Mental health policy: protecting community mental health during the COVID-19 pandemic.

Despite the growing interest in the treatment and management of COVID-19, communities still end up experiencing multiple stresses with mental health crisis, due to the pandemic. When this is not addressed, it causes stress in the long run, with further mental health damage in individuals and the communities. Furthermore, relevant policy related to the community mental health was identified as awareness in promoting mental issues, yet there are still failures recorded in the aspect of adequately addressing the well-being concerns. This study aims to support community mental health during the crisis, through useful information from relevant articles. It also explains some perspectives from literature reviews, case reports, with society responses from Google Scholar, Science Direct, and Proquest databases concerning recent community mental health issues, and government policy on the impact of the COVID-19 pandemic. The inclusion criteria required articles that were peer-reviewed, by using i) English language March-September 2020; ii) Presented empirical studies related to COVID-19 (quantitative and qualitative); iii) Searched terms related to the general and community mental health, their policy, and COVID-19 pandemic. This study showed 19 articles related to community mental health issues or psychological wellbeing topics. The interventions provided to strengthen community mental health during the pandemic included emergency psychological crisis treatment, hotline assistance, online counseling service with mental care course, and outpatient consultation. Therefore, community mental health issues should be addressed with physical wellness. In addition, the community plays a key role in influencing stakeholders and governments, to increase the priority in supporting mental health.

Introduction

As the effects of the COVID-19 pandemic continues, current response strategies need to emphasize more on the importance of tackling mental health issues. Despite the growing interests in the treatment and management of COVID-19, communities still experience multiple stresses, with mental health crisis due to the pandemic. When this is not addressed, it causes more stress level, feeling of overwhelmed, and further increase in mental health damage among individuals and the communities. Advanced mental health care infrastructures and well-being concern systems are needed, to provide the best appropriate treatment and care.

Generally, the government help in implementing a number of COVID-19 preventive responses, to reduce the risk of disease transmissions by hands washing, social distancing measures, staying indoors, and promoting work from home.[1,2] The most important aspect in this policy, is the certain considerations for emergency conditions. However, these responses made quite a number of people feel isolated, inconvenient while working from home, and lonely. Previous research showed that, seven out of ten working staffs experienced stress during this pandemic, which in particular, is well indicated by an increase in medical prescriptions, such as, antidepressants, antianxiety, and anti-insomnia drugs.[3] Long term isolation certainly affects the health of people, both physically and mentally.

Earlier studies showed varieties of mental health issues during the COVID-19 pandemic, ranging from feeling overwhelmingly stressed, grief, mistrust towards medical professionals or treatment, panic attacks, anxiety, depression, anger, fear, stigmatization, child maltreatment, abuse, suicidal ideation, etc.[4-6] The health professionals and young people are the most vulnerable population, to experience mental health issues. Higher prevalence of anxiety and depressive symptoms are found among people less than 35 years old, health professionals that spent more than 3 hours/day during the pandemic, have poor sleep quality in comparison with other occupations.[7] In another study, poor knowledge, lack of training, and inadequacy of personal protective equipment lead to severe distress among health professionals,[8,9] with this condition weakening their immune systems, as studies found higher infection rates in practitioners’ well-being.[10]

Furthermore, in developing mental health policy, it is very important to consider all psychological well-being issues arising in the community, including, stigmatization discrimination towards COVID-19 patients and health professionals.[11] Most importantly, adequate support from the entire communities, stakeholders, decision-makers, and the government is highly needed. Stigma is detrimental not just to COVID-19 patients, and also to the whole society. The negative stigma surrounding the patients, causes reluctance to attend screening tests and seek treatment, therefore, leading to speedy transmissions of the infectious disease. The World’s Health Organization (WHO) provided recommendations and guidelines on how to combat stigmatization as regards COVID-19, all in a bid to help deal with mental health issues during the pandemic.[12] Moreover, this was an excellent idea to help address community mental health issues, to which had many advantages for the entire communities, families, health professionals, stake holders, and policy makers. This study aims to support community mental health during the crisis, through useful information from relevant articles. Therefore, it is expected that the communities follow government’s advice, comply with health policies, practice healthy lifestyles, and provide support during the crisis.

Design and Methods

This study explained some perspectives from the literature reviews, case reports, with society responses from Google Scholar, Science Direct, and ProQuest databases with regards to the recent community mental health issues, due to the COVID-19 pandemic impact. The inclusion criteria required articles that were peer reviewed, by using i) English language between March 2020 to September 2020; ii) presented empirical studies related to COVID- 19 (quantitative and qualitative); iii) searched terms related to psychological wellness, community mental health, COVID-19, pandemic, and mental health policy. This study showed 97 articles related to mental health issues or psychological wellness topics to be reviewed during the pandemic. Articles were then included, when they directly described community mental health issues, and its policy during outbreak or crisis or pandemic. Articles of about 19 were found eligible to be reviewed (Figure 1). Also, reasons for writing the article along with opinions about the topic were fully expressed.

Figure 1.

Flowchart of study protocol.

Results and Discussions

Table 1 described the recommendations for strengthening mental health services. Any relevant articles, presenting evidence on mental health approaches during pandemic were also included in the analysis. Furthermore, this study was complemented by grey literature reviews from newspapers’ reports, government websites while upholding the rules and regulations, with current situation updates on COVID-19.

Table 1.

Recommendations for strengthening mental health services.

Target population	Mental health strategies
Individual	Emergency psychological crisis treatment
	Hotline and online counselling service
	Online mental health course
	Outpatient consultation when needed
Children	Online application for mental health counselling
	Continuity of care
	Mental health interventions
Elderly	Counselling services
	Psychological crisis treatment
Health care workers	Adequate support from families, communities
	Mental health interventions
Community	Health education about adapting and responding to COVID-19
	Healthy activities during self-isolation
	Access to resources and healthcare services
	Community empowerment

In order to strengthen mental health policy during the pandemic, it is important to first identify mental health issues related to the present situation and place it in the overall process recommendations (Table 1). An interesting study in China investigated the effect of excessive exposure to social media, with about 83.1% respondents experiencing this, which in turn, influenced their mental health issues. About 48.3% respondents had depression, 22.6% felt anxiety, and 19.4% possessed the combination of both, respectively. [13] One third of the U.S populations described mental health and financial issues related to the impact of pandemic, such as stress, anxiety, grief, and major hardships to overcome the challenges. [14] Participants were reported having a moderate level of fear of having COVID-19 (M=2.84, S =1.07) and worried that their closed relatives becoming ill with this disease (M=3.53, SD=1.03).[15] Another study revealed that women suffered more symptoms than men, characterized by depression, anxiety, stress, and suicidal ideation.[16] The implementation of lockdown policy and other social distancing create a more physical and psychological issues as some workers lose their jobs.[17] These mental health issues are also commonly found in vulnerable people such as, psychiatric survivors, health professionals, children, adolescents, elder people, specific ethnic groups, homeless, community members, and people who live in rural and remote areas.[18-20] Therefore, mental health interventions during the pandemic should focus on 6 vulnerable groups; i) confirmed COVID-19 patients; ii) suspected victims; iii) health professionals; iv) losed contact with confirmed wards; v) those who refused to get proper treatment; and vi) group of suspects in public areas.[21]

Furthermore, since spreading misleading information related to COVID-19 have the potential to cause distressful harm, several interventions should be provided such as emergency psychological crisis treatment, hotline assistance, online counseling service with mental health course, and outpatient consultation when needed. [17,18,22] However, these online mental health services were not often available in low- and middle-class sections of developing countries. Most people were not too familiar with the use of technology, resulting in it being such a challenging task for the government and health professionals, in a bid to make available mental health services for the community.[23] In Africa, partnerships with social media platforms were built, to provide sufficient information related to the pandemic, and reduce the fears, along with the stigma of COVID-19.[24] Changes in school routines became stressful for children, as most did not see their peers, which resulted in further mental health issues creation. In UK, 83% children felt their mental health had worsened during the pandemic.[25] For children that felt stuck while studying at home, they shared their thoughts and feelings through online application for mental health, hotline counseling services, or offline channels, with help from community mental health team.[6,26] Another study stated that about 52.1% young people felt worried due to the impact of pandemic, hence, they received a great support from friends and families.[27] However, specific attention needs to be paid to children with special demands, and other disabilities, as they face mental health risks more greater, due to lack of recommended therapies, or educational wants. Also, behavioural issues happening while special needs children stay at home during school hours, which results in parental stress, adding more tension to the children, should be well addressed.

There are 10 strategies made available, for reducing tension between parents and special need children: i) describe briefly what COVID-19 is; ii) restructure routine plans; iii) develop semi-structured activities; iv) enhance cognitive function, through simple games; v) engage in shared video arcade for both parties; vi) plan hobbies together; vii) online therapies; viii) media consultations; ix) frequent contact with school teachers; x) relaxation and break time for the kids.[28] These strategies are used to help parents manage additional behavioural problems, during isolation at home. Elderly people often feel anxiety with depression, therefore counselling service, and psychological crisis interventions should be provided as well. Mental health interventions best for elderly people during the pandemic are i) strengthening the support environment for those with low educational level, divorced, widowed, living alone, sleep disorders, and history of mental diseases; ii) improve overall health issues, as they have weaker immune systems that are prone to infection; iii) facilitate wellness orientation along with psychological well-being support; and iv) refer to accurate medical professionals when needed, for further consultations.[5]

Health care workers often feel fatigue and depressed, also, they need adequate support from families, communities, and mental wellness interventions.[29] Factors associated with increased risk in mental health issues among medical professionals are socio-demographic characteristics (young age, female), social aspects (support, stigma to COVID-19), job status, lack of sufficient training and experience. It is very important to facilitate emotional support, to boost their confidence, self-efficacy, and coping mechanisms in this pandemic, mindful of the fact that they have had to work under pressure, as many do not go home during the on-going crisis.[30,31] Positive coping styles were reported to increase mental health status among individuals, such as using positive reframing, acceptance, and humour.[16] Therefore, to improve community mental health during COVID-19 pandemic, medical professionals and communities need to collaborate with the government, to deliver mental health education, about adapting and responding to COVID-19, creating therapeutic environment during the pandemic, along with promoting healthy activities during self-isolation.[31-33] It is also very important to disseminate potential access to resources and healthcare services, while also empowering communities to fight COVID-19.[4]

Conclusions

In conclusion, it is important that mental health issues should be addressed as well as physical well-being. Also, there is need to strengthen mental health policy to deal with psychological issues, stigma, and discrimination during the pandemic. The community plays a key role in influencing stakeholders and governments, to increase the priority in supporting mental health during COVID-19 pandemic. Therefore, this study recommends that the policy makers should develop a better understanding of community mental health needs during the pandemic and enable intermediaries to contribute for a better procedure.