LETTER TO EDITOR
Public mental health during the COVID-19 pandemic: challenges and game plan
The ongoing coronavirus disease 2019 (COVID-19) pandemic has caused an unprecedented impact on multifarious domains, including socio-political, healthcare, economic, religious, and various others. Along by, psychological issues such as acute stress, anxiety, and depression have affected the public. With the unfolding of the crisis, we would further witness a change in the way life is looked at and how technology is utilised. This has forced us to redefine priorities, so as to prepare for the current effects, and the aftermath of the crisis. Public mental health which is “the art and science of improving mental health and wellbeing and preventing mental illness through the organised efforts and informed choices of society, organisations, public and private, communities and individuals” has become the need of the hour.
Facing the first major pandemic, our generation is experiencing an escalation in mental health problems with the disruption of normal aspects of life. There is not only a diffused distress that all are experiencing, but, also, there are special groups such as the frontline healthcare workers, people at quarantine/isolation, people who have tested COVID positive and those vulnerable to psychological issues who are facing unique stress at this time. People have developed high levels of fear, anxiety, and uncertainty in response to this health threat that is invisible to the naked eye. “Stigma” faced by persons suffering from mental health issues along with the “stigma” related to the pandemic has been a concern for affected individuals. Change in normal routines, adopting to physical distancing, new norms of wearing a mask, practices of hand washing/sanitisation, and maintaining cough/sneeze etiquette have caused worries due to unfamiliarity to these. Adding to these, is the “infodemic” during the pandemic. People are showered with excessive information, and also, misinformation, rumours, gossips, and conspiracy theories. Attempts to fight the COVID-19 pandemic has been disrupted by such “infodemic” and a “collective perceptual bias” further leading to rise in uncertainty, fear, prejudice, disgust, and xenophobia. As we prepare ourselves to face the pandemic and its aftermath, by focusing on research regarding viral transmission and interrupting it, we also need to pay attention to the public mental health dimension. The emergence of psychological issues due to the pandemic such as acute stress, anxiety, depression has brought challenge to the framing of strategies from a public health perspective. Amalgamation of public health and mental health would certainly help in diversion from the harsh routes the pandemic could take. Public health authorities and mental health professionals need to work in liaison with each other to address issues, plan, respond, and mitigate the mental health burden consequent to the pandemic and in its aftermath.
PUBLIC MENTAL HEALTH ISSUES: PREVENTION AND MITIGATION STRATEGIES
Adequate social support for the general population with regard to at risk populations (e.g. infected patients, quarantined individuals, medical professionals, unemployed, etc.) should be provided by offering targeted, tailored messages as per the most reliable scientific evidence. Relevantly, a variety of mental health supporting strategies are required in order to facilitate lifestyle changes and re-adaptation activities.
Public mental health interventions comprise of “mental disorder prevention” and “mental wellbeing promotion”. “Mental disorder prevention” can be at primary level (addressing risk factors, providing adequate information/risk, and crisis communication), secondary level (early/timely intervention for mental disorders), and tertiary level (interventions for those with mental disorder to prevent enduring ramifications and disability while on treatment). “Mental wellbeing promotion” involves “first increasing the value that individuals and societies give to mental health and wellbeing, and then implementing interventions to enhance mental wellbeing in different situations. Interventions to enhance mental wellbeing can occur across the life course”. It includes interventions from parental levels, childhood, pre-school and school period, during normal course of life, work till ageing. To play down the feelings of fear and uncertainty, health education needs to be provided using online platforms, and the social fear related to COVID-19 needs to be adequately addressed while stigma and discrimination need to be recognised as major challenges. Hospital protocols linked to the early and effective management of health emergency need to be implemented while healthcare professionals need to be supplied with adequate protective gear. Unmet needs should be rapidly identified by medical staff who need to communicate effectively and promptly with patients to help them understand emerging psychological issues or worsening of a pre-existing psychological distress.
Furthermore, helplines numbers, internet-based platforms such as social networking sites, dedicated blogs, and mental health forums should be utilised in order to reduce social isolation and loneliness, particularly for those away from their near and dear ones. Marginalised populations such as elderly individuals, children, persons facing domestic violence, and those with psychological problems should be able to actively consult with mental health professionals to rapidly detect warning signs. Finally, telepsychiatry should be actively used, especially in areas where mental health services are poorly represented or severely impaired by the rapid spread of pandemic and lockdown restrictions. It is important that mental health professionals identify symptoms of acute psychological crisis, and monitor for adverse drug reactions during management of patients using telepsychiatry. Experiences of utilisation of services of telecounselling by those in distress in the recent times show a promising role of such services now and in the future. Recommendations for public mental health strategies at individual, organisational, and state/policy levels are presented in Table 1.
Former Tutor, Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India
Correspondence: Dr Bemma Konthoujam, c/o Jiten Konthoujam, Nagamapal Singjunbung Leirak, Imphal West, Manipur-795001. firstname.lastname@example.org
Received: 3 August 2020
Revised: 24 August 2020
Accepted: 24 August 2020
Epub: 29 August 2020
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Source of support: Nil. Declaration of interest: None.
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