COVID-19 Webinar 11: Stories from the field - ensuring continuity of mental health care during COVID-19
The Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net and United for Global Mental Health organises a series of weekly webinars designed to provide policy makers and the wider health community with the latest evidence on the impact of COVID-19 on mental health and how to address it.
Chair: Peter Ventevogel, UNHCR
Alal Single Dora; Country Director of Thrive Gulu, Uganda
Paul Fearon; St. Patricks Mental Health Service, Ireland
Javiera Rojas-Uribe; Psychologist, Chile Family Therapy
Francisco J. Muñoz Martinez; Chile Family Therapy
Dr Wisam Aldhannoon; Psychiatrist, IMC Iraq
Peter Ventevogel, UNHCR
As part of his work with UNHCR he was chairing a working group of the Inter-Agency Standing Committee (IASC) Reference Group on mental health and psychosocial support (MHPSS) in emergencies. This group has been focussing on the continuation of MHPSS services during the COVID-19 pandemic, a topic which is closely linked to this webinar.
This webinar has a practical focus, with stories from the field about how mental health professionals have been ensuring continuity of services. This is part of a larger project organised by WHO and MHIN to highlight the incredible efforts and experiences of organisations providing MHPSS during the pandemic all over the world. They have asked practitioners to document these experiences. You can find more: www.mhinnovation.net
This webinar will be in the format of a round of brief presentations by the speakers and then questions in the chat box. We encourage you to follow along on social media with the hashtag #COVID19MH.
Introduced speakers, who were selected from those who submitted entries to the WHO/MHIN project in the category of “challenges to MHPSS provision and practical adaptations.”
Introduced Alal Single Dora, who works to support the mental health of survivors of conflict in Northern Uganda – including refugees. How has THRIVE Gulu adapted their MHPSS services to ensure continuity of care for target populations during this COVID-19 pandemic?
Alal Single Dora, THRIVE Gulu, Uganda
Thank you for inviting us. [Remarks inaudible]
[Written statement provided below]
THRIVEGulu has adapted in the following ways: On community awareness on MHPSS issues:
Use of radio talk shows and spot messages to provide correct information on Mental health issues to the communities
Use of Caravan drives within the villages to take care of the most disadvantaged households who do own radio handsets. We drive the van/pick up vehicle mounted with loudspeakers with pre-recorded messages on MHPSS and our counselors are also live talking to the community at small gathering points like markets, trading centres.
On Increasing access to MHPSS Services:
We continue to strengthen our lay counselors’ structures trained as first line respondents to provide low intensity MHPSS services
Our THRIVE Gulu counselors continue to provide remote counseling support and tele counseling. We reached over 200 clients.
We are working with the government psychiatric teams to take mental health medications to lower government health facilities which usually do not have mental health medications. We have been able to reach over 300 MH patients with their medications.
See link here for more information about the project.
Peter Ventevogel
How did you adapt your services in Ireland?
Paul Fearon, St Patricks, Ireland
Ireland has a population of 4.5 million and we provide mental health services to 8-10% of the population and have a staff of around 700. The first priorities are the safety of services; treating as many as possible; and keeping services going. We adopted physical distancing, and reduced footfall in and out of services, as well as adopting remote clinical working. Within two and a half weeks, 100% of outpatients were being seen remotely. We also had to recognise the challenges of approximately. 300 in-patients, and looked at delivering the in-patient experience at home, taking into account: nursing care, seeing psychologists, receiving prescriptions and more. We managed to find solutions, and rolled out a home care service that has been running for a couple of months. This has meant that about 80 in-patients are being treated at home, and we plan to continue this into the future as it has been surprisingly effective.
Peter Ventevogel:
What challenges have you faced or had to overcome?
Paul Fearon:
We had to act quickly and carefully, informing patients and carers and getting acceptability for it -, this was especially important as it was a completely new service. The advantages were that luckily we had already developed an electronic health record, and therefore service users and staff could work remotely and could reduce risk of infection through accessing notes online instead of hard copies. We were already doing online CBT and were piloting adolescent services online, so were able to expand on this. We assigned everyone a bed so they knew what ward they would be on, and therefore we could track their care and reassure them they could be hospitalised if they wanted. Now one third of patients are having their care delivered remotely.
Peter Ventevogel
Introduced Wisam Aldhannoon to learn more about what is happening in Iraq in the Middle East.
Wisam Aldhannoon, International Medical Corps, Iraq:
Currently working for IMC in a refugee camp in Mosul, Iraq, where there are movement restrictions in and out of the camp which create a lot of difficulties for people and a lot of mental health distress. We are adapting our services accordingly; every mental health employee has a mobile phone to call and they can also use the internet in order to follow up with a client. The problem is not everyone in the camp has access to a phone and there can be issues with a lack of privacy during the call. There is also the added challenge of prescribing medication for them.
Peter Ventevogel
Wisam, please could you explain a bit more about the link to primary health care?
Wisam Aldhannoon:
We are integrating mental health with primary health care, by cooperating and coordinating our work with others working in primary health care, including doctors (General Practitioners or GPs). We train them in the WHO’s mhGap, and psychological first aid and offer direct supervision of GPs, so they are therefore ready to help us treat mental health conditions. Yesterday and today I couldn’t go to the camps due to restrictions, so instead the GPs had to help support my patients with their prescription.
Peter Ventevogel
Introduces the speakers from Chile. In terms of MPHSS support for families, how have you adapted services to ensure continuity of care?
Javiera Rojas-Uribe, Chile Family Therapy
[taken from written statement]
Because of the pandemic, we had to transform ourselves. Information and communication technologies are not widely used in health interventions in Chile; we are very oriented to face-to-face interaction. This generated the need to innovate and develop different actions in mental health services to maintain the continuity of support for the population. In this aspect, we focussed on the strategies to maintain therapeutic support for families of boys and girls in primary mental health care.
Peter Ventevogel
What did you do to replace home visits?
Javiera Rojas-Uribe
[taken from written statement]
Through technology, the usual coverage and frequency was recovered, mainly using remote means, such as telephone calls, text messages and other information technologies, to monitor and intervene despite the restrictions of the pandemic. Smartphones were acquired and videoconferencing equipment was used for remote intervention with families, as well as for remote collaborative assistance between primary care professionals and specialists in mental health.
Peter Ventevogel
What was the initial impact that stopping home visits had on families and what strategies were put in place to mitigate this?
Francisco J. Muñoz Martinez, Chile Family Therapy
[taken from written statement]
The contents of the program’s family intervention approach (Beardslee) were adapted so that they could be more easily distributed through digital means (including the use of telephones, video calls and social networks), ensuring that mental health care information can be delivered at a distance, through infographics, manuals, videos and audios.
The purpose of using social networks like FACEBOOK is to promote “healthy thinking” and the development of different self-care strategies, creating instances that allow families to anticipate situations that could affect their mental health. It has also been used to suggest tools for conflict resolution, emotional management, behavioral management of children at home, breathing exercises, among others that allow families to talk about their experiences.
This approach to family intervention through remote means, as well as raising the frequency of therapeutic contact, has allowed for easier transmission of information, generating more motivation and perception of self-efficacy, as the families themselves feel the main responsibility for change.
It has also been observed that families have greater knowledge regarding their mental health, which increases their ability to express their needs, and provides mental health professionals with more information to support and meet the needs of the families.
Community networks (with churches and other civil society organizations) were also activated to complement the work of primary health centers, with a virtual support offer in spiritual, educational, occupational, socioeconomic fields, among others.
More information: https://www.facebook.com/PASMI.SSVSA
https://www.facebook.com/Redsaludmentalssvsa
http://ssvalposa.redsalud.gob.cl/
Peter Ventevogel
Question for Dora: What sort of speakers did you invite to participate in the radio shows and how language(s) did you ask them to use?
Alal Single Dora
We used community level counsellors and ensured a diversity of speakers and used translators from among the trained volunteers in the settlements. Usually we encourage the use of simple language to help enable people to understand what we are talking about.
Peter Ventevogel
Question for Paul: What are the main recommendations for service managers at the beginning of the process to migrate services online? Particularly staff and clients accessing the necessary technology platforms?
Paul Fearon
You do need really good liaison between clinical and IT services, management and service users. We use Microsoft teams because it is built into our system. We also have someone employed to proactively set up the IT infrastructure, plus having an electronic health record is a massive advantage. It's also hugely important to be very clear in what you can and cannot deliver. Not everyone has video, and some people prefer telephone consultations. The idea of people being able to meet their team physically - even if it is just at the beginning - is a point of reflection now. All stakeholders need to be bought into this and think it is a good idea.
Peter Ventevogel
Question for the team in Chile – how do you work with poor or disadvantaged families who don’t have internet or telephone access?
Francisco J. Muñoz Martinez
Not everyone has internet access, if they don’t have regular internet access, sometimes they can access it every so often. We do mainly telephone interventions in that case and try to get everyone's contact details and get them on the phone. If that doesn't work then we try to still make social or home visits but ensure protection for health workers. If we can't do any of that then we work through social networks.
Peter Ventevogel
Question for Wisam; how hard is it to keep people looking after their mental health when they have so many other priorities? What strategies do you use?
Wisam Aldhannoon
We follow up with patients and they are thankful that we call them. For those without phone access we send them to the outreach centre and call them there. Regarding COVID-19 we don’t see that in the camps and the population is thankful for that. We follow up with new cases of mental health problems, and we post instructions on walls about how to deal with the threat of COVID-19 and do individual sessions to follow up.
Peter Ventevogel
Questions from Douglas Mental Health institute in Canada to Paul and Wisam. Are all these innovations recovery oriented? To what extent are you able to work in a recovery oriented way?
Paul Fearon
This does fit a recovery model of treatment well. Treatment in their own home means their own environment and family. We are mostly concentrated on acute services but we also provide occupational services, recreational and social activities. This may evolve to be a hybrid service as a middle ground for those able to remain in their own home with additional care.
Wisam Aldhannoon
This is a new situation for us all, working by phone and remotely. Although, I have had my own online psychiatric service for 7 years; I am used to working with patients for 30-60 minutes sessions, and also with families online. I am also used to working with GPs or a pharmacist in this way, and so we, in the IMC, try to give insight to health staff not used to working in this way.
Peter Ventevogel
And what about your work with children at Chile Family Therapy?
Francisco J. Muñoz Martinez
We work with parents, by sending videos and engaging wherever possible.
Peter Ventevogel asks each panellist for their one final statement.
Alal Single Dora, ThriveGLOBAL Gulu: resources for mental health across the world are very limited and we need more. Thank you to all those who support mental health across the world.
Francisco J. Muñoz Martinez, Chile Family Therapy: one of the most important things is to take advantage of the pandemic to install innovative practices including working with CSOs who can provide MHPSS.
Wisam Aldhannoon, IMC Iraq: health authorities and medical organisations must integrate mental health with primary health care because it is an important part of medical work. Try to do continuous training on mental health programmes so that all organisations have trained staff, as you don’t always know when you will need it.
Paul Fearon; St. Patrick's Mental Health Service, Ireland: You need to be very clear what your main reason is for getting up in the morning and then get on and do it – be decisive and innovative. Get continuous feedback, and learn from that. People who got up and did things innovatively in the early part of the COVID-19 pandemic fared better than those who waited around.
Peter Ventevogel: Thank you very much. Please continue to ask questions on twitter using #covid19mh.
