|Year : 2020 | Volume
| Issue : 5 | Page : 61-63
Intersectoral activities in the time of COVID-19
Rajesh Sagar, Mahadev Singh Sen
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||07-Aug-2020|
|Date of Acceptance||07-Aug-2020|
|Date of Web Publication||02-Oct-2020|
Dr. Rajesh Sagar
Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sagar R, Sen MS. Intersectoral activities in the time of COVID-19. Indian J Soc Psychiatry 2020;36, Suppl S1:61-3
Intersectoral activities, as the name suggests, require involvement and integration of the mental health sector with public health, medicine, and various stakeholders. The infection that shook the world, COVID-19, not only is causing physical problems but is also causing a surge in mental health issues. It is a matter of concern that people are having “COVID stress” and related problems which is directly or indirectly leading to mental health issues. The motto “No health without mental health” stands true in this time also. Not only this but there may also be a surge in such cases even after the resolution of the problem. There is already concern in the rise in the demand of mental health professionals and a fear of how to meet such a demand. Most emergency departments are not well equipped to handle psychiatric emergencies, and economic burden is another concern. Such disasters disrupt normal lives and affect us in many ways. Such times require a strong leadership from government, and the functions include assessment of various risks to the society along with bringing together various specialized agencies to address those risks and damage control. Since the Declaration of Alma-Ata, the concept of intersectoral coordination for economic and social development of health in general has gained importance and the concept has been applied to mental health sectors as well. The authors have claimed that the intersectoral coordination is lacking in our country citing examples of many health policies related to infectious diseases, national health policy, etc., leading to poor management, unresolved issues, and direct and indirect economic burden. Similar scenarios hold true for the mental health sector in India, and no importance is given to this aspect. Similarly, the “National Disaster Management Guidelines on Psychosocial Support and Mental Health Services in Disasters” is not very forthcoming with the concept of intersectoral collaboration. Although in the National Mental Health Policy, the term “intersectoral collaboration” has been mentioned which focuses on sectors such as education, employment, housing, and social sector which includes private and nongovernmental sectors as well. However, observation from the field has pointed a rather incomplete implementation in the National Mental Health Programme that it was limited by “financial and human resource constraints, lack of community participation, ineffective training, poor nongovernmental organization (NGO)/private partnership, and lack of a robust monitoring and evaluation (M and E) system.”
Thus, “desperate times call for desperate measures,” such is the desperate situation we are going through at present and we need urgent desperate measures to tackle the current situation. Now is the opportunity for us to start building the future and come victorious. As we know that there is a huge gap in the mental health services and severe deficiency in professionals, especially in a country like India, there needs to be a unique plan which caters to its need. There is a need to focus on developing special teams that not only consist of mental health professionals (incl. psychiatrists, psychiatric nurses, psychologists, and social workers) but also colleagues from other specialty including medicine, public health specialist, and stakeholders. The collaboration should be bi-dimensional, that is, on the one hand, there should be horizontal collaboration which includes different sectors related to health and administration at the same time; on the other hand, vertical collaboration that includes managing decisions from a joint committee which are smoothly carried out by those working in the field. The focus should start from the public and inclusion of preventive measures. The decisions should be made jointly or collaboratively, and the process should first start with frequent and productive meetings of representatives of various departments. It is important to ensure that every viewpoint is considered, and the ultimate decision taken should benefit the masses. Active efforts should be made to keep the group together and avoid any topics or interests causing division. Sometimes, it may happen that the decisions may favor one group than the other; hence, caution must be taken to have the consent of all the parties involved in the decision-making.
While talking about horizontal collaboration, the task distribution should be done as per relevance, and inputs from all parties should be taken. The administrative action should include provision of a better and safe method of access to health care for everyone. This not only includes tele-psychiatry but also other initiatives such as online support groups, emergency services, strengthening of local community-based services, and addressing the basic needs of food and shelter. People from medical specialties who are already burdened by the caseload of COVID patients may have to bear even more because of the association between worsening mental health with degrading physical health. The medical outpatient departments are expected to be flooded with patients having health concerns, hypochondriasis, obsessions, anxiety, and depressive symptoms in the aftermath of the COVID-19 spread and the countrywide lockdown. A short-term training for general physicians and other medical specialists would be beneficial. Special inclusion of medical trainees and interns can also be a helping hand in some less-skilled tasks required in such times. Furthermore, a part of the general medical outpatient services as well as emergency can be tailored to people with mental health issues. These steps may benefit in early detection and ultimate lowering of the caseload. The role of NGOs is also particularly important as mentioned in the guidelines laid by the National Disaster Management Authority. For the role of these NGOs, 11 points have been specifically mentioned ranging from damage assessment to social protection and planning recovery. It is also very apparent that the role of private sector is variable yet fundamental. The private sector not only includes private medical professionals and establishments but also includes other nonstate-controlled organizations and companies. The functions can range from private–public partnerships, financial contributions as a part of corporate responsibility, help in research and analysis, etc.
Vertical collaboration should include smooth execution of the plan from top to bottom. Then comes the need of the more severe psychiatric patients who may go through relapses and suffering additional new symptoms. The damage control can be done by urgent referral, sensitization of general medical practitioners, family members, etc. These patients and their caregivers also face a dilemma of going to the emergency setting, getting treated, procuring medicines versus getting COVID infection, and getting stigmatized, especially those who are not in the vicinity of hospitals and related medical establishments. These dilemmas will probably lead to even more worsening of the clinical condition. Active collaborative efforts with community health workers, accredited social health activist workers, and some NGOs should be made. Involvement of pharmacists to procure and distribute medicines is also important especially when chronic illnesses would require people to procure medicines repeatedly and for longer duration. People with severe mental illness especially in rehabilitation facilities or halfway homes are more vulnerable to contract the virus. Along with this, there are several medical comorbidities in psychiatric patients such as obesity, hypertension, and diabetes, which may further complicate the clinical scenario and is a poor prognostic marker. The intervention at their places has to be intense so as to protect them. Any person living with mental disability should be a special focus from an administrative point of view as they are more vulnerable to abuse and concerns such as poverty, housing, and lack of medical care.
The focus should be to keep the groups together and working with shared interest, values, and objectives. While sometimes it may be difficult to achieve the targets may be shifted, to more concrete steps, in order to have visible results and thereby being practical. Ultimately monitoring of the services delivered is a must and a vital part of sustaining the output of joint efforts which should be welcomed by the community. Monitoring and sustainability of the program also depends on the support of the government, which is also a key component. We would like to conclude by stating that intersectoral collaboration is the backbone of program execution, and we need to focus on all the components in both dimensions so that we emerge successful.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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