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Psychological Treatments in COVID-19 Pandemic

Psychological treatment

The principles of crisis intervention that can be carried out during a pandemic are:
- understand the mental status of different populations induced by a pandemic that occurs;
- identify people who have a high risk of suicide and aggressive actions;
- provides psychological intervention in people in need.

Psychological Treatments in COVID-19 Pandemic

Populations based on treatment targets are divided into four levels:
  1. Level 1, the population most vulnerable to mental health problems, such as patients confirmed COVID-19 being treated, patients with a critical physical condition, medical personnel, and administrative staff at the forefront
  2. Level 2, quarantined patients, including self-isolation or patients with minimal symptoms who are in contact with patients suspected of COVID-19
  3. Level 3, populations that are in close contact with individuals level 1 and 2, such as family, coworkers, friends, and rescue teams or volunteer workers involved during treatment
  4. Level 4, the population of people who experience the effects of preventive activities and public control.

Psychology Treatment  during Quarantined

Psychological stress can persist after quarantine is finished. Factors that influence are the presence of symptoms related to viral infection during quarantine, unmet needs, social activities, history of mental disorders, and financial loss. According to a systematic review that patients with comorbid mental disorders need extra support during quarantined.

Based on research, some of the efforts that need to be made are:
  • Quarantine duration is sought as short as possible and with certain period limitations. Some studies suggest the duration of quarantine can be adjusted according to the incubation period. An extended period of quarantine can exacerbate frustration symptoms.
  • Official health institutions give adequate information regarding quarantine goals and a comprehensive understanding of the disease at hand. Adequate information plays a role in reducing the stigma that occurs after quarantine.
  • Guaranteed supply during the quarantine.
  • Reducing boredom by maintaining social contact through telephone or other media, especially with family, loved ones, or friends; and keep working or doing activities by utilizing an internet connection, including continuing to undergo distance education for students.
  • Providing support groups from fellow people who undergo home-based quarantine makes someone feel understood, validated, and strengthened by others who live it.
  • Altruism can reduce the level of stress experienced. Gratitude by the health authority for the independent quarantine carried out proved to reduce mental disorders.

Psychological Treatment for Medical Worker in Health Facilities

Medical personnel and support staff at the forefront require more dedicated support, related to workloads and high risks experienced. The supports that can be provided include:
  • Support from other medical personnel is proven to reduce feelings of isolation and is a negative predictor of PTSD (Post-Traumatic Stress Disorder)
  • Support from medical service providers, such as training, completeness of personal protective equipment so as to increase self-confidence, the division of work tasks to reduce burnout, the formation of psychological intervention teams, the provision of temporary shelter that is guaranteed food intake and daily needs, as well as facilities for health workers, can continue to be connected with their families.
  • Support from the government and policymakers in the form of providing adequate information on disease management and prevention training, the development of a pandemic situation, and infection control protocols when returning home. The government must also provide effective means of communication to discuss conditions or obstacles encountered in the field, including the availability of personal protective equipment.

Psychology Treatment for Patients

Providing treatment, both pharmacotherapy and psychosocial interventions by mental disorders, help the recovery of patients. Psychosocial interventions can be carried out to both individuals and groups. This intervention is useful to improve the patient's understanding of what he is experiencing, how to deal with it to connect with the community's help he needs later. Providing religious guidance or a cultural leader can help provide hope and confidence that patients can get through the epidemic. For some patients, especially elderly patients and patients with comorbid mental disorders, assistance by people around them is needed to be able to access the needed health services. 

Patients who are rescued from an outbreak or who have survived an outbreak may also experience traumatic disorders such as acute stress disorder and PTSD. This is a consideration of the importance of screening for psychiatric disorders after the pandemic ends. Mainly to look for symptoms of acute stress disorder, PTSD, depressive disorders, substance abuse disorders, and disorders related to the stigma that occurs.

Treatment of Patients with Comorbid Psychiatric Disorders

Patients with comorbid psychiatric disorders need to be given special attention, through discussion and finding solutions with the family. Some policies that can be given are:
  • The provision of medicine rations is extended to several months during a pandemic. Still, it must involve supervision from a trusted family.
  • Carry out more stringent monitoring according to the severity of the disease after the pandemic ends, for example, by turning the consultation into twice a month or even weekly.
  • For patients who are unable to access health services, telepsychiatry can be performed if possible.

Family Psychology Treatment

Family management is often not the focus of an epidemic, so issues regarding mental health are often overlooked. Families enter into the 3rd level of the level of risk of mental disorders, therefore handling family psychology also requires the participation of policymakers and stakeholders, such as:
  • Providing crisis intervention services for families, including providing cognitive and behavioral therapy online to deal with depressive symptoms
  • Provide adequate self-protection equipment, work schedule arrangements, temporary accommodation, and communication services for medical personnel so that families feel protected and can continue to provide two-way support
  • Provide adequate information from the government regarding the pandemic situation and the condition of his family. That provides increases the feeling of having self-control, understanding, and the ability to cope with the psychological effects of the plague faced.

Psychological Intervention Team

The formation of a psychological intervention team is a team consisting of psychological therapists who can perform several services, namely:
  • Hotline service and regular visits to the rest area. Regular visits function to listen to complaints during work and provide psychological support.
  • Screening psychiatric symptoms and intervening to both individually and in groups. Screening and intervention are carried out both during the handling of the pandemic and after the pandemic ends.
  • Provide training in identifying and responding to psychological problems in patients, as well as how to deal with patients who are not cooperative.
  • Stress management, in the form of relaxation exercises, mindfulness, workforce resilience programs, self-management strategies, group work activities and moral formation, activities to appreciate work, and assistance by religious leaders. 

Stigma and Social Media

After getting treatment or when the pandemic is over, some patients and medical staff experience certain stigma such as rejection by their local community. This can lead to self-blame, barriers to returning home or work, and obstacles to seeking help. While uncontrolled social media lead to excessive reporting, spreading fear, even increasing the risk of mental illness to those who receive messages or send messages. In addition, social media can also increase the stigma of patients and health workers undergoing quarantine.

Some steps that can be taken to overcome stigma are:
  • Provide validation of the experience he experienced, especially by those closest to him and the environment
  • Some countries give the title of hero to health workers or patients who have survived
  • Fostering the resilience of the person and the community, to achieve self-efficacy and defense in the face of differences that occur.
  • The widely shared message increases the influence of perception, to increase behavior change. Therefore, limitations on the announcement of information, and the creation of official media for the dissemination of valid information, are needed to help understand the situation.

Social media and messages that are conveyed continuously can be used as behavioral interventions. The expected behavior change is in the form of implementing a healthy lifestyle that is needed for controlling infections such as the application of handwashing, social distancing, work from home, the use of self-protection equipment, cough ethics, and sneezing. For individuals who use social media, it is important to restrict the use and filtering of social media content to reduce perceived anxiety.

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