NEW DELHI: The NIMHANS has come out with guidelines for general medical and specialised mental health care, noting that the COVID-19 outbreak threatens to weaken the already fragile mental health system across the country.
The guidelines by the National Institute of Mental Health and Neuro-Sciences (NIMHANS) said the management and treatment of severe mental disorders should not be interrupted as far as possible and emergency care services must remain functional and be bolstered to handle additional influx of patients anticipated during the situation.
The document also advised that online training programmes in tele-psychiatry for the mental health professionals across the country need to be conducted, keeping in mind the framework that professional bodies may have laid down.
The NIMHANS said that considering the "mammoth nature" of the pandemic and available meagre resources, there is an immediate need to address a mental health gap in trained personnel who will be able to make simple mental health assessments.
The guidelines cover different sections of people.
For mental health assessment of COVID-19 patient in healthcare and community settings, the guidelines said psychological issues following the pandemic are likely to be common.
"Most affected will require only brief assessments and immediate support. This will require all front-line personnel to be competent in simple psychological assessment of the affected in the community and treatment settings of COVID-19," it said.
For mental health issues of those in home quarantine, the document said isolation and social distancing in the times of a raging pandemic can be psychologically distressing for many people.
"However, there are simple and effective actions that you can take as a health care provider. Key among them is providing information. As a health care provider, you would be seen as a reliable and trustworthy source of information. Explain the rationale of quarantining and social distancing," it said.
"Promote reliable sources of information. Inform patients what symptoms to watch out for and what symptoms not to worry about. Encourage people to remain in touch with each other over virtual means. Finally, if you come across anyone having significant distress have them referred to a mental health professional," it said.
On handling domestic violence, the guidelines said people in abusive relationships face challenges during lockdown and restrictions in movements (as in COVID-19) as they are likely to be in close confined spaces with the perpetrators and may have difficulties in accessing help.
"Frontline personnel need to be aware and if required explore sensitively and offer timely support to the victims," it said.
For mental health issues in children and adolescents, the guidelines advise parents to keenly observe for any emotional or behavioral changes in their adolescent kids.
"Parents can play a vital role in ensuring that their adolescents maintain their mental health by listening to them, acknowledging their difficulties, clarifying their doubts, reassuring them, generating hope and providing emotional support in resolving issues," it said.
For addressing mental health issues among pregnant and postpartum women during COVID-19, the document noted that addressing perinatal mental health issues is critically important for both the mother and the baby.
"Given the likelihood that mothers during the COVID-19 outbreak are likely to experience heightened distress, identifying and addressing these should be a high priority for health care providers," it said.
On challenges faced by people with disability, it noted that persons with disabilities (PwDs) may face multiple challenges during the COVID-19 pandemic.
"Policy makers and health care professionals should ensure continued delivery of vital services, help preserve access to benefits, and guide advocacy to preserve the rights of PwDs," it said.
For psychological issues of frontline personnel combating COVID-19, the document said almost all frontline personnel in pandemics like COVID-19 are likely to experience stress to a certain degree.
"Steps need to be taken proactively to ensure that it remains in control. Personnel should practise 'self-care'. Team leaders should employ steps to minimize mental health difficulties. Administrators should be aware that the mental health support of personnel is an important part of the COVID-19 response," it said.
The document further noted that social stigma increases during infectious disease outbreaks and is often not given the emphasis required.
"Steps need to be taken at all levels to ensure that stigmatising behaviours are strongly discouraged. A failure to control stigma will impede and slow disease control response," it said.
On suicidality in the context of COVID-19 pandemic, the document said the likelihood of suicide risk may be higher among subjects exposed to the COVID-19 pandemic.
"The guidance are envisaged to help frontline personnel to assess those at risk for suicide, determine their risk level and provide appropriate management," it said.
The document further said that yogic practices aim at aligning an individual's bio-rhythm with that of nature, thereby improving overall health.