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Tele-psychotherapy: Mental healthcare in times of COVID-19

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Tele-psychotherapy offers a creative and flexible solution in responding effectively to the crisis. Expanding its usage is vital to coping with the upsurge in mental health symptoms, writes, Dr Michelle Normen, Lead, Psycho-Oncology Services, Cytecare Cancer Hospitals

The COVID-19 crisis has ushered in unprecedented challenges, reshaping our world as it unfolds. Human civilisation is indeed passing through the most crucial phase when its very existence is being challenged by the novel severe acute respiratory syndrome coronavirus (SARS-Cov-2). Even as it rapidly invaded several territories across the world, the pandemic has turned life, as we know it, upside down, ushering in myriad and far-reaching challenges. 

While basic needs such as food, clothing, and shelter requirements are being addressed to an extent by the government and the NGOs, there is another dimension that the pandemic has created which remains largely disregarded. This is the issue of mental health. While the COVID-19 crisis is, primarily, a physical health crisis, it contains the seeds of a major mental health crisis as well, if necessary action is not taken. 

Varied types of lockdown-induced trauma and stress have affected all age groups from all walks of life. From school going kids to adolescents to working-class people to senior citizens, none have been left unimpacted. In fact, since the Second World War, no other world event has ever had as much of an impact on mankind as the COVID-19 crisis. This fact was underlined by the UN Secretary-General, Antonio Guterres, no less, at the virtual launch of a report on responding to the socio-economic impact of COVID-19.

COVID-19 stressors
Much of the distress related to COVID-19 centres around the immediate health impacts of the virus and the consequences of physical isolation. Many are afraid of infection, dying, and losing family members. Individuals have been physically distanced from loved ones and peers. Millions of people are facing economic turmoil, having lost or being at risk of losing their income and livelihoods. As a result of this, people are becoming prone to various kinds of psychological anomalies such as increased levels of anxiety, fear, sadness, frustration, irritability, loneliness, depression, anger, increased alcohol and drug use, self-harm or suicidal behaviour and the demanding stress-coping-adjustment process which is ongoing. 

Frontline healthcare workers and first responders have also been exposed to numerous stressors. Ensuring the mental health of healthcare workers is a critical factor in sustaining COVID-19 preparedness, response and recovery. 

A Lancet study in December 2019 estimated that one in every seven Indians was affected by mental disorders of varying severity, that included 45.7 million having depressive disorders and 44.9 million with anxiety disorders. People who already have mental health issues find it hardest to deal with the uncertainty of the pandemic. Adverse psychosomatic outcomes among common people are nevertheless expected to increase significantly due to the pandemic itself and due to constant flow of readily available information (and misinformation), and reinforced messages that are being circulated online via social networking platforms. 

E-mental health solutions
During the past few months, there have been concerted efforts initiated to support people in distress and to ensure care for people with mental health conditions. Innovative ways of providing mental health services have been implemented, and initiatives to strengthen psychosocial support have sprung up. However, on account of the size of the problem, the vast majority of mental health needs still remain unaddressed. Therefore, it is the need of the hour to access help despite poor investment in mental health promotion, prevention and care by economies. The solution lies in choosing a more individual approach to recognise and make available the help that is needed.

Fortunately, with access to technology, e-mental health is an area available for help. Tele-psychotherapy is one such approach. It refers to the provision of psychotherapy services using telecommunication technology including email, text messaging, video conferencing, online chat, or internet phone by trained mental health professionals. It helps give access to both counselling and even follow-up through online aids. The practice of tele-psychotherapy presents both opportunities and challenges to traditional psychotherapy practice.

While there are challenges in using communication technology to access and to care effectively, the current tele-psychotherapy scenario has proved to be particularly effective during the COVID-19 pandemic; when access to in-person psychotherapy sessions is limited and stress levels may be high. Providing mental health care at a ‘warm’ distance, via video-conferencing psychotherapy and internet interventions, is increasingly finding acceptance and proving effective. Tele-psychotherapy is based on national and international guidelines formulated in response to the emergent needs of access and continuity of mental health services. The immediate need for such e-mental health services to function effectively is to have a scientific and ethical validation using user experience and of course maintain confidentiality, data privacy and security.

Tele-psychotherapy offers a creative and flexible solution in responding effectively to the crisis. Expanding its usage is vital to cope with the upsurge in mental health symptoms due to the coronavirus. Unusual times, after all, call for unusual solutions.

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