Prof. P K Dalal,
President, Indian Psychiatric Society,
Head, Department of Psychiatry, KGMU, Lucknow
The COVID-19 pandemic is great challenge for us, and it has disrupted our daily lives in personal and professional spheres beyond our expectations. Governments across the world are taking unprecedented steps to curtail the spread of illness and quick succession of changes are happening around us, making people bewildered and confused. Additionally, the working of every organization and professional bodies are being affected. As you are aware, we have been forced to postpone our executive council meeting on 21st March 2020 at Bhubaneshwar. Several other such scientific meetings by Indian Psychiatric Society are being postponed. We are resetting our own priorities and conducting public planning, interactions and activities through digital medium and telecommunication.
We are all aware that the effects of COVID-19 are not limited only to our physical health but are going to affect the psychological and emotional health of large number of people in the country. As mental health professionals, it is our responsibility and duty to deal with the current situation with great courage, extraordinary spirit and resilient mind-set. We need to be in touch with our local community in every possible way and help government in implementing necessary steps for prevention of further spread. In our individual capacities, many of us may already be working to guide public and communities towards a healthy way of coping. Please share with us your endeavours and we will be more than happy to be a part of these activities, plans and initiatives and help you in your endeavours. A good emotional and mental health support for people in our country is likely to help us tread in difficult time in a better way.
Be safe and healthy, try to give your best to the community and contribute to our organization in all meaningful ways. Together we can become a great force.
In these challenging times of COVID-19 pandemic, there are intense apprehension among mental health professionals regarding triage of OPD and IPD patients. Keep yourself abreast with the latest official advisories as the situation is rapidly evolving and new guidelines are being communicated by Government of India almost daily.
Currently, we are in the Stage 2 of the pandemic and a plethora of psychiatric morbidity and complications are expected in patients in the upcoming days. With regards to stage 2 of pandemic, our medical fraternity needs to practice safety, in relative social isolation and we need to triage patients in our daily practices.
We are currently able to offer some important evidence-based advices for your day to day work. Follow them if they are practical and implementable in your situation:
- Wherever possible, mental health professionals should practice measures for safety to themselves and healthcare professionals working with and under them. These include keeping distance with all patients during interview, universal precaution and preventing crowding in places of consultation.
- Practice taking declaration from every patient at registration for any travel outside country or other cities in last 30 days or any history of any contact with COVID-19 positives or any signs of flu like symptoms with ID proof. In any case of suspicion, refer the patient to nearby fever clinics.
- Phone consultations and longer duration of follow-up can be provided to patients with pre-existing psychiatric conditions who are stable or minimally symptomatic with written instruction to continue the medications till COVID-19 pandemic is over. Ensure in writing duration of follow up, so that patients do not face difficulty in procuring medications.
- Discharge of inpatients who can be managed in their own homes should also be prioritised. With quarantine and disruption of transport expected in coming days, early discharge of patients from inpatient set-ups will help patients and family members manage their logistics better. Discharge of inpatients also help in prevention of infection to patients, family members and health care workers.
- Patients with emergency psychiatric conditions like suicidality and aggression, catatonia, unmanageable psychotic symptoms, severe withdrawal symptoms or intoxication should be given priority as Inpatients.
- Providing relevant information about the dos and don’ts regarding COVID-19 and allaying anxiety concerning infection, spread, curfew, isolation and quarantine to patients and their family members coming for consultation of mental health problem (in addition to mental health advise) should be practiced in all cases. A clinician’s words can help dispel many myths patients might have gathered from lay sources, as happens at the times of pandemic.
- In times of stress, we as mental health professionals are uniquely positioned to comfort and counsel individuals and communities to remain positive and hopeful and to fight together. Undertake public communication and discussion using digital methods and mass media like radio and television. Focus on ways of positive coping, stress management, relaxation, yoga and meditation, family bonding and anxiety management.
- Our colleagues working in emergency, medicine, pulmonology and other allied disciplines are going through immense stress and anxiety, yet bravely facing the pandemic. Juniors managing screening OPD are in an exceptionally vulnerable position due to their young age, long hours of work, shortage of supplies and possibility of infection. Kindly take time to talk to them, provide hope and prioritise their needs. Use supportive methods to help them cope and provide free consultation to those who specifically require them.
- Communicate with government, local and state authorities to include mental health services as a part of COVID-19 management. The experience of psychiatrists can help in a major way in boosting the public morale, ensuring public action and in preventing pandemonium and chaos.
- Academic and research organizations should also make a concerted endeavour to study the mental health aspects of the pandemic, isolation, quarantine and national curfew, as we are all going through historic times. The evidence generated will help us plan all services better in the coming days.
We are also developing an advisory for general public and a document on “Psychiatric aspects of COVID-19: Challenges and solutions” which we will be publishing shortly.
Finally, I wish each and every member of our organization “good health”. These are indeed exceptional times and I implore all of you to stay safe and to take care of yourself and your loved near and dear ones. I am hopeful that together we will stand strong and defeat this pandemic and also the fear that seems to be gripping our beloved country.
Long Live India, Long Live Health Professionals, and Long Live IPS!Download Message