key: cord-0793740-kmiol64o
authors: Selvaraj, Sowmya; Reddy, Preethi V.; Muralidharan, Kesavan; Gangadhar, Bangalore N.
title: Impact of COVID-19 on mental health: a watershed moment in tertiary care service provision in India?
date: 2020-06-15
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102229
sha: 377951309658f76d1f7534b4b5fa5333b9814a2f
doc_id: 793740
cord_uid: kmiol64o

nan

Prevalence of psychiatric morbidity in India is 10.8%, with 0.8% having severe mental disorder (Sagar R, 2020 ) . There are just 3 psychiatrists per million population, with a treatment gap of 83%, particularly for tertiary care (Gautham et al., 2020) .

COVID-19 pandemic has changed the circumstances in which people live and has led to increase in stress levels. There is reportedly a significant effect of COVID-19 pandemic on mental health and vice versa (Tandon, 2020) . Preliminary data suggested that 18-28% experienced anxiety and depression as a common reaction to the pandemic (Rajkumar, 2020) .

A recent survey in India reported that more than 80% of participants experienced anxiety and preoccupation with contracting COVID-19, 12.5% sleep difficulties and 34.6% distress related to social media. More than 80% perceived a need for mental health care (Roy et al., 2020) . While a matter of concern, it represents a greater demand on the limited mental health care resources, over and above the existing treatment gap.

Our tertiary care centre in South India has been recognized as one of the world's best hospitals by Newsweek (Newsweek). In the past year, a total of 6 lakh patients received specialised neuro-psychiatric treatment at our centre. About 80 per cent of them (4.5 lakh) received the treatment at a highly subsidized cost (NIMHANS Annual Report, 2019). To contain the spread of COVID-19, the Government announced a nationwide lockdown in March 2020 and hence we closed down our outpatient services. We continued to provide emergency and inpatient care, like several other tertiary care centres in the country.

The closing down of outpatient services necessitated the rethinking of service provision.

Telephone follow-up consultation of patients previously registered with the hospital was initiated. The hospital contacted 6000 plus patients who were due for a follow-up visit. They Newer groups of people, who were hitherto uncovered, were brought under our services. A COVID-19 mental health helpline was initiated to help the general public with their mental health concerns and two lakh plus calls have been registered till date. Brief online mental health screening and psychosocial support for quarantined individuals in isolation facilities and migrants in shelter homes was initiated. Furthermore, our centre has taken up leadership roles in developing guidelines which include COVID-19 mental health care for general medicine and specialised mental health care settings, telemedicine practice guidelines and tele-psychotherapy guidelines.

The tertiary care hospital based model of mental health service provision has given way to a community based approach. Tertiary care services have extended beyond the walls of the hospital and into patients homes, through tele-medicine. The district mental health services, once neglected, are now viewed as an alternate system for decentralising mental health services. The potential of tele-psychotherapy is being explored and we have developed guidelines for the same. The demand for elective inpatient care for persons with mental illness has drastically reduced. Triaging is the likely way forward in determining preferential in-person versus tele-consultations. With the pandemic not showing signs of abating and with restrictions in travel and mass gatherings likely to remain, hospital based tertiary care appears J o u r n a l P r e -p r o o f Letter to the editor to be a less likely preferred option for mental health service provision in India in the foreseeable future. Has COVID-19 caused a watershed moment in mental health service provision in India? Only time will tell if challenges would be converted to opportunities for a better change.

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Newsweek World's Best Hospitals-Top Specialized

COVID-19 and mental health: A review of the existing literature

Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic

The burden of mental disorders across the states of India: the Global Burden of Disease Study

The COVID-19 pandemic, personal reflections on editorial responsibility