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EDITORIAL

A novel approach to address the novel threat

Mythili Hazarika1, Bornali Das2, Shyamanta Das3, Suresh Bada Math4, Samrat Singh Bhandari5, Lakshmanan S6, Kailash Karthik7, Pomi Baruah8, Najeeb Hazarika9, Hardeep Singh Bambrah10, Kanika Suri11; the Monon: Assam Cares programme

1,2,3Gauhati Medical College Hospital, Guwahati, Assam, India, 4National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India, 5Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India, 6,8National Health Mission (NHM), Assam, Guwahati, Assam, India, 7Office of the Deputy Commissioner, Kamrup Rural District, Assam, India, 9,10Piramal Swasthya, Guwahati, Assam, India 11Piramal Swasthya, Hyderabad, Telangana, India

Abstract

The editorial highlights the mental health initiative of the Government of Assam, India through the Monon: Assam Cares programme to deal with the coronavirus disease 2019 (COVID-19) pandemic. Through this initiative, trained mental health professionals proactively reached to people with COVID-19 to provide psychological aid.

Keywords: Mental Health Professionals. Teleconsultations. Psychosocial Factors.

Correspondence: Dr. Mythili Hazarika, PhD, Associate Professor of Clinical Psychology, Department of Psychiatry, Gauhati Medical College Hospital, Bhangagarh, Guwahati-781032, Assam, India. hazarika.mythili@gmail.com

Received: 17 July 2020

Revised: 21 July 2020

Accepted: 22 July 2020

Epub: 27 July 2020

Assam, one of the eight North-Eastern (NE) states of India, has a population of 3.1 million.[1] Here, the first novel coronavirus disease 2019 (COVID-19) positive case was reported on 31 March 2020,[2] reaching almost 20 thousand confirmed cases in just three and a half months.[3] Like the rest of the world, the government has resorted to intermittent lockdown along with the norms like physical distancing, wearing masks, and hand hygiene measures.

In view of lockdown and mental health challenges faced by sudden lockdown, on 11 April 2020, a group of authors drafted, peer-reviewed the content, and released the Best Practice Guidelines for Telepsychology during Disasters (COVID-19 Pandemic).[4] The Committee on Mental Health, constituted by the Government of Assam, approved the Best Practice Guidelines and subsequently uploaded on the website of the National Health Mission, Health & Family Welfare, Government of Assam, along with video modules.[5]

The Government of Assam started a mental health support programme, named “Monon” (meaning ‘the act of discerning’) for COVID-19 positive individuals and quarantined persons in the state. The Monon: Assam Cares programme was launched on 13 June 2020.[6] Based on the guidelines, a team of mental health professionals were trained through webinars and personal communications. Through the programme, this team consisting of psychiatrists, psychologists, social workers, and counsellors started calling the COVID-19 positive individuals in the state of Assam.  The trained service providers made the telephone calls via “Sarathi” (meaning ‘driver’) – ‘104’, a health helpline.[7]

Inquiry about health and well-being was made. Physical, mental, and social health were evaluated. Depressive, anxious, suicidal (when found necessary), and sleep issues were probed. Interventions, if required, were provided through teleconsultation, including telemedicine according to the Telemedicine Practice Guidelines, notified by the Government of India.[8] The tele-mental health services provided was free of cost, i.e. the service providers did not charge any fees from anyone while doing the intervention during this time of pandemic; hence, termed “voluntary”.

In phase 1 of Monon during the first week, we have observed that most of the beneficiaries who are/ were in institutions/ isolation centres, have mental health-related symptoms secondary to psychosocial factors rather than the disease itself. Starting from financial reasons to staying away from family and friends, these psychosocial factors also included certain COVID-19 specific concerns as well, like stigma and discrimination.

Incorporating the above-mentioned psychosocial factors and concerns into the plan of action, Monon entered phase 2 and 3. Within three weeks, 5387 unique beneficiaries were proactively contacted. Satisfaction and appreciation of the beneficiaries for this unique approach (novel approach for novel threat) of Monon service providers reaching out first instead of waiting for the needy to initiate the process, have boosted the morale and enriched the mental health initiative from this part of the globe.

Tele-mental health is now going to be the rule rather than the exception, globally.[9] Thinking in advance to deal effectively with the consequences of the pandemic, including rehabilitation, the earlier group of authors has come up now with the Guidelines for Mental Health and Psychosocial Support Services during Pandemic.[10]

In reference to the Government of India’s directions, we would like to state that Assam had already taken steps to bridge the gaps in mental healthcare and the Assam model is the only model in India which has been of individually reaching out to people who are COVID-19 positive to address their specific issues related to the mind. The issues are well documented from each and every individual to address their needs as part of the Assam Government plans for the future. Keeping in view of the increased need of mental healthcare in general population and patients having COVID-19 as well, the government has started thinking about psychosocial rehabilitation for long-term care and services.

ACKNOWLEDGEMENTS

Pranjal Kumar Saikia, Debajit Phukan, and Upasana Bhuyan; Dr. Linda Cottler and the FOGARTY team. INDO-US program in chronic non-communicable diseases (CNCDs) #D43 TW009120 (M Hazarika, Fellow). India-US Fogarty Training in Chronic Non-Communicable Disorders & Diseases Across Lifespan Grant # 1D43TW009120 (SS Bhandari, Fellow; LB Cottler, PI).

REFERENCES

  1. Das RK. Census of India 2011: provisional population totals- Assam. Director of Censor Operations, Assam [Internet]. 2011 Mar 31 [cited 2020 Jul 8]. Available from: http://censusindia.gov.in/2011-prov-results/data_files/assam/Paper-1-I.pdf
  2. Barakbulletin. Fist corona case in Assam: 52-year-old tested positive in Silchar Medical College [Internet]. 2020 Mar 31 [cited 2020 Jul 8]. Available from: https://www.barakbulletin.com/en_US/first-corona-case-in-assam-52-year-old-tested-positive-in-silchar-medical-college/
  3. National Informatics Centre. Assam Covid-19 Dashboard [Internet]. 2020 Jul 16 [cited 2020 Jul 16]. Available from: https://covid19.assam.gov.in/
  4. Hazarika M, Das B, Das S, Hazarika D. Best practice guidelines for telepsychology during disasters (COVID-19 pandemic. Guwahati: Society for Mental Health in LAMIC (SoMHiL) [Internet]. 2020 Apr 11 [cited 2020 Jul 8]. ISBN): 978-81-935934-4-8. Available from: https://globalpsychiatry.org/2020/04/11/best-practice-guidelines/
  5. National Health Mission, Health & Family Welfare, Government of Assam. Monon: Assam cares [Internet]. 2020 May 17 [cited 2020 Jul 8]. Available from: https://nhm.assam.gov.in/portlets/monon-assamcares
  6. Global Psychiatry. Monon [Internet]. 2020 Jun 13 [cited 2020 Jul 8]. Available from: https://globalpsychiatry.org/2020/06/13/monon/
  7. National Health Mission, Health & Family Welfare, Government of Assam. Sarathi – ‘104’ [Internet]. 2020 Jun 18 [cited 2020 Jul 8]. Available from: https://nhm.assam.gov.in/portlets/sarathi-%E2%80%93-104
  8. Board of Governors in supersession of the Medical Council of India. Telemedicine practice guidelines: enabling registered medical practitioners to provide healthcare using telemedicine [Internet]. 2020 Mar 25 [cited 2020 Jul 8]. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf
  9. Hazarika M, Bada Math S. Tele-mental health during the coronavirus disease 2019 (COVID-19) pandemic. Open J Psychiatry Allied Sci [serial online]. 2020 Jun 4 [cited 2020 Jul 9]. [Epub ahead of print]. Available from: https://www.ojpas.com/get_file.php?id=34126196&vnr=242747
  10. Das B, Sarathy K, Avadhany V, Hazarika M, Das S. Guidelines for mental health and psychosocial support services during pandemic. Guwahati: Society for Mental Health in LAMIC (SoMHiL) [Internet]. 2020 Jul 8 [cited 2020 Jul 19]. ISBN: 978-81-935934-5-5. Available from: https://globalpsychiatry.org/2020/07/08/guidelines-for-mhpss-during-pandemic/

Hazarika M, Das B, Das S, Math SB, Bhandari SS, S L, Karthik K, Baruah P, Hazarika N, Bambrah HS, Suri K; the Monon: Assam Cares programme. A novel approach to address the novel threat. Open J Psychiatry Allied Sci. 2020 Jul 27. [Epub ahead of print]

Source of support: Nil. Declaration of interest: None.

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