Immediate Care for Psychological Events and Emergencies in the Context of COVID-19 Pandemic

1 Associate Professor, Department of Mental Health Education, NIMHANS, Bangalore

2 Deputy Editor, Journal of Mental Health Education 1Assistant Professor, Department of Mental Health Education, NIMHANS

3 Associate Professor Department of Clinical Psychology NIMHANS

4 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

5 Senior Professor of Psychiatry, Dean, Behavioral Sciences & Head, Department of Mental Health Education, NIMHANS

6 Department of Mental Health Education, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

7 Department of Mental Health Education, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

8 Department of Mental Health Education, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

9 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

10 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

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*Author of Correspondence: Dr. Meena K S, Additional Professor and Head, Department of Mental Health Education, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

E-mail: meenaksiyer@gmail.com

The focus of attention of the entire world for the recent few months has been the massive outbreak of the novel coronavirus disease, commonly called the COVID-19. The rapid spread of the disease, wasn’t limited to any geographical locations and has affected almost every continent in the world. Due to the disease’s contagious nature of this magnitude, the World Health Organisation (WHO) declared this as a Public Health Emergency of International Concern, making it into what is called the Pandemic. (WHO, 2020) The Governing bodies of various countries are trying their best to curb the spread of this virus by reducing the physical contact among people as much as possible. In order to ensure the same, counties around the globe have been enforced with strict lockdown rules and guidelines to refrain people from getting exposed to the virus directly or indirectly through any kind of physical contact. Thus, the COVID-19 pandemic of this nature leading to lockdown and the exercise of governmental

rules has called for a time of crisis for the whole world, generating stress and anxiety through all age groups throughout the population. Adding on to this, the unpredictability of the spread of the disease, its increased risk, roped with the uncertainty of the ways to control the disease are reasons strong enough to trigger mental health crisis among the population.[2]Due to this psychosocial impact on the mental health of the people, it is important to address the mental health crises among those affected, so that they do not succumb to a full-blown mental illness such as depression or anxiety disorder.

The National Institute of Mental Health and Neurosciences (NIMHANS) is a premiere institute dedicated to mental health care and neurosciences located in Bengaluru, in the southern part of India. The Department of Mental Health Education at NIMHANS is a department solely dedicated to the aim of promoting health and wellbeing of people in the community through educative and training process thereby enhancing the mental health in the country.[3] As a part of its regular activities, the department conducts a series of workshop called the Immediate Care for Psychological Events and Emergencies for the general public. The objective of this workshop is to help the community identify the day-to-day mental health crisis which anyone can face and to address the same effectively before it turns into a full-blown mental illness.[4]

The Rationale for an e-workshop in the context of COVID-19

Based on similar objective, the department planned to conduct an e-workshop to address the potential mental health crisis among people, which may arise in face of COVID-19 pandemic. This current lockdown and other protective measures adopted by government are influencing mental health of the community. The widespread outbreak of this disease and its rapid spread has been causing considerable psychological distress among the masses.[5]Hence, it is critical to introduce some measures to eradicate these concerns. The e- workshop on “Immediate care for psychological events and emergencies in the context of COVID-19 pandemic” was an effective initiative to address the mental health concerns spreading among the public by being an immediate carer in this contemporary scenario. The specific workshop was an effort towards addressing the various risks leading to mental health crisis among individuals, how to recognise them and steps for becoming an effective immediate carer during this COVID-19 related crisis. Few of the reasons which could trigger crisis included indefinite postponement of exams, financial crisis, loss of job, fear of acquiring or transmitting infection and stigma among those who recovered or under

quarantine. Online platform using ZOOM video conference was chosen to host this e- workshop to reach out to a larger population in the community over a short time period during the lockdown. A total of 200 participants had logged in for the webinar.

Highlights of the e-workshop

The workshop has given insight into the importance of giving immediate care to people who go through anxiety due to the unprecedented quarantine measures, physical distancing, information overload, misinformation and fake news. Table 1 explains the various points covered in the workshop.

Contents

Overview of Mental Health Crisis during COVID-19 pandemic

Why is Immediate Care important during COVID-19 pandemic?

Identifying the signs of the need of Immediate Care in a person

Approaches to Provide Immediate Care

Referrals

Addressing Burnout among Immediate Carers

Table 1: Contents of the e-workshop Significance of immediate care and immediate care providers

In this current COVID-19 crisis and further lockdown measures people are going through concerns about protecting oneself, feelings of isolation infection fears, frustration, boredom, and the stress and anxiety resulting out of longer quarantine duration, inadequate supplies, inadequate information, inability to perform daily activities and financial crisis. Some people are able to cope effectively with these mental health issues but not everyone. People react to this crisis differently based on factors like the severity of event, experience with previous stressful events, psycho-social support received, physical health and other demographic factors. People are scared to open up about their symptoms with the fear of getting isolated. Ignorance about the mental health issue delays help seeking at the correct time. Stigma and misconceptions associated with the pandemic causing delay in seeking professional help. Early intervention can help to alleviate the issues. Hence, immediate care, being the humane and practical psychosocial assistance offered to those in need during a crisis situation, is critical.

Potential Immediate Care Providers

Immediate care can be provided by relatives, family members, neighbours, teachers, community members, emergency medical teams, mental health professionals, counsellors, police, and NGO or Govt. Staffs.

Beneficiaries of Immediate care

In this COVID-19 outbreak, people likeCOVID-19 survivors and their families, children and adolescents, separated from their caregivers, pregnant or nursing women, elderly population people with disabilities and chronic health conditions and people at risk of discrimination can take benefit of immediate care.

Major stressors leading to mental health crisis

Nobody is free from undergoing mental health issues during this crisis. Children have to go through stressors regarding their uncertainty in their academic life, separation from parents, abuse, boredom and lack of social contact. Adolescents have to go through uncertainties regarding academic plans, abuse and lack of social contact. Adults are at the risk of job loss, financial crisis, violence, different work structure, etc. Frontline workers, pregnant women, people who recovered from COVID-19 or suspected of COVID-19 are more vulnerable to develop mental health issues. Elderly population has to go through loneliness, loss of contact with children, violence, ill health, lack of support system, unable to socialize etc.

Addressing myths related to COVID-19

Stigma is being developed and most prevalent in the society. Stigma associated with COVID- 19 is being developed against people, who travelled abroad, people from a specific region, race or religion, people who are symptomatic, people who have recovered from or suspected of COVID-19 etc. It was essential to address the myths for the public which was fulfilled successfully.

Identifying Signs of need for immediate care

Some important signs are there to be looked for to identify people with immediate care need. The signs include overwhelming sadness or helplessness, lack of interest in surroundings, inability to feel pleasure in joyful activities, anger outbursts, altered sleep and eating patterns, expression of negative feelings on Social Media, unusual and unexpected behaviour and unexplained physical health problems. There are certain verbal cues to be looked for, which

are words spoken, low tone and silence. And the non-verbal cues to be identified are eye contact, facial expressions, gestures, body language, posture and appearance.

Providing immediate care

In order to explain this, a video was prepared and demonstrated to the registered participants. The Video explained in details about the do’s and don’ts of talking to a person going through a sudden mental health crisis during the COVID-19 pandemic. Following this, the presentation continued. There are different approaches to provide immediate care to be taken care by the immediate care provider. The approaches include communicating effectively, promoting sense of safety and connectedness, helping responsibly, building up coping strategies, and encouraging professional help seeking. Effective communication includes being empathetic and establishing rapport, ensuring person’s comfortableness, taking care of demographic factors, being non-intrusive, rephrasing and summarising. Ensuring confidentiality, reassurance, suggesting to get connected with loved ones virtually, and helping the person to filter out news consumption are significant to ensure safety and connectedness. Being warm and supportive, encouraging the person to come out of the situation, act in interest of the person, etc ensures responsibly helping the person. Helping the person to develop coping strategies based on his or her strength and suggesting professional help are critical to ensure effective immediate care.

Practicing do’s and don’ts while providing immediate care

There are various aspects to remember while providing immediate care. Respecting uniqueness of each individual, respecting the norms, culture and traditions of the respective communities, treating the person with respect and dignity, showing concern, letting the person take decision, being active listener, observe the verbal and non-verbal cues in communication, and providing authentic and transparent information are the important things to be practiced while providing immediate care. Commanding person to take help when he/she is not ready to take help, arguing with the person, blaming the person for his or her problems, being sarcastic, over involved or over protective, taking decisions for others, giving promises, committing to share the person’s responsibilities, offering solutions to their problems, taking any ownership of success or failure, sharing one’s own problems or troubles and forcing the person to lead life based on one’s values should not be practiced while providing immediate care.

Addressing burnout among immediate carers

Burnout may occur among immediate carers when they listen to the problems of people in need for help for a longer time. The signs of burnout include feeling tired and less energy, feeling constantly exhausted even after taking rest, feeling helpless and hopeless, being impatient and irritable, overreacting to situations and neglecting self-care. Burnout can be addressed through taking care of self, connecting with emotions, seeking help or mentoring from experts, understanding boundaries, accepting limitations, avoiding feeling sorry for one self, never blaming oneself or others, etc.

After the presentation, the workshop had a question and answer session to address the queries of participants. A panel of faculty experts from various departments like Mental Health Education, Clinical Psychology and Psychiatric Social Work were available to answer the queries related to providing immediate care in the context of the pandemic. Questions were taken from various participants hailing from various professional background and geographical locations. Dealing with the uncertainty of the situation evokes a number of questions in people’s minds. Thus, various queries related to addressing children’s mental health to that of the elderly were catered to. After the Question and Answer round, a general feedback of the webinar was taken through the help of a poll.

Along from the psycho-social impact of the outbreak, the gripping fear among the masses due to the outbreak of the disease is inarguably not an uncommon phenomenon as people from any gender or socio-demographic status can be affected.[6]Thus, anyone can be susceptible to a mental health crisis of immediate nature due to the uncertainty of the situation. Therefore, there is a need to empower the people in the community with the proper steps to provide immediate care to anybody going through a crisis. Thus, this webinar was conducted with the aim to empower the community with the correct methods of immediate care-giving to the person in need.

References

  1. World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak, 18 March 2020. World Health Organization; 2020.

  2. Zandifar A, Badrfam R. Iranian mental health during the COVID-19 epidemic. Asian journal of psychiatry. 2020 Jun;51:101990.

  3. Krishnamurthy S, Meena KS, Bhola P, Kapanee AR, Agrawal S, Parveen R, Chaturvedi SK. Learning Mental Health Education: Experiences from a short-term course.

  4. Murthy MK, Kapanee AR, Desai G, Chaturvedi SK. Exploring the knowledge and attitude of public about mental health problems: A pilot intervention for effective mental health promotion. Journal of Education and Health Promotion. 2019;8.

  5. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian journal of psychiatry. 2020 Apr 10:102066.

  6. Ho CS, Chee CY, Ho RC. Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic. Ann Acad Med Singapore. 2020 Jan 1;49(1):1-3.