The pandemics and the urgency for Telepsychiatry
By: Fayaz Ahmad Paul
The Covid-19 pandemic along with lockdown measures to prevent the spread of the disease has worsened the mental health status of the people of Kashmir. The valley is vulnerable to several types of disasters particularly earthquakes, landslides and various avalanches due to its geographical characteristics, the health-seeking behaviors of the masses have also been seriously affected by curfews, lockdowns, and communication black-outs due to the long political turbulence. Telepsychiatry has been recommended as a cost effective strategy which meets the needs for mental health services particularly in the areas that have experienced high intensity conflict scenarios.
The psychological impact of the Pandemics must be recognized alongside the physical symptoms for all those affected. Telehealth, specifically telemental health services, are practically feasible and appropriate for the support of patients, family members, and health service providers during this pandemic. As of 05 June 2021 in Jammu and Kashmir 297,602 people are affected by novel coronavirus. Sadly, 4026 patients have died also. India has 28,694,879 confirmed cases of Covid-19 and of these cases, 344,082 people have succumbed to the infection while 26,795,549 have recovered. Similarly the virus has globally impacted people and there are 17, 25, 76,591 confirmed Covid-19 cases across 193 counties, which has led to 37, 12,006 deaths, reports the World Health Organization.
Psychological symptoms relating to Covid-19 have already been observed on a population level including anxiety-driven panic buying and paranoia about attending community events. Research scholars, university or collage students and workers who have been prevented from accessing their training institutions, workplaces, homes, respectively, are expected to have developed psychological symptoms due to stress and reduced autonomy and concerns about income, job security and so on. Various governments from all over the world have highlighted the psychological side effects of Covid-19 and have voiced concerns regarding the long-term impacts of isolation and that the fear and panic in the community could cause more harm than Covid-19.
In the absence of a proper medical cure for Covid-19, the global response is a simple public health strategy of isolation for those infected or at risk, reduced social contact to slow the spread of the virus, and simple hygiene such as hand washing to reduce the risk of infection. While the primary intervention of isolation may well achieve its goals, it leads to reduced access to support from family and friends, and degrades normal social support systems and causes loneliness adding to the risk for worsening anxiety and depressive symptoms. If left untreated, these psychological symptoms may have long-term health effects on patients and require treatment adding to the cost burden of managing the illness.
In relation to mental health professionals like Psychiatrists, Psychiatric social workers, Clinical psychologists, Psychiatric nurses, Clinical and non clinical staff are also at risk of psychological distress as they are expected to work longer hours with a high risk of exposure to the virus. This lead to stress, anxiety, burnout, depressive symptoms, and the need for sick or stress leave, which would have a negative impact on the capacity of the health system to provide services during the crisis. Providing psychological treatment and support may reduce the burden of co-morbid mental health conditions and ensure the wellbeing of those affected.
The biggest hurdle is to provide mental health services in the context of patient isolation, which highlights the role of tele-mental health in the form of Whatsapp, videoconference, e-mail, telephone, or smart-phone applications. Provision of mental health support will likely helps patients maintain psychological well-being. To support the effectiveness of telemental health are fairly diverse, especially in the context of depression, anxiety and delayed stress disorders and Obsessive compulsive disorder. Video-conferencing, online forums, smart-phones have been shown to be useful communication methods for the delivery of mental health services in different parts of India and all over the world.
So many countries are actively providing various telemental health services during the outbreak of Covid-19. These services are from government and academic agencies and include counseling, supervision, training, as well as psycho-education through online platforms. These services have been prioritized for people at higher risk of exposure to Covid-19, including clinicians on the frontline, patients diagnosed with Covid-19 and their families. Telehealth program is restricted to special needs groups and the wider population does not have access to the program. A major benefit of expanding tele-health, including mental health, with no restrictions would reduce person-to-person contact between health service providers and Covid-19 and reduce the risk of exposure of non-infected but susceptible patients in waiting room areas. Expansion of access to telemental health support services with a focused public education campaign to promote these services would begin to address this need.
Communication of all health needs is important when patients have to be isolated. We need to support the use of tele-health as a valuable way of supporting both physical and psychosocial needs of all patients irrespective of geographical location. Simple communication methods such as e-mail and text messaging should be used more extensively to share information about symptoms of burnout, depression, anxiety, and delayed stress disorder and Obsessive compulsive disorder (OCD) during Covid-19, to offer cognitive and relaxation skills to deal with minor symptoms. Telemental health services are perfectly suited to this pandemic situation giving people in remote locations access to important services without increasing risk of infection.
The author is a Research Scholar in the Department of Psychiatry, Government Medical College and Hospital.