Mask anxiety, face coverings and mental health

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 have made it compulsory for people to wear
masks or face coverings in certain places, like on public transport. But the exact
places and rules are slightly different in England and Wales.

 The UK Government has guidance explaining the latest rules for masks
across England and other parts of the UK.
 The Welsh Government has guidance explaining the latest rules for
masks in Wales.
 Mencap have produced easy read versions of the coronavirus rules,
including about face coverings.

Why masks can cause difficult feelings

We all want to help stop the spread of coronavirus. And we know it feels
difficult. It means making big changes in our lives, like social distancing and
wearing masks.

But masks are not easy for everyone. Some of us may find covering our face
very hard, or even impossible to cope with.

Others may find it hard to interact with people who are wearing masks, or not
wearing them. And for those of us with existing mental health problems, masks
may pose extra challenges.

Some challenges of wearing masks

 You might feel anxious or panicky, as covering your mouth and nose
might affect the air you breathe. This can cause symptoms like feeling
dizzy or sick, which you may then associate with your 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.
 Certain materials touching your skin might feel very hard to cope with
(which may create sensory overload).
 If you wear glasses, they might steam up so you can't see clearly. This
might add to feeling overwhelmed.
  Seeing people with covered faces might make you feel uneasy or scared
of others. They might seem threatening, sinister, or dehumanised.
 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.
 Wearing or seeing people wear masks might trigger a memory of a
traumatic event. If this is the case for you, there is further guidance on
the Victim Support website.

"I get very anxious about all the people who wear masks, they make me feel like
I am full of dirt and germs."

Some challenges of not wearing masks

 Even when you're exempt from wearing a mask, you might feel worried
by the possibility of being asked to pay a fine.
 Even with an exemption, you still might feel anxious about being
judged, shamed or stigmatised in public. This may feel especially hard
if the reason you can't wear a mask is also linked to your mental health.
 You might feel very anxious or upset around people who aren't
wearing masks in public. Although many people are exempt from
wearing them, you won't always know their reasons. Read more about
how you can be supportive to others.

Do I have to wear a mask?

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

But there are circumstances where people may not be able to. The Government
says you do not have to wear a mask if you have a 'reasonable excuse'.

You might also hear people talking about being 'exempt' or having a 'mask
exemption'.

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 for 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.
  If someone is assessing your health, you may be asked to remove your
mask.

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 reasonable excuses besides the mental health reasons above.

 You can find the full list of mask exemptions in England on the UK
Government website.
 You can find the full list of mask exemptions in Wales on the Welsh
Government website.

What counts as 'mental impairment' or 'severe distress'?

There are no clear-cut definitions of 'mental impairment' or 'severe distress' in

mask regulations. These terms may cover a lot of different experiences.

For example, wearing a mask might trigger acute symptoms of your mental
health condition. Because of this, you might feel impaired or severely
distressed.

Some examples might be:

 panic attacks, flashbacks or other severe anxiety symptoms

 paranoia or hearing voices
 dissociating, or switching alters (something that happens to people with
dissociative identity disorder)
 thoughts of self-harm or suicidal feelings.

It can be hard to judge if you feel 'unwell enough' to have a reasonable excuse
not to wear a mask. But remember: you are the expert on your own
experience.

Some mental health problems are considered a disability under the Equality Act
2010.

If you cannot wear a mask because of your disability, being refused entry or
service (at a shop, café or on public transport for example) could be disability
discrimination.
See our legal information about disability discrimination and reasonable
adjustments. If you think you've experienced discrimination, see our page on
how to challenge disability discrimination.

What if I don’t have a reasonable excuse for mental health?

You might not have an existing mental health diagnosis. But you may still feel
overwhelmingly anxious, distressed or unwell when wearing a mask.

 If you're not sure, try finding a way to make covering your face feel
more bearable. Our tips for coping with masks and face coverings might
help. You might be able to lessen your symptoms, so you feel less unwell.
 You might have tried everything and nothing helps. If so, you might
decide you do have a reasonable excuse for not wearing a mask. That's
ok.
 Remember that your feelings might change. You might have better or
worse days, times or places. This means 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 for mental health?

You don't need to prove you have a reasonable excuse. 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, if you feel able to. Try saying "I'm exempt for health
reasons", or "I have a good reason that you can't see. Please be kind".
 Write down your reason and show it to people. This could be written
on a piece of paper, or displayed digitally on your phone.
 Consider printing or downloading an exemption card. These are not
required at all, but might make you feel more at ease when explaining to
others.

Mask exemption cards

Some organisations have created optional exemption cards, lanyards and

badges that you can display.

You do not need to apply for or buy one, and you do not need to carry or
show one. But having this to hand might make you feel more comfortable. It is
your choice.
If you choose to carry one, you can find exemption cards to print or download
on the UK Government website, in English.

You can also find exemption cards to print or download on the Welsh
Government website, in English and Welsh.

Unfortunately, you might find that not everyone understands, or is supportive.

This can be hard to cope with, but you're not alone. Consider trying some
general self-care tips and ideas to help look after yourself.

Tips for coping with masks and face coverings

You may never feel totally comfortable with masks. But there are lots of ideas
you could try to help make your experience easier.

Anxiety, panic and breathing issues

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

 Get some fresh air. You can try breathing in air outside before and after
you need to wear your mask.
 Do something to relax before and after wearing your mask. For
example, you could do a short breathing exercise. We have some tips on
relaxation exercises you could try.
 Choose a face covering that fits differently. Try one that hangs down
your neck, rather than fitting around your jaw. This type of covering is
called a 'neck gaiter'. It might feel breezier.
 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 mask. It might help to use a familiar
fragrance (like your own perfume or aftershave) or a smell that reminds
you of someone else. A few drops of lavender oil can be soothing.
 Reduce the time you spend having to wear your mask. For example,
try planning your shopping in advance before going out. This can help
you cut down the time you spend browsing in shops.

"It's so hard to wear a mask and carry on all day when underneath I feel sheer
panic."

Physical discomfort

If wearing a particular material creates sensory overload, you could:

  Experiment with various fabrics. Try making your face covering from
an old t-shirt that you don’t mind the feel of. You can search for mask-
making tutorials online. The Government also has instructions on how to
make your own mask.
 Try securing your mask in a different way. Some fit round the ears,
some tie behind your head. You could try attaching buttons to a hat or
hairband, so the mask doesn't irritate your skin.
 Choose another type of face covering. Try using one that doesn't touch
your face in the same way, like a neck gaiter.

"I feel very claustrophobic and the masks make my face sore."

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

 Wash your glasses with soapy water. You can polish them with a tissue
after. A thin layer of soapy film may make it harder for the lenses to
steam up.
 Sit your glasses on top of the fabric. Do this by raising the top of your
mask up onto your nose. Then place your glasses on top of the material.
 Line your mask with a tissue. The tissue helps to absorb some of the
moisture from your breath.

Body and identity issues

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

 Think of your mask as a fashion accessory. A mask or face covering

with a design or pattern might better express who you are. You could use
a scarf or bandana. Or try to find a selection of colours that you can
match your outfits with.
 Choose a transparent mask or see-through face covering. This way,
the fabric doesn't hide your face in the same way.

Anxiety around other people wearing masks

If seeing other people in masks makes you feel uneasy or afraid, you could:

 Shift your focus away from someone's face. While talking to someone,
try switching the angle of your body. It might feel better if you’re not
directly opposite them. You can be side-by-side and both look ahead in
the same direction.
 Try to pay extra attention to non-human surroundings. This might be
trees, traffic, shop windows, 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 familiar, you might feel calmer.
 Distract yourself while you're out. For example, listen to music or
podcasts through headphones or call someone you enjoy chatting to. Or
try something simpler like focusing on breathing, or picturing yourself
elsewhere. See our page on tips for relaxation for more ideas.
 Let the person wearing a mask know how you feel. Someone you have
to see often (like a friend or housemate) might wear a mask that you find
scary. If so, you could try gently telling them how it makes 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 aren't wearing masks. Don’t assume that by
not wearing a mask, someone is 'just being selfish' or 'breaking the rules'.
Many people are exempt from wearing masks, but their reasons might not
be obvious.
 Acknowledge people in a friendly way. You could say a friendly "hello"
or "good morning" as you pass them, or wave your hand. Some people
who can't wear masks might feel like others are avoiding or ignoring
them.
 Communicate with people in other ways. Try using your voice, eyes,
hand gestures and body language. This could help compensate for what
you're unable to show through smiles or other facial expressions.
 Ask people what would help. If you see someone regularly who is
uncomfortable with people wearing masks, ask how you can help. For
example, you can maybe get a transparent mask to wear with them.
 If someone tells you they’re exempt, accept their word for it. It might
be difficult for some people to go into detail about their reasons. If you
work in a place where masks are compulsory, make sure you understand
the exemption rules of your workplace. See our page about going into
work during coronavirus for more information.