When COVID-19 Hit Psychiatry: We Hit Back!

Reflections from the mental health perspective

No one is so brave that he is not disturbed by something unexpected. ~Julius Caesar

We started to hear reports that Wuhan in China was facing the wrath of a novel virus that caused severe illness and death in their population. Malaysia reported its first cluster of cases, but most of them had travel or close contact history with other patients. We were all hoping that we would not be affected and things would be contained.

Our experiences during the current COVID-19 pandemic and how it has affected all of us in the medical fraternity

The worst pandemic in modern history was the Spanish flu of 1918, which killed 10s of millions of people. Today, with how interconnected the world is, it would spread faster. ~Bill Gates

And in 2020, with the most advances seen in technology and science, here we are, alarmed with the rising number of deaths daily in various countries. We are all distressed and rising tensions amongst colleagues who have to delineate policies to suit this outbreak. There is worry about the safety of all our health care colleagues. We are also concerned about many of our patients, and their families, as after the second wave hit us, we realise that our place of practice can be a potential area where the virus can spread. We are also worried about bringing home the risk to our family members.

Measures taken during this pandemic

First and foremost, we need to start treating it like the pandemic that it is.

We started to take some measures to practice social distancing and reduce the number of non-essential appointments. Some of our patient’s parents were happy to postpone their appointments as well. We proactively called our patients, and practiced telephone consultations to minimise physical exposure. Our vigilance on practising hand hygiene and sanitisation increased. As we are not situated in the high-risk zones of the hospital, we did not use masks regularly. We already had our Psychological First Aid teams prepared to address personal medical stress and burn out issues.

However, once the second wave hit us in early March 2020, the exponential increase in the number of cases shook the entire medical fraternity. We realised that we would now scramble and consolidate our services and reinforce our psycho-social pandemic preparedness.

Both the Psychiatry Department of Hospital Kuala Lumpur and the Paediatric Psychiatry Department of Hospital Tunku Azizah Women & Children’s Hospital Kuala Lumpur have tasked the department’s Infection Control team to come up with the protocol on how we can manage our patients, both outpatients and inpatients. We also started to use webinar meetings and reducing the need for physical contact.

We are preparing to help patients and the community to manage their anxiety and stay focused on staying well. Strong recommendations have been made to not participate in mass gatherings.

Challenges ahead and unmet needs

I think the debate is about when should we step up precautions and preemptive strategies. We have now thought about calling and rescheduling all non-essential ,follow-up appointments. We are attempting to reduce the number of new cases to only those with eminent risks such as active psychosis or suicidal risks. We are calling up our patients a day or two before their appointments to see if they can continue medication at home. We are considering dissemination of information via email and phone consults.

The difficulties that we face to implement these policies is that we need to consider our Ministry of Health’s direction as a whole. But we are trying to balance both risks and current policy at the ground level. The onus is on the public as well.

Suggestions for rational optimisation of the medical services during this pandemic

We can draw upon lessons from previous pandemic situations where we can manage many of outpatients through Telepsychiatry. This would reduce the need for contact and help to reduce the risk of spread and contagiousness. To quote Bill Gates in his recent article, the Covid-19 transmits very efficiently. This would mean that we need to reduce all non-essential patient contact if possible.

Advice to children and adolescents, the general public, health professionals, including yourself during this pandemic

In any crisis, leaders have two equally essential responsibilities: solve the immediate problem and keep it from happening again. ~ Bill Gates

We think to solve the immediate problem, all non-essential travel should be postponed and social distancing needs to be practised strictly. This is a global crisis. Information dissemination is vital. Example is to share via social media platforms sites like https://ourworldindata.org/coronavirus and also booklets on educating kids and adults about the virus and how to protect themselves. It is a collective responsibility from all levels of society. We need to be mindful, calm, and not panic, as this will not help the situation. We need to continue doing what we can to keep our mind and body healthy.

We should optimise our psychological and social pandemic preparedness in order to optimise scarce resources.

By:

Dr .Anita Codati

Fellow YoungMinds Malaysia

MBBS (IMU), MsPsychMed (UM)

Psychiatrist, Child & Adolescent Psychiatry Fellow

Women & Children’s Hospital Tunku Azizah

Kuala Lumpur.

16 March 2020

Resources:

March 15, 2020 Young minds Covid-19 covid-19