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.

Anxiety

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Anxiety is a feeling of unease, worry or fear which, when persistent and impacting on daily life may be a sign of an anxiety disorder. Generalised Anxiety Disorder, which is one common type of anxiety disorder, is estimated to impact 5.9% of adults in England1.

Symptoms

Symptoms of anxiety include changes in thoughts and behaviour such as2:

  • Restlessnes
  • A feeling of dread
  • A feeling of being “on-edge”
  • Difficulty concentrating
  • Difficulty sleeping
  • Irritability

It can also involve physical feelings such as dizziness, nausea, heart palpitations (a noticeably strong, fast heartbeat), sweating, shortness of breath, headache, or dry mouth.

Occasionally feeling anxious, particularly about events or situations that are challenging or threatening, is a normal and extremely common response. However, if feelings of anxiety regularly cause significant distress or they start to impact on your ability to carry out your daily life, for example withdrawing or avoiding contact with friends and family, feeling unable to go to work, or avoiding places and situations then it may be a sign of an anxiety disorder2.

Types of Anxiety Disorder

There are different types of anxiety disorder, each of which will have slightly different symptoms and treatment. Some examples of anxiety disorders include2-5:

  • Generalised Anxiety Disorder
  • Panic Disorder (regular sudden attacks of panic or fear)
  • Post-traumatic stress disorder (PTSD)
  • Social Anxiety Disorder
  • Obsessive-Compulsive Disorder (OCD)
  • Specific Phobias (overwhelming and incapacitating fear of a specific object, place, situation or feeling)

Causes

There are many different factors that may contribute to the development of mental health problems like anxiety disorders. These factors include biological factors (for example genetics6, experience of chronic physical illness or injury7 and psychological or social factors (experiences of trauma or adversity in childhood8, struggles with income or poverty1, employment status1, family and personal relationships, and living or work environment1.

Getting Support

There are a range of approaches for treatment and management of anxiety disorders, and the most appropriate method will vary depending on the type and severity of anxiety disorder, and personal circumstances.

Some common approaches to managing and treating anxiety disorders include:

Psychological Therapies:

This can involve working through thoughts, feelings and behaviours with a clinical psychologist or other mental health professional in regular sessions over a set period of time.

Cognitive Behavioural Therapy (CBT) which helps to teach strategies for recognising and overcoming distressing or anxious thoughts, is one of the most common therapies for treatment and management of anxiety disorders2,3,5.

Self-Help and Self-Management:

This involves specially-designed resources (like information sheets, workbooks, exercises, or online programmes and courses) to support people to manage their feelings of anxiety in their own time.

Some of these approaches may involve the support of a therapist or other mental health professional, and some may be entirely self-led2-5.

Group Support:

Group sessions with other individuals experiencing similar problems where people can work through ways of managing anxiety. Some groups may involve the support of a therapist or other mental health professional2.

Medication:

Your GP or other healthcare provider can discuss different medication options to manage both the physical and psychological symptoms of anxiety. There is a range of medication that can be used to manage anxiety and it is important to discuss with your GP which one would be most appropriate for your circumstances2.

For more information about medication for anxiety disorders, visit the NHS Choices website.

Other Approaches

There may be other treatments or approaches available that are not outlined here. If you are considering support for anxiety disorders, we recommend getting in touch with your GP or primary care provider to discuss which approach may be best for you.

Clinical Depression

Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Clinical depression is the more-severe form of depression, also known as major depression or major depressive disorder. It isn’t the same as depression caused by a loss, such as the death of a loved one, or a medical condition, such as a thyroid disorder.

To diagnose clinical depression, many doctors use the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Signs and symptoms of clinical depression may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Reduced appetite and weight loss or increased cravings for food and weight gain
  • Anxiety, agitation or restlessness
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches

Symptoms are usually severe enough to cause noticeable problems in relationships with others or in day-to-day activities, such as work, school or social activities.

Clinical depression can affect people of any age, including children. However, clinical depression symptoms, even if severe, usually improve with psychological counseling, antidepressant medications or a combination of the two.