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 Table of Contents  
PERSPECTIVE
Year : 2020  |  Volume : 9  |  Issue : 5  |  Page : 55-57

Structured action plan for mental and behavioral preparedness against virus COVID19 outbreak in India (SAMBAV Bharath): Proposal for augmenting mental health services


1 Department of Psychiatry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
2 Department of Clinical Psychology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India

Date of Submission25-Apr-2020
Date of Decision01-May-2020
Date of Acceptance02-May-2020
Date of Web Publication04-Jun-2020

Correspondence Address:
Dr. M Kishor
Department of Psychiatry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_60_20

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  Abstract 


The world Health Organization (WHO) has designated the novel coronavirus outbreak (COVID19) as a pandemic. It is estimated that 125 million to 250 million people in India will be affected and 70% of humanity is likely to be infected within 1 year. The psychological impact can be from stress or economic-socio-occupational disruption, and people may suffer from fear of infection, anger, anxiety, depression, suicidal ideation, increased substance use, or relapse of psychiatric disorders. This can be of great concern for India, which already has high mental health morbidity but the lowest number of mental health experts, according to the WHO. Hence, it is imperative to consider the empowerment of available human resources. Here, we propose a structured action plan for mental and behavioral preparedness against virus COVID 19 disaster currently but virtually for any disaster in the country (SAMBAV Bharath). It designed to enable people by providing online training for individuals as mental health facilitators, who can assist the needy during and aftermath of the disaster.

Keywords: COVID19, India, mental health, psychological impact of disaster


How to cite this article:
Kishor M, Ekanand D. Structured action plan for mental and behavioral preparedness against virus COVID19 outbreak in India (SAMBAV Bharath): Proposal for augmenting mental health services. Int J Health Allied Sci 2020;9, Suppl S1:55-7

How to cite this URL:
Kishor M, Ekanand D. Structured action plan for mental and behavioral preparedness against virus COVID19 outbreak in India (SAMBAV Bharath): Proposal for augmenting mental health services. Int J Health Allied Sci [serial online] 2020 [cited 2020 Jul 15];9, Suppl S1:55-7. Available from: http://www.ijhas.in/text.asp?2020/9/5/55/285998



The World Health Organization (WHO) has designated a novel coronavirus outbreak (COVID19) as a pandemic.[1] It is estimated that 125 million to 250 million people in India may get infected with Covid19, according to the center for disease dynamics, economics, and policy in collaboration with John Hopkins University, USA. Leading epidemiologist from Harvard, Marc Lipsitch has estimated that 70% of humanity will be infected within 1 year. The psychological impact on millions of people, including those who are quarantined due to COVID19, can be devastating. The psychological impact can be from stress or economic-socio-occupational disruption and people may suffer from fear of infection, anger, anxiety, depression, suicidal ideation, increased substance use, or relapse of psychiatric disorders. This can be of great concern for India, which already has high mental health morbidity, with 197.3 million people affected which includes 45.7 million due to depression and 44.9 million due to anxiety.[2] In the month of March 2020, there have been media reports about suicide-related to the COVID19 scenario in India and case studies on self-harm reported.[3] Moreover internationally, suicide among people in leadership such as that of German finance minister of state can be warning for the probable increase in suicide globally. It is in this background, there is an urgent need to consider a plan of action for mitigating the psychological impact of the COVID19 outbreak in the coming months and to enable the psychological recovery of people in India. It is a matter of concern that, India has the lowest number of mental health experts according to the WHO mental health atlas 2017, there are 0.3 psychiatrists per 100,000 populations.[4] Hence, it is imperative to consider the empowerment of available human resources. Interestingly, India has the largest number of young people in the world, 600 million people under the age of 25 years. India also has one of the largest number of mobile phone users in the world, about 400 million. Youth in India, more so in health and allied sciences institutions can play an important role. Imparting training to students in health and allied sciences across the country can be one of the feasible ways to build a human resource that enables psychological support for millions of affected people in the COVID19 crisis and during the aftermath of COVID19, particularly in coming months. Hence, it is possible in India (literally means SAMBAV Bharath in Hindi) to build a human resource for mental health support. To the best of our knowledge at the time of writing this proposal, there are no certificate courses offered from recognized universities in India for facilitators of mental health in relation to the disaster. Here, we have proposed a model as a question (Q) and answer (A) format for ease of presenting.

Q1) What is SAMBAV Bharath?

A: It is an acronym for Structured Action plan for Mental and Behavioral preparedness Against Virus COVID 19 disaster (Virtually for any disaster) in the country (Bharath). However, the model is built on the premise that it should be useful for all disasters. It designed to enable people and capacity building of human resources for providing mental health services and addressing the psychological impact of the disaster. It proposes to provide online training for individuals as mental health facilitators during or the aftermath of the disaster.

Q2) Who can be trained?

A: Any adult aged 18 years and above, who knows English can be trained in the first phase. This can be easily made available in most of the regional languages. Initially, 10% of all health and allied sciences students in India can be trained at the earliest period to enable them as mental health facilitators.

Q3) What will be they trained in?

A: They will be trained as mental health facilitators through brief modules that enhances mental and behavioral abilities in addressing psychological distress and in assisting people during or the aftermath of the disaster.

Q4) Who will train them?

A: A team of psychiatrists, psychologists, and psychiatry social workers

Q5) How will the training occur?

A: Predominantly with Information and Communications Technology (ICT), including simulated or virtual reality-based, through online portals, or mobile applications. Moreover periodically, if needed contact classes can be offered after re-opening of institutions. Such training can be held in institutions of health and allied sciences such as medical, dental, nursing, physiotherapy, pharmacy, and others.

Q6) What will be the benefits for those who complete the training?

A: It shall provide an opportunity for serving the people in the national disaster. They can serve as mental health facilitators. They will be awarded certification at the successful completion of the course and the course can be considered for credit points in their semester and or other benefits that can be considered.

Q7) Which center can be the nodal center for providing online training in India?

A: Educational institutions such as JSS Academy of Higher Education and Research (Deemed to be University), which are already providing online courses, can be a nodal center and other centers can be considered as needed.

Q8) How will the SAMBAV Bharath mental health facilitator course-integrated or aligned with other agencies that are working for COVID19?

A: It can be integrated or aligned with resources or guidance from the WHO, National Institute of Mental Health and Neurosciences (NIMHANS) and National Disaster Management Authority (Govt of India)

Q9) How much time does it require for completing the SAMBAV Bharath certificate course as Mental Health Facilitator?

A: The course can have five modules, each delivered in two sessions of 60 min each. The total course can be carried out in twenty sessions and the total duration of 600 min (10 h).

The five modules can be

  1. Understanding disaster and the psychological impact
  2. Identifying and screening for the mental health conditions
  3. Risk assessment and prevention
  4. Approach and management of the mental health issues
  5. Integration of services and facilitating care.


Q10) Can one component of the module be described?

A: The BATHE technique is a globally accepted psychotherapeutic procedure and serves useful for anxiety, depression, and situational stress disorders.[5] The BATHE technique consists of four specific questions about the individual background, affect, troubles, and handling of the current situation, followed by an empathic response; the procedure takes approximately a few minutes according to studies. The trainee may use the BATHE technique to connect meaningfully with people, screen for mental health problems, and empower people to handle many aspects of their life in a more constructive way.

The BATHE Procedure: session begins with an assessment of “Background” of the person, the sociocultural factors, and recent adverse events (What is happening or what has happened?), which gives reasonable information about “the individual.”

Then “Affect” associated with it are explored “How he/she feel about it? It is important to facilitate “Troublesome” feelings and “Their meaning of the situation”.

Assess “Handling”-How are you handling that? Then, trainee assists an individual by suggesting methods of “Handling” through education and reassurances about common reactions to adversaries of life as perceived by the people

Empathetic listening to an individual's view, beliefs, and uncertainties, followed by appropriate empathy, “This must be very difficult for you.” Empathetic education, problem-solving approaches, coping strategies, reassurances, and support to reduce worry, reduce the feeling of helplessness, and irrational fears.

Q11) What are the strengths and limitations of this proposal? Has this proposal been critically evaluated by the experts?

A: The proposal is about enabling people as facilitators of mental health, it is economically feasible and training can be provided by existing resources. Trained facilitators can bridge the gap in mental health services by identifying and referring more serious conditions to available mental health experts in India, such as psychiatrists, psychologists, and psychiatric social workers. It can also serve as a foundation course on which more customized courses can be designed, such as enabling faculty in educational institutions to address psychological issues related to the disaster among students rejoining the institution after lockdown period.[6],[7] It can also be incorporated and customized for enabling team leaders in industries such as Information Technology to address mental health issues of team members, in the aftermath of the disaster.

The course content has to be critically evaluated but considering the time-constrained at the time of presenting this model, it has received comments from an external expert who has worked in India on mental health issues related to the disaster, Dr. Mohan Isaac, Clinical Professor of Psychiatry, University of Western Australia, Visiting Professor of Psychiatry, NIMHANS.

Acknowledgment

The proposal has been conceptualized based on the constant encouragement for innovations from Dr. B. Suresh, Pro-Chancellor, JSSAHER, and the support of Vice-Chancellor, JSSAHER, Dr. Surinder Singh and Dr. H. Basavana Gowdappa, Dean, JSS Medical College, JSSAHER.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Available from: https://www.who.int/emergencies/dise ases/novel-coronavirus-2019. [Last accessed on 2020 Apr 18].  Back to cited text no. 1
    
2.
Sagar R, Dandona R, Gururaj G, Dhaliwal RS; India State-Level Disease Burden Initiative Mental Disorders Collaborators. The burden of mental disorders across the states of India: The Global Burden of Disease Study 1990-2017. Lancet Psychiatry 2020;7:148-61.  Back to cited text no. 2
    
3.
Sahoo S, Rani S, Parveen S, Pal Singh A, Mehra A, Chakrabarti S, et al. (2020). Self-harm and COVID-19 Pandemic: An emerging concern - A report of 2 cases from India. Asian journal of psychiatry, 51, 102104. Advance online publication. https://doi.org/10.1016/j.ajp.2020.102104.  Back to cited text no. 3
    
4.
World Health Organization. Mental Health Atlas 2017. Geneva: WHO; 2018. Available from: https://www.who.int/mental_health/evidence/atlas/profiles-2017/IND.pdf?ua=1. [Last accessed on 2020 Apr 18].  Back to cited text no. 4
    
5.
Lieberman JA 3rd, Stuart MR. The BATHE Method: Incorporating counseling and psychotherapy into the everyday management of patients. Prim Care Companion J Clin Psychiatry 1999;1:35-8.  Back to cited text no. 5
    
6.
Kishor M, Vinay H, Kusuma KS, Kantanavar P, Chandran S. A faculty training module on the art of counseling students in academic issues. Int J Health Allied Sci 2018;7:210-1.  Back to cited text no. 6
  [Full text]  
7.
Kishor M, Chandran S, Vinay HR, Kusuma KS, Kantanavar P. A faculty training module on the art of counseling students on non-academic issues. Int J Health Allied Sci 2018;7:273-5.  Back to cited text no. 7
  [Full text]  




 

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