Mental Health Interventions during the COVID-19 Pandemic: A Conceptual Framework by Early Career Psychiatrists

Abstract

The emergence of mental health (MH) problems during a pandemic is extremely common, though difficult to address due to the complexities of pandemics and the scarcity of evidence about the epidemiology of pandemic-related MH problems and the potential interventions to tackle them. Little attention has been devoted so far to this topic from policymakers, stakeholders and researchers, resulting in a lack of replicable, scalable and applicable frameworks to help plan, develop and deliver MH care during pandemics. As a response, we have attempted to develop a conceptual framework (CF) that could guide the development, implementation, and evaluation of MH interventions during the ongoing COVID-19 pandemic. This CF was developed by early career psychiatrists from 16 countries that cover all the WHO regions. Their opinions were elicited via a semi-structured questionnaire. They were asked to provide their views about the current MH situation in their countries and to elaborate on existing 'myths' and misinformation. They were also asked to name the resources available and to propose solutions and approaches to provide accessible and affordable care. The CF was prepared based on the extant literature and the views discussed in this group; it illustrates the epidemiology of MH problems, preparedness plans, stage-specific plans or innovative solutions, opportunities to integrate those plans and possible outcomes at policy level. This CF can serve as a technical guide for future research regarding pandemics. It can be used to monitor trends and to optimize efforts, and to develop evidence based MH interventions. Still, further research focusing on the individual components of this framework is needed.

Keywords: COVID-19; Framework; Interventions; Mental health; Pandemic.

Fig. 1

Emotional Epidemic Curve of the COVID-19 Pandemic in acountrywithoutadequatemeasures (mitigation) (A double peak phenomenon). Footnote: Illustrative simulations of an Emotional Epidemic Curve of the COVID-19 (red), Number of confirmed cases of COVID-19 (blue) & Number of deaths due to COVID-19 (black dotted curve), both curves may be the potential predictor of peak [i.e first peak (a) and second peak (c)] This is a qualitative illustration only, not a quantitative estimation.

Fig. 2

Mental Health Preparedness and Action Framework (MHPAF). Footnote : a) Color of text box is similar to color of Phases on time line, b) Text color is similar to component (legend 2)Abbreviation: MHSS-Mental health surveillance system, HCW-health care worker (modified and developed as per WHO-GIPP Plan).

Fig. 3

Effect of MHPAF + WHO-GIPP on Epidemic Curve and Health Care System. Footnote: Illustrative simulations of Number of confirmed cases of COVID-19 (blue) Effect of inclusion of MHPAF + Measures to reduce transmission on Epidemic Curve of the COVID-19 (green), Effect of inclusion of only Measures to reduce transmission on Epidemic Curve of the COVID-19 (red) and Incease in overall capacity of health care system (green arrow). (This is a qualitative illustration only, not a quantitative estimation.).

Fig. 4

Effect of MHPAF + WHO-GIPP on Emotional epidemic curve. Footnote: Illustrative simulations of an Emotional Epidemic Curve of the COVID-19 (blue), Number of confirmed cases of COVID-19 (dotted black curve), Additive effect of Mental health measures on both COVID-19 epidemic curve and Mental health curve. Health care system and mental health system can cope with volume of both group patients i.e. COVID-19 and mental health problems due to COVID-19.This is a qualitative illustration only, not a quantitative estimation.