COVID-19 and adaptation to mental health services

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Summarizing how NGOs providing outreach mental health services to marginalized and vulnerable populations in India have adapted care services during the ‘new normal’, Dr Sapna Nair, Health Research Fellow, LEAD at the University of Krea and Dr R Padmavati, Director, Schizophrenia Research Foundation (SCARF, India) make critical recommendations, including the the importance of framing policies and programs of care for the population with mental illness in administrative and disaster planning strategies, in particular the need to integrate housing, transport and medicines for people with mental illness

COVID-19 has caused disruption in services for the mentally ill in several countries around the world. While these disruptions have been well documented, few studies have looked at the perspective of service providers. Mental health outreach services for marginalized and vulnerable populations in India were started by NGOs and it is important to understand how these organizations adapted care services during the ‘new normal’. A recent study conducted by LEAD at the University of Krea and the Schizophrenia Research Foundation explored the dynamics of care from the perspective of service providers at SCARF, based in Chennai, Tamil Nadu. The organization provides mental health care services for a range of mental disorders.

The first two weeks of “confinement”

Services were disrupted with the nationwide lockdown in March 2020, and guidelines were released by the government to switch to telemedicine, to ensure continuity of care. The practice of telepsychiatry has raised concerns about patient dynamics, appropriate diagnosis, and legal issues, but has been successful in some settings. Services to the rural and elderly population, which were still problematic, deteriorated during the pandemic.

During the two-week full lockdown, all services were affected, after which essential care-related services were able to resume. Non-essential services such as awareness, training, research and mass awareness programs have been partially picked up on digital platforms. From the service provider’s perspective, two areas of concern were stopping center-dispensed medications and changing patient status. Additionally, service providers faced additional barriers in navigating modified routines and managing their care responsibilities.

Accessibility, availability and personal challenges

Access to all mental health care services was affected during the early lockdown, as patients could not physically access the centre’s services due to restrictions. Obtaining psychotropic drugs, a standard of care for people with chronic mental illness, was a challenge for most patients, as not all neighborhood pharmacies had these drugs in stock, and if they did. , some pharmacists were reluctant to dispense them. For some patients, especially in rural areas and district borders, movement restrictions were particularly difficult.

The unavailability of medications led to worsening of the results, especially in conditions such as schizophrenia or mood disorders, often requiring hospital care. However, the pandemic has restricted admissions due to fears of a possible spread of COVID-19.

Service providers also had to respond to the multiple contextual issues faced by families. The outgoing and rehabilitated clients expressed their concerns about the lack of professional and social activities at the center. For home care assistants, the closure of the vocational training center and daycare has led to an increase in the care load apart from cross-cutting issues such as job losses, wage cuts and increased costs. indebtedness.

Additionally, providers faced challenges in maintaining work-life balance and providing appropriate quality care while making accommodations. Their personal time was also affected by extended working hours, care-related fatigue, decreased time spent with family, and reduced formal and informal interactions with co-workers. There was also the perceived risk of contracting COVID-19 while traveling or interacting with patients.

3 Rs of adaptation were the key

The main goal of service delivery was to maintain continuity of care while minimizing the risk of infection. We find that three elements of service delivery were essential: relationships with communities, reactivity patient needs and resilience ensuring continuity.

System adaptations included the use of telecommunication platforms, electronic prescriptions and the continued use of expired prescriptions as well as institutional-level strategies such as segregation and liaison psychiatry for patients. patients diagnosed with COVID-19.

Each service department – operations, pharmacy / clinical services and non-pharmacy / counseling services, worked on a set of adaptations and took on challenges through informal communication channels such as WhatsApp groups, which have proven to be useful for decision making, emotional support and burden sharing.

Operational and management adaptations were aimed at the following ongoing objectives:

  • Establish standard security protocols in the premises
  • Ensure staff and patients have the required documents to travel
  • Introduce a smart list system that effectively links patients and providers, physically or by teleconsultation, and provide 24-hour helpline services for the general public and existing patients

Safety protocols included streamlining patient movements, standard precautions such as disinfection, temperature checks, masks, and social distancing guidelines, which were adopted early and enforced. The documents required by staff and patients for travel required staff to be constantly available to authenticate themselves with authorities.

Lessons from the past

Lessons learned from past calamities such as floods, tsunamis and cyclones in Tamil Nadu have proven useful in helping to adapt service delivery during the crisis. The previous experience of providers in implementing telepsychiatry has made implementation during the pandemic a little easier. The importance of framing policies and programs of care for the population with mental illness in administrative and disaster planning strategies, in particular the need to integrate housing, transport and medicines for people with mental illness is crucial. It is also important to sensitize law enforcement authorities to the diverse needs of the mentally ill. Finally, it is imperative to have training programs for health workers to strengthen their capacity to deal with isolation, infection and resettlement, and a similar commitment for caregivers and families.

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