The isolation, lockdowns and the economic disruption caused by the coronavirus pandemic will reverberate throughout the country generating nation wide psychological trauma. The repercussions of uncertainty, fear and frustration are bound to create high levels of stress and anxiety among many. People who are already experiencing mental health issues will become more vulnerable, burdening the already stretched thin, limited, resources and services.
We need to be ready for an increase in depression, substance use, post-traumatic stress disorder and other psychosocial issues that often arise after traumatic incidents.
Although the government has been working with all the relevant ministries, agencies and organisations to provide mental health and psychosocial support, there still is a large number of the population that is out of reach and a vast majority suffering untreated due to the unavailability of services in their respective communities or difficulty in accessing services they need.
The systems in place to adress the already prevailing national challenges, such as substance use and substance use disoders, are vastly under resourced and deeply fragmented. Coordination between two sections of the same ministry or agency can be almost non existent. The need for a rejuvenation of resources, strategising and strengthening of care coordination is of utmost importance. Ideologies need to be discarded, evidence and expert informed decision making must become a norm.
We took many drastic steps to prevent the spread of coronavirus infections, from closing down schools and offices to city wide curfews and lockdowns. In just the same way we need to be ready for the wave of behavioural health needs that will undeniably arise after the pandemic. A way forward will be in establishing mechanisms in atoll hospitals and island health centres for mental health screening and better access to services through the provision of telehealth. There are computer based tools available that can be used for screening mental health disorders, like CARS - 5, Computerised Assessment and Referral Systems - 5 and web based applications that can deliver Cognitive Behavioural Therapy (CBT) interventions.
Even now we could build the capacity of those already working in the system through webinars and other web based learning services and this must start now. Consistent availability of psychiatric medication is also something we need to look into. Using medication assisted programs, we can assist people who use drugs to stop using, help stop them from developing substance use disoders and help those who have already developed substance use disorders to find recovery.
All we need to do is establish telehealth services in the atolls and Islands, and come up with ways to dispense medication to those in need.
"Quis custodiet ipsos custodes" is a Latin phrase which translates to "Who will guard the guards?" In our case we should be asking this about our doctors, nurses and healthcare workers. Among 1,257 doctors and nurses in China, during the country’s coronavirus peak, around half reported depression, with 45 percent admitting to anxiety and 34 percent experiencing insomnia.
I sincerely hope that we have plans and strategies in place to address burnout, compassion fatigue and other issues our frontliners face as well as for those who are providing much need psychosocial support. We must do all that we can to help them get the support they need.
Ali Adyb ICAP, RC is a highly experienced, nationally renowned, International Drug Demand Reduction Master Trainer specialising in Prevention, Treatment and Recovery.