Mask anxiety, face coverings and mental health

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Explains why masks can cause difficult feelings, and gives practical tips on how to cope. Includes information on exemptions for mental health reasons.

What is the law about masks?

The UK and Welsh Governments are making it compulsory for people to wear masks or face coverings in certain places, like on public transport. But the exact places and dates are slightly different in England and Wales. 

Why masks can cause difficult feelings

We all want to help stop the spread of coronavirus. And we know it isn’t easy. It means making big changes in our lives, like following social distancing guidelines, and now wearing masks.

But masks are not straightforward for everyone. Some of us may find covering our face very hard, or even impossible to cope with. And for those of us with existing mental health problems, masks may pose extra challenges.

For example:

  • Covering your mouth and nose might affect the air you breathe, which might make you feel anxious or panicky. This can then cause other symptoms as well, like feeling dizzy or sick, which you might associate with the mask.
  • You might feel trapped or claustrophobic.
  • Covering your face changes the way you look, which may cause negative feelings around your identity or body image.
  • Having certain materials touching your skin might feel very hard to cope with (sensory overload).
  • If you wear glasses, they might get steamed up so you can’t see clearly. This might add to feelings of being claustrophobic
  • Masks are a visual reminder of the virus, so seeing masks might make you feel on edge or unable to relax. It might seem like danger is everywhere.
  • Seeing people covering their faces might make you feel uneasy or scared of others. They might seem threatening, sinister, or dehumanised.
  • On the other hand, you might feel very anxious or upset around people who are not wearing masks in public. (Although many people are exempt from wearing them, and you won’t always know their reasons.)
  • If you are exempt from wearing a mask, you still might feel very anxious about being judged, shamed or stigmatised in public. Or about the possibility of being asked to pay a fine. This may feel especially hard to cope with if the reason you can’t wear a mask is also to do with your mental health.

Do I have to wear a mask?

If you feel able to wear a mask or face covering, then you must.

But there are some exceptions. The Government says you do not have to wear a mask if you have a ‘reasonable excuse’ not to. 

The exact guidance on how this applies to mental health conditions is written differently for England and Wales. And it’s being updated quite often. But in practice the meaning is similar.

In both nations, reasonable excuses to do with mental health include:

  • If you’re not able to put on, wear or remove a face covering, because of a physical or mental illness or impairment, or disability.
  • If it’s essential to eat, drink or take medication.

In England, the guidance also specifies that a reasonable excuse would be:

  • If putting on, wearing or removing a face covering will cause you severe distress.

(There are other exemptions besides these. You can find the full list of exceptions in England on the UK Government website, and the full list of exceptions in Wales on the Welsh Government website.)

What counts as ‘mental impairment’ or ‘severe distress’?

There is no clear-cut definition of ‘mental impairment’ or ‘severe distress’ in the mask regulations. These terms may cover a lot of different experiences.

For example, you might feel severely distressed or impaired if wearing a mask triggers acute symptoms of a mental health condition, like:

But even if you don’t have an existing mental health diagnosis, you might still feel overwhelmingly anxious, distressed or unwell when wearing a mask.

It can be difficult to judge if you feel unwell ‘enough’ to be excused from wearing a mask. But remember: you are the expert on your own experience.

  • If you’re not sure, look for a way to make covering your face feel more bearable. Try some of our tips for coping with masks and face coverings, and see if they help. You might be able to lessen your symptoms, so you feel less unwell.
  • If you’ve tried everything and nothing helps, you might decide you do have a reasonable excuse for not wearing a mask. That’s ok.
  • It might change. For example, you might have better or worse days, times or places. So you might feel exempt sometimes, but not all the time. That’s ok too. Use your face covering as much as you are able.

How do I prove I have a reasonable excuse?

You don’t need to. There’s no legal document or proof that you need to carry on you.

If you’re challenged about not wearing a mask:

  • You could tell the person: “I’m exempt for health reasons”, or “I have a good reason that you can’t see. Please be kind”.
  • Or you could write down your reason to show people, on a piece of paper or on your phone.
  • Various organisations have created optional exemption cards and badges that you can display. You do not need to buy or apply for one, and you do not need to carry or show one. But you may find having something like this to hand makes you feel more comfortable. It’s your choice. (You can find exemption cards to print or download on the UK Government website).

The Welsh Government is advising you to carry evidence of your condition if possible in Wales, but you do not have to.

Unfortunately, you might find that not everyone understands, or is supportive. This can be really hard to cope with. But you’re not alone. It might help to think about extra self-care ideas, to help look after yourself.

Tips for coping with masks and face coverings

You might not ever feel totally comfortable with masks. But there are lots of things you could try to help make the experience easier for you.

Anxiety, panic and breathing issues

If wearing a mask makes you feel panicky or like it’s harder to breathe:

  • Get some fresh air outside before and after you wear your mask.
  • Do something to relax you before and after you wear a mask. For example, you might do a short breathing exercise. (We have some tips on relaxation exercises).
  • Choose a face covering that hangs down your neck, rather than fitting around your jaw. This type of covering is called a ‘neck gaiter’. It might feel more breezy.
  • Keep your body as cool as possible. For example, by wearing loose-fitting clothes or sitting by an open window on the bus.
  • Add a comforting scent to your face covering. This might be a few drops of lavender oil, your own perfume or aftershave, or a smell that reminds you of someone else.
  • Reduce the time you spend having to wear your mask. For example, by planning your shopping in advance to help you keep browsing time down in shops.

Physical discomfort

If wearing a particular material creates sensory overload:

  • Experiment with different fabric types. You could try making a face covering from an old t-shirt that doesn’t bother you to touch. You can search for mask-making tutorials online. The Government also has some information on how to make your own mask.
  • Experiment with different ways to secure your mask. Some fit round the ears, some tie behind your head. You could try attaching buttons to a hat or hairband, so the mask does’t irritate your skin.
  • Choose another type of face covering that doesn’t touch your face in the same way, like a neck gaiter.

If wearing a mask steams up your glasses and makes it hard to see:

  • Wash your glasses with soapy water, and polish them with a tissue. A thin layer of soapy film may make it harder for the lenses to steam up.
  • Sit your glasses on top of the fabric by raising the top of your mask up onto your nose.
  • Line your mask with a tissue so it absorbs some of the moisture.

Body and identity issues

If covering a part of your face makes you feel uncomfortable in your identity or body image:

  • Think of your mask as a fashion accessory. Search for a mask or face covering with a design or pattern that expresses who you are. You could use a scarf or bandana. Or try to find a selection of colours that you can match in with your outfits.
  • Choose a transparent mask or see-through face covering, so it doesn’t obscure your face.

Anxiety around other people wearing masks

If seeing other people in masks make you feel uneasy or afraid:

  • Shift your focus away from someone’s face when communicating with them. Try switching the way your body is facing so that you’re side-by-side with the person you’re talking to, and both looking in the same direction.
  • Try to pay extra attention to your non-human surroundings. This might be trees, traffic, shop window displays, or the sounds and smells you notice. It may not be possible to avoid looking at people entirely. But by balancing it with other things that feel more usual, you might feel more calm.
  • Take a distraction out with you. For example, listen to music or podcasts through headphones, or call to someone you enjoy chatting to.
  • If someone you have to see often (like a friend or housemate) wears a mask that you find very scary, you could try gently letting them know how you feel. They might be able to change it or cover it up in your presence, to help you.

Being supportive to others

There are many ways we can be supportive to people who might be struggling with masks.

  • Don’t judge people who are not wearing masks. Don’t assume that someone not wearing a mask is ‘just being selfish’. Many people are exempt from wearing masks, and it might not be immediately obvious why.
  • Acknowledge people. You could say a friendly ‘hello’ or ‘good morning’ as you pass them, or wave your hand.
  • Communicate in other ways. Try using your voice, eyes, hands and body language to compensate for what you aren’t able to show through smiles or other facial expressions.
  • If you see someone regularly who is uncomfortable with masks on other people, ask them what would help. For example, you might be able to get a transparent mask to wear with them.
  • If you work in a place where masks are compulsory, make sure you fully understand the exemption rules. If someone tells you they are exempt, accept their word for it.

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