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Table of Contents
EDITORIAL
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 1-3

Psychedemic of mental health problems and COVID-19: Are we doing enough?


Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India

Date of Submission10-Jun-2021
Date of Acceptance14-Jun-2021
Date of Web Publication29-Jun-2021

Correspondence Address:
Sonu Hangma Subba
Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcfm.ijcfm_45_21

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How to cite this article:
Subba SH. Psychedemic of mental health problems and COVID-19: Are we doing enough?. Indian J Community Fam Med 2021;7:1-3

How to cite this URL:
Subba SH. Psychedemic of mental health problems and COVID-19: Are we doing enough?. Indian J Community Fam Med [serial online] 2021 [cited 2021 Nov 30];7:1-3. Available from: https://www.ijcfm.org/text.asp?2021/7/1/1/319960



As India and the world reels under the second and the third waves of COVID-19, there runs parallelly a “psychedemic,” i.e. the mental health aspect of the pandemic, which seems to get side-stepped in the rush of massive caseloads and deaths. The sheer size of the pandemic would translate into a high burden of mental health disorders. However, in the present situation, the here and now of survival garners all the effort, and mental health takes a backseat. Nobody is counting the mental morbidity and the impact thereof except for what one can find in the registers of the helpline numbers and the pages of scientific journals. It is not that mental health is facing total neglect. The World Health Organization (WHO) and the Ministry of Health and Family Welfare, Government of India (MOHFW) have acknowledged from the beginning of the pandemic the requirement of mental health needs of the people and the health-care workers (HCWs) and have continued to do their bit to deal with this large problem. However, is it enough? It may be too little and too fragmented to make much impact.

The SARS-CoV-2 causes varied mental health problems among patients and their families, HCWs, and the general population ranging from organic disorders, worsening of the existing disorders, substance abuse, psychological stress, anxiety, depression, sleep disturbances, posttraumatic stress disorder (PTSD) to suicide in varying proportions.[1] Multiple mechanisms are involved in the causation of such disorders among the COVID-19 patients, from neuroinflammatory pathway causing neuropsychiatric manifestations such as psychosis, relapse or exacerbation of already existing disorders due to interruption in the treatment as a consequence of lockdowns, psychological effects of isolation, or PTSD due to severe disease.[2] Among the HCWs, fear of getting infected or infecting one's family members, burnout, having to stay away from the family, psychological, and social stress due to helpless witnessing of enumerable death and suffering, getting stigmatized, quarantine, isolation, and losing close associates to COVID-19 would all contribute to mental health problems.[2] In the general population, besides quarantine, witnessing severe disease and death of one or more loved ones within the family, fear of getting infected, social stress of unemployment, lack of earning and ostracising of the family if any member became positive, and the inability to venture out and stay indoors for a long duration due to lockdowns have all been instrumental in causing mental health problems. Added to the burden is the large number of children orphaned by the pandemic, who will have their own set of psychological disorders that can jeopardize their future. Any plan to rehabilitate them has to take into account their mental health needs.

This psychedemic of mental health problems which is striking against the shores of humanity is obscured at present by the imagery of gasping patients and bundled bodies. However, it will eventually rear its ugly head and the ramifications will be both visible in terms of high morbidity and mortality and invisible in terms of negative impact on the country's socioeconomic development. Therefore, it is vital that we recognize the gravity now and implement measures to mitigate the mental health effects of COVID-19. A look at what exists already shows that plenty of documents exist on the government and nongovernmental organizations' websites to help people and HCWs deal with their own and the patients' mental health problems. However, in a country like India, how many people can have access to those documents? How many health workers will have the time and energy to search multiple websites and download those documents or watch the videos? Not undermining the importance of these materials to help people, we must also accept that these have their limitations. When a person is under severe depression or are suicidal, they do not have the inclination to search nor use these resources. Therefore, the useful approach under such circumstances, i.e., 24 × 7 helpline numbers and telepsychiatry facilities are being provided by many agencies in the country including MOHFW. There is no arguing that these helpline numbers would have saved many lives and improved others. However, we must acknowledge that the reach of these helpline and telepsychiatry numbers and the self-help material would be mainly catering to the educated and the urban populations. That the rural and low literacy populations would be excluded with these strategies is only part of the problem. There are other issues with mental health in India; people have low mental health literacy, resulting in the inability to recognize the symptoms of psychological stress or disorder and hence fail to seek help, and where they recognize, it may cause added fear of stigma and make them more stressed.[3] Hence, in a sociodemographically diverse population like India, there must be a multipronged, well-planned, systematic approach to be of substantial benefit to the people.

COVID-19 has seriously affected the population's mental health, and this effect will continue in the aftermath of the pandemic. There is need to take care of the mental health-care needs of the people beyond the currently existing strategies in terms of both coverage and repertoire of services. The strategy must include short-term measures for the pressing needs and long-term plans. In the short term, with limited resources, effort should be made to maximize the utility of the already existing ones. Currently, the helpline numbers, telepsychiatry, and capacity strengthening activity for HCWs are mostly working in silos. There is a need to integrate these activities. The telepsychiatry network must reach spatially and socioeconomically remote populations. The National Mental Health Program (NMHP) should be strengthened whereby its network is used as a platform to create a system of an all-pervasive telepsychiatry facility, should be linked with the 24 × 7 helpline numbers. Mental health care should be part of the management package for all COVID-19 patients including postdischarge continuity of care for severe cases. A mechanism should be in place for active intervention for HCWs as they may not get the time, energy, nor inclination to seek active care. Ideally, every hospital should have a team to look after the mental health of their staff. They should also be made aware of existence of such a team and various means of approaching them, should the need arise. However, it will not be possible for every hospital or peripheral health institutions (PHI) to have a team to look after the mental health of their HCWs, and this gap can be filled by a common pool catering to geographically proximate PHIs and hospitals.

The community mental health component should be strengthened using the stepped care model proposed by the WHO with country-specific modifications.[4] The grass root level workers such as the Accredited Social Health Activist, auxiliary nurse-midwife, and male health workers should be trained to recognize the symptoms of mental illness, including substance abuse, and refer them. Given the shortage of psychiatrists in the country, the MBBS doctors in the primary health centers or other specialists in the Community Health Center, Subdistrict Hospital or a District Hospital can be trained in the short course of community mental health in the lines of what was done for the training of surgeons for cesarean section and anesthesia to reduce maternal mortality.[3] These PHIs are supposed to have a trained counsellor under the National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular disease, and Stroke Programme for noncommunicable disease patients. Integration can happen at this level with the same workforce being used for mental health care. With a counsellor and a doctor trained in mental health in the PHIs, a vast majority of cases can be solved within the district. Only severe and challenging cases may be referred. In this way, mental health services will be within reach of the people. In the absence of a doctor trained in mental health, the telepsychiatry facility may be used. Meanwhile, there should be more aggressive advocacy and communication strategies to remove the stigma and encourage people to seek help when needed.

Long-term measures are well elucidated in the NMHP, but they must be followed in letter and spirit if mental health care is to be made effective and widely available. The number of postgraduate seats in psychiatry should be increased. Besides psychiatrists, there is a severe shortage of other mental health professionals such as clinical psychologists, psychiatric nurses, and psychiatric social workers. These courses should be made available in all the medical colleges. There should be a strong forward and back referral of cases so that patients can continue their treatment through the primary care physicians once the treatment is started and titrated at the secondary or tertiary care levels. There should be good record linkage between the specialists and primary care physicians. Eventually, all the best-planned programs can be nullified by the lack of adequate budget allocation, and the best budget may not yield the desired results in the absence of a systematic monitoring and evaluation system. These could be the Achilles heels of NMHP unless remedial measures are taken at relevant levels.

COVID-19 took the world and India by surprise this time. It has caused substantial morbidity and mortality despite modern medicine and all its benefits, like accelerated vaccine production. Mental health disorders related to COVID-19 have been varied in manifestations and burden has been high, but it has not received the attention it warrants. As history has shown, we cannot avoid epidemics and pandemics altogether. With the implementation of short-term measures, we can still hope to mitigate the mental health impact of this pandemic and with effective implementation of long-term measures, the potential future pandemics should be less devastating mentally than this time.



 
  References Top

1.
Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun 2020;89:531-42.  Back to cited text no. 1
    
2.
Szcześniak D, Gładka A, Misiak B, Cyran A, Rymaszewska J. The SARS-CoV-2 and mental health: From biological mechanisms to social consequences. Prog Neuropsychopharmacol Biol Psychiatry. 2021 Jan 10;104:110046. doi: 10.1016/j.pnpbp.2020.110046. Epub 2020 Jul 28. PMID: 32730915; PMCID: PMC7384993.  Back to cited text no. 2
    
3.
Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India, 2015-16: Summary. NIMHANS Publ 2016;128:1-62.  Back to cited text no. 3
    
4.
World Health Organization and Calouste Gulbenkian Foundation. Integrating the Response to Mental Disorders and Other Chronic Diseases in Health Care Systems. Geneva: World Heal Organ; 2014. p. 1-50. Available from: http://apps.who.int/iris/bitstream/10665/112830/1/9789241506793_eng.pdf?ua=1. [Last accessed on 2021 Jun 08].  Back to cited text no. 4
    




 

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