustion, such as the length of isolation, dissatisfaction, boredom, financial losses, social stigma, and insufficient supply and information delivery.^[2]De Lima, C., Cândido, E., Da Silva, J., Albuquerque, L., Soares, L., Do Nascimento, M., De Oliveira, S., & Neto, M. (2020). Effects of quarantine on mental health of populations affected by … Continue reading

We are social beings, and spending two weeks locked in a room without social interactions can be extremely challenging. Solitary confinement is one of the hardest punishments because isolation messes with your mental health and well-being. At the end of this blog post, I will suggest some tips and strategies to stay sane during hotel quarantine.

COVID-19 in Australia

China confirmed cases of viral pneumonia caused by an unknown pathogen in December 2019. The pathogen has been described as a novel (new) coronavirus (recently called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)), which is genetically similar to the virus that triggered the 2003 SARS outbreak. SARS-CoV-2 is the virus that causes Coronavirus Disease 2019 (COVID-19).^[3]Australian government. 2020. National Review of Hotel Quarantine. [online] Available at: https://www.health.gov.au/sites/default/files/documents/2020/10/national-review-of-hotel-quarantine.pdf  … Continue reading
The last report stated that as of 3 pm, on May 6, 2021, there had been a total of 29,886 COVID-19 cases recorded in Australia, with 910 deaths.^[4]https://www.health.gov.au/resources/publications/coronavirus-covid-19-at-a-glance-6-may-2021 It’s fair to say that Australia has been exceptional in managing the pandemic and keeping death and contagion rates down compared to other countries.

In order to avoid the spread of COVID-19, Australia enforced international border restrictions early in the pandemic. Furthermore, in order to prevent the virus from spreading, countries such as Australia and New Zealand imposed border restrictions as well as a 14-day quarantine period. All returning travellers must spend 14 days in quarantine in a designated facility beginning March 28, 2020. Since then, more than 130,000 foreign and domestic travellers have been quarantined in Australia, slowing the spread of COVID-19.^[5]Ganesan, B., Al-Jumaily, A., Fong, K., Prasad, P., Meena, S., & Tong, R. (2021). Impact of Coronavirus Disease 2019 (COVID-19) Outbreak Quarantine, Isolation, and Lockdown Policies on Mental … Continue reading

Quarantine vs isolation

Quarantine and isolation are two of the most common containment techniques used to protect the public by preventing the spread of infectious diseases. Both tactics are mainly concerned with restricting movement and limiting personal interactions.^[6]Henssler, J., Stock, F., van Bohemen, J., Walter, H., Heinz, A., & Brandt, L. (2021). Mental health effects of infection containment strategies: quarantine and isolation-a systematic review and … Continue reading
Quarantine is the isolation and restriction of movement of people who have been exposed to an infectious disease in order to see whether they become ill and spread the disease to others. This is distinct from isolation, which is described as the separation of people who have been diagnosed with an infectious disease from those who are not. However, the two words are often used interchangeably, especially in public communication.^[7]Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the … Continue reading

In the most recent outbreak of the coronavirus disease 2019 (COVID­19), quarantine was used. Such steps have been used before. During the 2003 outbreak of extreme acute respiratory syndrome (SARS), citywide quarantines were placed in China and Canada, and entire villages in several west African countries were quarantined during the 2014 Ebola outbreak.^[8]Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the … Continue reading The next few paragraphs will explore COVID-19 and its implications for mental health in isolation and quarantine.

Hotel quarantine and mental health

Hotel quarantine is a costly procedure that necessitates a highly specialised workforce to sustain the system, which includes clinical, welfare, and security services, in order to minimise risk and meet the duty of care obligations. The effects of hotel quarantine on mental health and wellness are arguably one of the most important factors in the hotel quarantine scheme, as even those who have never encountered mental illness may find the experience taxing.^[9]Ganesan, B., Al-Jumaily, A., Fong, K., Prasad, P., Meena, S., & Tong, R. (2021). Impact of Coronavirus Disease 2019 (COVID-19) Outbreak Quarantine, Isolation, and Lockdown Policies on Mental … Continue reading

Isolation and quarantine have been shown to have negative mental health effects, including depression, anxiety, stress-related disorders, anxiety and anger.^[10]Henssler, J., Stock, F., van Bohemen, J., Walter, H., Heinz, A., & Brandt, L. (2021). Mental health effects of infection containment strategies: quarantine and isolation-a systematic review and … Continue reading In a rapid study, Brooks et al. found that people who were quarantined have more negative psychological effects, such as post-traumatic stress symptoms, confusion, and frustration. Furthermore, citizens in a state of confinement can experience restraint and express fixation on the disease’s progress, as well as psychosomatic symptoms such as insomnia.^[11]Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the … Continue reading

According to Henssler et al. (2021), major stressors for someone’s mental health in quarantine include:
– Longer quarantine periods
– Infection concerns
– Agitation
– Boredom
– Insufficient supplies
– Insufficient knowledge
– Financial loss
– Stigma ^[12]Henssler, J., Stock, F., van Bohemen, J., Walter, H., Heinz, A., & Brandt, L. (2021). Mental health effects of infection containment strategies: quarantine and isolation-a systematic review and … Continue reading

Longer quarantine is linked to worse psychological results, which is perhaps unsurprising given that the stressors identified by participants may have a greater impact the longer they are exposed to them.^[13]Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the … Continue reading Prolonged confinement is clearly linked to psychological harm, and these psychic losses could last for months after the confinement ended in some cases.^[14]De Lima, C., Cândido, E., Da Silva, J., Albuquerque, L., Soares, L., Do Nascimento, M., De Oliveira, S., & Neto, M. (2020). Effects of quarantine on mental health of populations affected by … Continue reading This is not to say that quarantine should never be used; the psychological consequences of not using quarantine and allowing disease to spread may be worse.^[15]Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the … Continue reading

Hotel quarantine is difficult to bear, particularly for those who are vulnerable.^[16]Ganesan, B., Al-Jumaily, A., Fong, K., Prasad, P., Meena, S., & Tong, R. (2021). Impact of Coronavirus Disease 2019 (COVID-19) Outbreak Quarantine, Isolation, and Lockdown Policies on Mental … Continue reading Persons with mental illness, low income, or a lack of social network, for example, may be especially vulnerable during and after quarantine or isolation.^[17]Henssler, J., Stock, F., van Bohemen, J., Walter, H., Heinz, A., & Brandt, L. (2021). Mental health effects of infection containment strategies: quarantine and isolation-a systematic review and … Continue reading

In the primary research, Henssler et al. (2021) found the following determinants of psychological outcomes were found to be statistically significant:

Age
Younger people had a higher risk of stress-related disorders/PTSD, while people over 55 had a higher risk of depression.

Gender
Women were found to be at higher risk for depression, PTSD, and general mental health impairments, while men were found to be at higher risk for any (non-psychotic) psychiatric condition and for alcohol use disorder.

Education
Lower levels of education were linked to more serious stress-related disorders/PTSD symptoms as well as a higher risk of depression.

Earnings
In pandemics, lower household income and financial loss or economic impact were linked to a higher risk of negative psychological effects, such as depression, anxiety, frustration, and stress-related symptoms. Lower-income was also linked to a longer duration of PTSD symptoms for three years. Surprisingly, having a higher household income was linked to a higher risk of developing an alcohol use disorder.

Social networks
Low social capital, low perceived social support, and weak neighbourhood relationships have all been linked to higher levels of depression, anxiety, stress, and poor sleep quality. Being single was also linked to higher levels of depression and PTSD symptoms that lasted longer than three years.
In isolated, non-infected people, one study found higher levels of anger and anxiety when they used mail/texting and the internet, but not when they used the phone.

Mental disorder history
Prior mental disorder and psychiatric inpatient admission were linked to higher levels of anxiety and frustration. A history of trauma was linked to an increased risk of depression. A higher risk of consecutive alcohol use disorder was linked to depression and PTSD symptoms, as well as a history of using alcohol as a coping mechanism.

Physical well-being
Higher levels of depression were linked to a lower perception of current health status.

Quarantine/isolation timeframe
Higher levels of anger, frustration, anxiety, avoidance behaviour, and stress-related disorders/PTSD were positively associated with longer periods of quarantine or isolation. Isolation had negative psychological effects after 1 week, particularly after 2 weeks, regardless of infection status. Some research found no negative mental health effects after 1–3 days of isolation, whereas others did.^[18]Henssler, J., Stock, F., van Bohemen, J., Walter, H., Heinz, A., & Brandt, L. (2021). Mental health effects of infection containment strategies: quarantine and isolation-a systematic review and … Continue reading

The presence of assertive mental health screening and care available to hotel quarantine guests, as well as proof of the use of accredited mental health evaluation instruments, demonstrates good practice mental health support operations. Screening and in-reach to detect acute mental health and wellness issues, as well as regular follow-up with guests to identify developing or worsening psychological distress, are both good practices. It is also apparent that a person’s psychological readiness for quarantine is critical to their ability to cope.^[19]Ganesan, B., Al-Jumaily, A., Fong, K., Prasad, P., Meena, S., & Tong, R. (2021). Impact of Coronavirus Disease 2019 (COVID-19) Outbreak Quarantine, Isolation, and Lockdown Policies on Mental … Continue reading

Hotel quarantine vs Prison Solitary confinement

Solitary confinement is a method of dealing with troublesome or dangerous inmates. Solitary confinement is well-known for being difficult to bear; in fact, psychological stressors like isolation can be just as psychologically distressing as physical punishments. Nonetheless, prison authorities are still using a form of solitary confinement to punish and monitor difficult or violent inmates.^[20]Metzner, J. L., & Fellner, J. (2013). Solitary confinement and mental illness in US prisons: A challenge for medical ethics. Health Hum. Rights Chang. World, 1, 316-323.
Solitary confinement is practised in all Australia’s states and territories but is often known by different names, such as lockdown, seclusion, segregation, separation, and isolation. When a person is held in solitary confinement, he or she will spend 22 or more hours per day in a concrete cell the size of a single parking space. The individual will be subjected to a full-body strip search before being placed in the cell. The individual will also have minimal ventilation and natural light in their cell. Strong steel doors have slots in which meals are delivered^[21]https://www.hrlc.org.au/factsheets/2020/9/15/explainer-solitary-confinement-of-people-in-prison

Thousands of inmates worldwide spend years locked up 23 to 24 hours a day in small cells with rigid steel doors, in the so-called supermax prisons that have proliferated over the last two decades or in segregation (i.e., locked-down housing) units within normal prisons. They live in caged enclosures with extensive monitoring and security measures, a lack of regular social contact, irregular environmental stimuli, and few, if any, educational, vocational, or other purposeful activities (i.e., programs). They are held in cages with extensive supervision and security controls, no daily social interaction, unpredictable environmental stimuli, and few, if any, educational, vocational, or other purposeful activities (i.e., programs). Every time they leave their cells, they are handcuffed and sometimes shackled. Isolation may be detrimental to a prisoner’s mental health, with the extent and magnitude of the impact varying depending on the person, the period, and the circumstances (e.g., access to natural light, books, or radio).^[22]Metzner, J. L., & Fellner, J. (2013). Solitary confinement and mental illness in US prisons: A challenge for medical ethics. Health Hum. Rights Chang. World, 1, 316-323.

Many of the inmates who are exposed to long periods of isolation have severe mental illnesses, and the conditions of solitary confinement may worsen their symptoms or cause recurrence.^[23]https://www.hrlc.org.au/factsheets/2020/9/15/explainer-solitary-confinement-of-people-in-prison
Anxiety, depression, frustration, cognitive disturbances, visual distortions, intrusive thinking, paranoia, and psychosis are examples of psychological symptoms. Solitary confinement has particularly negative consequences for people who have a severe mental illness, which is generally described as a major mental condition (e.g., schizophrenia, bipolar disorder, or major depressive disorder) marked by psychotic symptoms and/or substantial functional impairments. Stress, a lack of regular social interaction, and unstructured days can aggravate mental illness symptoms and lead to recurrence. Suicides are more common in segregation units than in other parts of the prison. Mentally ill inmates often decompensate in isolation, necessitating crisis treatment or psychiatric hospitalisation. As the number and proportion of inmates with mental illnesses has increased, so has the use of segregation to confine them. Despite often lacking the necessary mental health resources, prisons have become de facto medical centres, despite being built and run as places of punishment.^[24]Metzner, J. L., & Fellner, J. (2013). Solitary confinement and mental illness in US prisons: A challenge for medical ethics. Health Hum. Rights Chang. World, 1, 316-323.

If you are quarantining in Australia, you will have access to a phone, television, and wifi. Furthermore, if you are in hotel quarantine in Australia, you will receive regular follow-up and assistance. Isolated inmates, on the other hand, are severely limited in terms of the type and amount of mental health care they may receive. So, no, being quarantined is not like being in prison solitary confinement!

Hotel quarantine tips

As a certified counsellor, my recommendations if you are in hotel quarantine would be:

Mindset
Humans have the ability to readjust their perceptions of reality. Think about this time as an opportunity to relax, recharge, work on pending work tasks and personal or professional development.

Entertainment
Netflix, Stan, Binge, YouTube, Amazon Prime Video, and TED are some of the apps you might consider downloading. Entertainment can be something you give yourself as a reward for productive tasks done. I, for example, have a rule for myself ‘no entertainment before 6 pm’.

Make a calendar and cross the days
Time distortion can happen in isolation; making a calendar of post-its can help you keep track of time.

Create a task list and a learning bucket list
In your task list, include all tasks pending that you need to do (e.g. bookkeeping, projects tasks, answering emails, etc.) in your learning bucket list include anything out would like to learn about; now it’s the time!

Stay connected
FaceTime, Zoom, and WhatsApp can be used to video call friends and family and make sure you stay connected.

Have a virtual date night
If you have a partner, you can organise a virtual date. If you are separated and want to spice up your relationship, you can both download an app called ‘spicer’. With this app, you will individually be asked questions about sexual fantasies, and you will be notified if you both have the same fantasies. This app will give you both something to look for after quarantine.

Exercise
You can hire a treadmill or stationary bike and some weights or at least buy a yoga mat. Remember, exercise is a natural antidepressant.

Deep breathing and meditation
To lower anxiety, try some guided meditations and take full breaths. When we have anxiety, we tend to breathe with our upper lungs and not provide enough oxygen for our brain to function properly.

Keep your room clean
Keep your room tidy and get some cleaning products delivered; you are going to need to do your own cleaning.

Nutrition
Process food might negatively affect your mental health. In a study investigating diets impact on depression, the researcher found that healthy eating habits avoiding processed foods may help prevent and treat depression.^[25]Ljungberg, T., Bondza, E., & Lethin, C. (2020). Evidence of the Importance of Dietary Habits Regarding Depressive Symptoms and Depression. International journal of environmental research and … Continue reading Get fresh food delivered by supermarkets such as Coles or Woolworths, friends or restaurants using Uber Eats.

Work if you can
Maintaining a routine is important for people’s mental health. Try to wake up at your regular time in the morning, shower and start working at the same time you normally would.

Read the news instead of watching the news
My first degree was in Public Relations and Marketing management, and if there is something I’ve learned about the news media is that they use sensationalism to make you watch more so that they can charge more to advertisers. Be mindful of the information you consume because it will affect your mental health. This doesn’t mean you shouldn’t get informed. But choose the most mentally healthy ways to do so. In my opinion, reading government guidelines and announcements on government websites works best.

Limit social media
In one report, heavy social media users had higher acute stress levels. During a crisis, this study emphasises the importance of providing substantive official alerts at regular intervals and tracking social media to minimise exposure to false information and anxiety.^[26]Ganesan, B., Al-Jumaily, A., Fong, K., Prasad, P., Meena, S., & Tong, R. (2021). Impact of Coronavirus Disease 2019 (COVID-19) Outbreak Quarantine, Isolation, and Lockdown Policies on Mental … Continue reading
Seeing pictures of your friends at the beach or at a dinner party without you will probably not make you feel better. Use this time alone for your own personal development.

Ask for help
Isolation isn’t easy; it’s normal to experience various unusual thoughts, some of which might be irrational and illogical. Be kind to yourself, remember that it’s going to end, and you just need to hang in there.
According to the NSW Government^[27]Health.nsw.gov.au. 2021. COVID-19: Information for people requiring hotel quarantine – Fact sheets. [online] Available at: … Continue reading, the medical staff includes qualified physicians, nurses, and mental health practitioners who are available 24 hours a day, seven days a week. You can reach them by calling your accommodation’s reception or the Health and Wellbeing line at 1300 290 994. You may also speak with your general practitioner or seek help from one of these organisations:
Lifeline Australia 13 11 14 is available 24 hours a day, seven days a week. Lifeline is a crisis support programme that offers short-term assistance to individuals who are having trouble coping and experience distress. You can also call the Coronavirus Mental Health Support Line at 1800 512 348; they provide advice on how to maintain mental well-being during the coronavirus pandemic. Finally, the mental health organisation Beyond Blue (1300 22 4636) can provide guidance and resources to help everyone in Australia, regardless of age or location, achieve their best possible mental health.^[28]Health.nsw.gov.au. 2021. COVID-19: Information for people requiring hotel quarantine – Fact sheets. [online] Available at: … Continue reading

Get online counselling or coaching
With counselling, you can use the two weeks of quarantine to address past issues that have perhaps been bothering you for years. In isolation, you will probably be faced with your issues more than you would in normal circumstances because, in isolation, you will have fewer avoidance behaviours available. Counselling and therapy work take some time to show results depending on the severity of distress, level of self-awareness and resources available. Yet, counselling has shown to be producing more lasting well-being results than any avoidance coping mechanism such as drinking or overeating.
Coaching is for people that are not necessarily experiencing mental health distress and want to set goals for themselves and make a plan to achieve their goals. Coaching helps you to clarify what you want and strategise how to achieve your goals, step by step. If you would like more information about my counselling services, click here, and if you would like more information about my life coaching service, click here.