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Role of telemedicine in reducing mental health burden

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On World Mental Health Day, we take a look at how telemedicine is making a breakthrough in mental health.

World Mental Health Day is observed on 10 October every year, with the objective of raising awareness of mental health issues around the world and mobilising efforts in support of mental health. This year, World Mental Health Day’s goal is increased investment in mental health and it comes at a time when our daily lives have changed considerably as a result of COVID-19.

People with mental health conditions may experience even greater social isolation than before. The past months have brought many challenges: for healthcare workers, who have had to provide care in difficult circumstances and have been fearful of bringing COVID-19 home; for students, who had to adapt to online learning with almost no contact with teachers and friends; for workers whose livelihoods are threatened, the economic consequences of the pandemic are already being felt, as companies let staff go; and those who have had to manage the grief of losing loved ones.

Due to these factors, it is expected that the need for mental health and psychosocial support will substantially increase in the coming months and years. Therefore, investment in mental health programmes, which have suffered from years of chronic underfunding, is now more important than it has ever been.

Mental health in numbers

Mental health is reportedly one of the most neglected areas of public health. Close to one billion people are living with a mental disorder, three million people die every year from the harmful use of alcohol and one person dies every 40 seconds by suicide. Furthermore, in a recent American Psychiatric Association poll, more than one-third of Americans said that the coronavirus was having a serious impact on their mental health, and most (59 per cent) said it was having a serious impact on their day to day lives.

Despite the high incidence, few people around the world have access to quality mental health services. In low- and middle-income countries, more than 75 per cent of people with mental, neurological and substance use disorders receive no treatment for their condition at all. Furthermore, stigma and discrimination are still widespread.

According to the WHO, countries spend on average only 2 per cent of their health budgets on mental health. Despite some increases in recent years, international development assistance for mental health has never exceeded 1 per cent of all development assistance for health. This is despite the fact that for every US$ 1 invested in scaled-up treatment for common mental disorders such as depression and anxiety, there is a return of US$ 5 in improved health and productivity.

Symptoms

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Mental health impairment also occurs in 8 per cent to 57 per cent of patients with Post-intensive care syndrome (PICS) and includes anxiety, depression and posttraumatic stress disorder (PTSD) noted both in patients as well as their caregivers. PICS refers to a patient with new or worsening impairment in any physical, cognitive, or mental domain after critical illness or intensive care. Studies have noted a higher prevalence of post-ICU psychological sequelae in patients who are younger, female sex, have poor recall of ICU stay and longer duration of ICU sedation.

Impact of COVID-19 on mental health

The mental health of healthcare workers has been particularly affected due to the pandemic. A cross-sectional study of 1,257 healthcare workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in China showed that a "considerable" proportion of healthcare workers reported symptoms of depression, anxiety, insomnia, and distress. This was especially true of women, nurses, those in Wuhan, and frontline health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Doctors and nurses revealed to TIME recently that they'd harboured dark feelings owing to fears of spreading the disease to families, frustration about a lack of adequate protective gear, exhaustion and deep sadness for dying patients.

Frontline healthcare workers are experiencing considerable stress. Hospitals should provide easy and confidential access to mental health services for their staff. For example, they can create helplines for one-on-one counselling when needed. Within the GCC region, the Abu Dhabi Health Services Company (SEHA) created the SEHA Employees Psychological Support Taskforce (SEPST) in the initial phase of the outbreak in anticipation of the pandemic’s adverse effects on frontline staff. SEPST organises weekly webinars in which experts guide the staff on stress management and mental wellbeing. SEHA has also launched a telephone helpline for staff to access in times of distress. Some strategies can also help managers support their teams by embedding new behaviours and offering reassurance where possible.

How telemedicine can help

Unfortunately, people in some communities may react to those who had the virus with fear or distrust. As a society, the stigmatisation of anyone with COVID-19 must be rejected. This virus knows no boundaries. People who survive the ordeal will most likely be ridden with guilt, especially if they have loved ones pass away. They will need social and emotional support for many years to come. Also, throughout the world, it’s clear that many patients who need mental healthcare cannot get access when they need it or choose not to seek treatment for fear of social stigma. Enter telemedicine.

Several studies found online counselling to be as effective, if not more, as conventional face-to-face therapy. Telemedicine can offer better access to more mental health specialists, especially during these testing times when people are going to need them more than ever before. Remotely located patients can now connect with the mental health specialist of their choice, through their local hospitals which are easily accessible to them. Moreover, for some patients with anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder, coming into a hospital or clinic creates an extra layer of anxiety and can trigger unwanted feelings and thoughts. Telemedicine offers more privacy and delivers therapy without triggering feelings of anxiety.

For example, Houston-based AccessHealth had to scale up its telemedicine offerings due to the pandemic. They found that the patients screened for depression with a treatment plan documented increased 5 per cent year over year. Currently, there is a 96 per cent overall compliance rate. Continuing treatment through telemedicine was important because there was a potential for increased anxiety and depression due to COVID-19. Using a technology platform enabled all parties involved to contact patients for visits, assessments and follow-ups. The end result showed an increase in mental health visits of 10 per cent.

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