Navigating the Coronavirus Pandemic-Personal thoughts-3

CHALLENGES: In most places, only emergency medical services are available, and only to those who have access to personal means of transport. So, essentially, the global lockdowns substitute one set of morbidity and mortality with another. I hope that medical scientists will keep track of the trade off.“Does anybody know of what options are available to those who suffer, and how we can help?”

A week is a long time. So much has changed in the last few weeks for the population and for mental health.
How true!!

On March 26, 2020, in the e-IPS group a member had raised the challenges of providing mental health care, as follows:
“Does anybody know of what options are available to those who suffer, and how we can help?”

I had responded to the same with 5 ways to reach those in need of services.
In the last 5 days, there have been such a bevy of new initiatives by so many professionals, This is a very heartening experience of innovation and commitment.

I revisited the brief note and the subject of the current blog.

Rich history of Community Mental Health Care in India

The rich history of community mental health initiatives in India is appropriate to organise mental health care during the current PANDEMIC.

In contrast to the economically rich countries, the development of community psychiatry in India, occurred against the background almost no mental health services and there were special challenges of lack of awareness in the community, existing systems of traditional care, stigma, poorly functioning institutions. Almost all of the persons with mental disorders are living in the community, most often without any organised services, with the family providing the care in whatever form they are able to do (ranging from isolation to committed care). In a way, community psychiatry has developed in India as “the service” and not as an “alternative” to institutionalised care.

Internationally, a major advance that has occurred in the last few decades, is the recognition that mental health care does not need to be provided by the mental health specialists alone. There are a wide range of innovations showing that primary health care physicians can deliver major part of the mental health care. School based interventions have been found to be effective in promoting mental health of children. Suicide prevention has been mainly supported by ‘lay counsellors’. Following disasters, a wide range personnel from doctors, health workers, teachers, survivors can address the needs of the population. Reports of effectiveness of a wide range of ‘self-care’ initiatives involving information technology, support groups makes individuals the centre of the care process.

A striking aspects of the developments of mental health services in India, is as much the location of the care in the community (where most of the ill persons were already living) as the utilisation of a wide variety of community resources of the community. For example, in the initial phase, family members were the focus, followed by the utilisation of the existing general health care infrastructure through integration of mental health services with general health services. This was followed by increased use of school teachers, volunteers, counsellors, mentally ill persons, survivors of disasters, parents of children with mental disorders, the personnel of education system occurred. In this way the three principles of community psychiatry –meeting population based needs, use of range of resources, and accessibility were partially addressed.

Here are 7 approaches to ‘REACH THE UNREACHED’

Excluding psychiatric emergencies that have to taken up by the hospitals using the public and private ambulances, majority of the psychiatric/emotional health advice, can be delivered by using the mobile phones, community radio, and other forms of social media.

Firstly, linkage with general medical personnel. This group of medical professionals and paraprofessionals are located closer to the population and are easily accessible to the general population. This approach of integrating mental health care with general health care was the founding principle of the National Mental Health Programme(NMHP) of India, formulated in 1982. This continues to be the foundation in 2020, with the change being the using of modern tools like ECHO programme of NIMHANS, Bangalore.

Secondly, setting up a help line (example of NIMHANS Helpline 080-46 110007) is one the best way to assure the population of easily accessible and availability source of information and emotional support. I know a number of professionals working in remote places have been servicing the population using this facility(eg. Dr.Shere, S. of Ratnagiri, Suicide Prevention centres)

Thirdly, reach through social media. Each of us are members of whatsapp groups of different varieties. As a psychiatrist, each person can offer to all my members access to information and advice. In most situations, the fact that you have a reliable source of information allays much of the anxiety, similar to having a credit care that makes one comfortable when going to market. Advice helps allay the anxiety and also solves a lot of problems at the initial stages. Such interventions can be of help has been demonstrated in a number of settings like refugees, disaster survivors.

Fourthly, each of us know of a school, old age home, or other types Institution. These people are vulnerable for emotional distress during the pandemic. Professionals can dialogue with the management, offer services to their members. Those of us living in an apartment complex can use the available network( email, website etc) to provide continuous information, support and advice.

Fifthly, at the clinical care level, from the records, take out the phone numbers and arrange to call by self or other clinic staff, to reassure that you are available by phone, so that they do not feel ‘isolated and helpless’ because restrictions of travel. This service is being offered by a number of Institutions , An example, Telemedicine: Stay Home. Apollo can come to you. Video Consult with any Apollo doctor on Apollo 247 App. Download Now klr.pw/PQLWc/QTM1tk–

Sixthly, support to medical personnel by those of us working in a medical setting, recognising the high prevalence of stress (see attached APA study), create opportunities for support at the institution (helpline, weekly meetings of sharing of information) and be available by phone and other communication channels so that they can receive help at early stages.

Seventhly, utilisation of mass media to reach the positive emotional health messages to the general population. It is very gratifying to see, nearly every day the TV and radio channels have discussions on mental health.

There are three reports from the recent issues of Psychiatric News, related to this subject and other resources prepared by other organisations and individuals. It is available in this folder.

My earlier blogpost 2 focusses on SELF-CARE measures to EMPOWER individuals for EMOTIONAL HEALTH.

A request to the group members, to share, GOOD PRACTICES adapted to empower each of us to give the best.
I am sure each of us is finding local solutions.
For example, I am deeply impressed by the app support/ monitoring of quarateened persons by the police in Kerala using smartphones.


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