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   Table of Contents - Current issue
Coverpage
May-August 2020
Volume 2 | Issue 2
Page Nos. 51-176

Online since Friday, August 14, 2020

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EDITORIAL  

The Plague by Albert Camus, the COVID-19 Pandemic, and the Role of Social Psychiatry – Lessons Shared, Lessons Learned Highly accessed article p. 51
Debasish Basu
DOI:10.4103/WSP.WSP_67_20  
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SPECIAL COMMUNICATIONS Top

World Association of Social Psychiatry Position Statement on the Coronavirus Disease 2019 Pandemic Highly accessed article p. 57
Rakesh K Chadda, Rachid Bennegadi, Vincenzo Di Nicola, Andrew Molodynski, Debasish Basu, Roy Abraham Kallivayalil, Driss Moussaoui
DOI:10.4103/WSP.WSP_22_20  
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Articulating Social Psychiatry and Person-Centered Medicine: Conceptual Bases and International Implications for COVID-19 Highly accessed article p. 58
Juan E Mezzich, Roy A Kallivayalil, Rachid Bennegadi, Michel Botbol, George Christodoulou, Doina Cozman, Afzal Javed, Marianne Kastrup, Fernando Lolas, David Ndetei, Armen Soghoyan, Zvi Zemishlany
DOI:10.4103/WSP.WSP_60_20  
Background: The World Association of Social Psychiatry (SP) and the International College of Person-Centered Medicine (PCM), while having their own background and goals, share some significant interests and concerns, raising hope for collaboration and synergism. Consideration of the COVID-19 pandemic that is severely challenging the world may also offer opportunities for organizations and programmatic perspectives to reflect on and optimize their paths. Objectives: This article is aimed at delineating a pattern of points of conceptual and strategic articulation between SP and PCM as perceived by scholars familiar with these perspectives, and to examine their implications for general health care and for responding to the evolving COVID-19 pandemic. Methods: This is primarily a consultation study involving clinical scholars familiar with the two perspectives at hand around a list of prospective articulation points between SP and PCM based on a selective literature review. The specific methods engaged involved elucidation of prominent SP/PCM articulation patterns through tabular displays of panelist ratings and contrast between such articulation points and recommendations from the UN and WHO for advancing general health care and responding to the COVID-19 pandemic. Results: The initial explorative elucidation of potential articulation points between SP and PCM, including a) Contextualized approach, b) Ethical commitment, c) Humanization of medicine, d) Concern for broad determinants of health, e) Commitment to health care and public health, and f) Contributing to UN SDGs, was supported by the ratings of panelists familiar with both perspectives and the recommendations of authoritative international health declarations (including those focused on COVID-19 response). This was particularly the case for complementary concern for health care and public health, a contextualized person/whole society approach, and ethical commitment to persons' values. Conclusions: The thrust of the results of the present study and their contrast with the emerging professional and scientific literature stimulated by the COVID-19 pandemic affords clarification and validity on the concepts and strategies of SP and PCM and opens new avenues for useful collaboration.
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INVITED COMMENTARIES Top

The WASP Position Statement: A List of Tasks for All of Us p. 69
Norman Sartorius
DOI:10.4103/WSP.WSP_24_20  
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The World Psychiatric Association Applauds the WASP Position Statement on the COVID-19 Pandemic p. 70
Helen Herrman
DOI:10.4103/WSP.WSP_58_20  
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The COVID-19 Pandemic: A National and Global Social Contracts Stress Test p. 72
Eliot Sorel
DOI:10.4103/WSP.WSP_53_20  
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World Association of Social Psychiatry Position Statement on Coronavirus Disease 2019 Pandemic: A Commentary from Lockdown in London p. 74
Thomas KJ Craig
DOI:10.4103/WSP.WSP_25_20  
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Ethical Sustainability and Social Psychiatry p. 76
Fernando Lolas
DOI:10.4103/WSP.WSP_26_20  
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PERSPECTIVE/VIEWPOINT - GLOBAL Top

The Need for a Public Mental Health Approach to COVID-19 p. 77
Jonathan Campion, Afzal Javed, Michael Marmot, Koravangattu Valsraj
DOI:10.4103/WSP.WSP_48_20  
Mental disorder is responsible for at least 20% of global disease burden which COVID-19 is likely to increase. Effective public mental health (PMH) interventions exist to treat mental disorder, prevent associated impacts, prevent mental disorder from arising and promote mental wellbeing. However, implementation is poor with only a minority with mental disorder receiving treatment even in high-income countries, far fewer receiving interventions to prevent associated impacts, and negligible coverage of interventions to prevent mental disorder or promote mental wellbeing. There is an urgent need to address this implementation failure which contravenes the right to health, results in broad population scale impacts and preventable suffering, and is further amplified by COVID-19. PMH practice including during COVID-19 can prepare for and address the implementation gap in the following ways: assessment of size, impact, and cost of the current and future PMH intervention implementation gap taking into account COVID-19; estimation of impact and associated economic returns from improved coverage of PMH interventions; use of this information to inform national policy and transparent decisions about acceptable levels of national coverage of different PMH interventions which then informs level of provision, required resource and commissioning; operationalization of intervention implementation nationally and locally; evaluation of coverage and outcomes; and communication to the population and different professional groups. Coverage of PMH interventions can be increased including during quarantine/lockdown through appropriate professional training, improving population knowledge, digital technology, settings and integrated approaches, maximizing existing resources and application of relevant legislation. PMH practice should be an integral part of the response to COVID-19.
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A Global COVID-19 Pandemic Needs an Integrated Global Response p. 84
Kamaldeep S Bhui, Anuj Kapilashrami
DOI:10.4103/WSP.WSP_49_20  
The global pandemic caused by coronavirus disease 2019 is challenging health care workers and public health specialists around the world. Most data and policy, including recommendations for controlling the pandemic, measures of lockdown, and strategy to relaxing lockdown, all appear to emerge from the high income countries. We present the situation in the UK, and consider the inequalities globally, calling to attention critical concerns faced by vulnerable groups. Ethnic minorities, migrants, those in care homes, those in mental health services, and health staff from migrant or minority groups are all at higher risk of death and need for intensive care. We call for more comprehensive evidence base to be generated across nations, and for the global health community to be more cognisant of actions and approaches in the Global South, and translating these lessons to develop more sustainable recovery pathways. Learning across geopolitical and economic divides and addressing entrenched social inequalities are critical if we are to recommence international travel and business, and ensure that health protections are enforced globally.
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Mental Health and the Coronavirus: A Global Perspective p. 88
Vandana Gopikumar, Deborah K Padgett, Alok Sarin, Roberto Mezzina, Andrew Willford, Sanjeev Jain
DOI:10.4103/WSP.WSP_51_20  
Any epidemic of infectious disease such as the present one that we are witnessing puts a strain on both the individual and the community. The very basis of physical and emotional health, dependent as it is on the body and social networks, is threatened. Existing inequalities in society get accentuated, and systemic responses that provide succor to all sections of society, especially the marginalized, are critical. Scientific and technological insights will, ultimately, provide solutions (or at least a better understanding), but the broader engagement of the “social body” in this endeavor is very important. Humans are social beings, and the isolation, stigma and the labeling of those infected; indeed, the very “othering” of the virus, makes us concerned about the long-term consequences of this pandemic. From health-care workers and those seeking help who are concerned about imminent infection and morbidity, to those displaced and dispossessed, who now face months of poverty and hardship, the spectrum of mental health needs is very large. Pandemics like this underline the urgent need to work beyond real and imagined boundaries. As a group of mental health professionals and social scientists, we hope that the social and psychological responses will help us emerge from this with a greater sense of harmony and cohesiveness.
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PERSPECTIVE/VIEWPOINT - COUNTRY/REGIONAL Top

Coronavirus Disease 2019 Pandemic in Low- and Middle-Income Countries: The Pivotal Place of Social Psychiatry p. 94
Oye Gureje
DOI:10.4103/WSP.WSP_54_20  
Coronavirus disease 2019 (COVID-19) is wreaking havoc across the world, upending every known facet of the human activity. Although a viral disease, it has nevertheless brought home to the world the huge importance of social factors as determinants of health and, of course, of ill health. These social determinants, though universal, are generally more inequitably skewed in low- and middle-income countries (LMICs). Since social factors are important in the acquisition and dissemination of the infection, it is no surprise that a number of the containment and mitigation activities are also essentially social. Yet, those mitigation efforts such as a stringent lockdown and social distancing create their own problems, more so in LMIC. The situation is precarious for LMIC in both ways. The consequences of both the disease and the mitigation strategies on mental health of the population are multifactorial and likely to be huge. Further, it is plausible to expect the effects of COVID-19 to include a widening of the treatment gap for mental disorders in LMIC. Social psychiatry provides an important platform to grasp the contextual demands of community response to COVID-19. A good understanding of the social contexts in which the mental health consequence of COVID-19 is being experienced will be vital to provide appropriate care to persons affected. These are not strategies and approaches to be seen as only for short-term use. Clinicians will require the necessary skills of social psychiatry as approaches to care for the long-term, as the mental health consequences of COVID-19, including associated stigma of those infected by the virus, may linger much longer in the LMIC.
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Psychosocial Response to COVID-19 in Africa, with Special Reference to Kenya p. 97
David M Ndetei, Victoria Mutiso, Christine Musyimi, Frida Kameti
DOI:10.4103/WSP.WSP_47_20  
On 11 March 2020, the World Health Organization declared the coronavirus disease-19 (COVID-19) outbreak a global pandemic. The coronavirus has affected different aspects of people's lives in different ways from physical isolation, job losses, schools, offices shutting down, etc., These changes have had an impact on people's emotional, psychological, spiritual, and physical well-being. The country has seen 2021 infections, 482 recoveries, and 69 people succumbing due to coronavirus as of May 31, 2020. The Kenyan government has taken measures to stop the spread of the disease, but this has come with its challenges as a large number of Kenyans rely on day-to-day income, live in shared accommodation, thus making social distancing a nearly impossible task to achieve. These factors among others have raised the fears of the expected impact on psychosocial needs and response during the COVID-19 period. It is likely that governments have focused on how to stop the spread of coronavirus and finding a cure, that attention on the psychosocial impact of the coronavirus has not been given the needed attention. This review has been done to examine the psychosocial responses undertaken by the Kenyan government and its stakeholders during the COVID-19 pandemic. The gaps likely to be felt by vulnerable populations have also been examined. There is a need to develop measures that will address the psychosocial stressors faced by the vulnerable populations. There will be a need for mental health services long after COVID-19 is managed and a working vaccine is developed; thus, the development and implementation of integrative treatment and services is imperative.
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COVID-19 Pandemic and Australia: “The Lucky Country” p. 100
Kevin Kendrick, Mohan Isaac
DOI:10.4103/WSP.WSP_28_20  
Australia has indeed come through the first-wave COVID lightly. The strain on Australian society is more from the secondary effects of adaptation to contain the outbreak than from the outbreak itself. On a societal level, Australia has several factors that have contributed to the comparative mildness of the impacts of the lockdown. Tertiary psychiatric service demands appear to have been well met, although there appears to have been an increase in required support in other areas. The mental health burden of COVID is unlikely to be spread proportionately across the population, with variations based on the rural location, ethnicity, age, and indigenous status. Beyond the acute phase of the pandemic significant challenges loom. One can expect severe economic repercussions, including a spike in unemployment and a concomitant rise in anxiety and depression as other social determinants worsen.
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Integrative Community Therapy in the Time of the New Coronavirus Pandemic in Brazil and Latin America p. 103
Adalberto de Paula Barreto, Maria de Oliveira Ferreira Filha, Milene Zanoni da Silva, Vincenzo Di Nicola
DOI:10.4103/WSP.WSP_46_20  
With the emergence of the COVID-19 pandemic, humanity experienced, at the same time, social confinement as a way to protect itself and the vulnerability of human life and institutions. In the past, overcoming calamities was done by being together, and now, with this pandemic, the form of protection is the opposite, social isolation. Over the past 27 years in Brazil, we have developed integrative community therapy (ICT) as a psychosocial intervention within the Brazilian Public Health System that is implemented in various contexts marked by the rupture of social bonds. The techniques of ICT, which have always had an essentially experiential character in face-to-face encounters, now need to be reinvented. To deal with the pandemic, ICT was offered to the general public virtually, with the following objectives: To strengthen bonds and build support networks; to minimize stigma and prejudices toward affected persons, encouraging empathy; and to offer a listening space by professionals involved in the fight against COVID-19. In March and April 2020, we conducted 100 sessions online with 3579 participants from 15 countries. The most frequent concerns expressed were fear and anxiety (53%), helplessness (30%), problems in dealing with family relationships (10%), and loneliness (7%). The techniques of virtual ICT became a support network for instilling hope for those in social confinement and moreover for discovering unknown potentials to transform life's adversities. Conducted in 15 countries and in four languages, emotional reactions were similar everywhere, demonstrating that pain and suffering have no frontiers and unite us in our humanity.
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Mental Health and Healthcare in Canada during the COVID-19 Epidemic: A Social Perspective p. 106
K Sonu Gaind
DOI:10.4103/WSP.WSP_45_20  
The impacts of COVID-19, both through its direct infectious sequelae, and through massive changes to our societal and health system functioning, are being felt differentially by different populations. In many ways, the disproportionate negative impacts are highlighting preexisting fault lines in our social fabric. Lessons learned during this epidemic can hopefully help guide long-term improvements to models of health-care delivery, and also draw attention to needed social changes for addressing vulnerable marginalized populations and inequities, and improving social resilience.
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A Chinese Perspective of Coronavirus Disease 2019 Outbreak through a Social Psychiatric Lens p. 109
Shaoling Zhong, Xiaoping Wang
DOI:10.4103/WSP.WSP_29_20  
The 2019 Coronavirus disease (COVID-19) has posed an emerging threat to global public health and brought challenges to policy-makers. Concerns are rising about the potential mental distress among frontline health-care workers, patients infected with COVID-19, and the public during the epidemic. We aimed to share a Chinese perspective through a social psychiatric lens to better respond to public emergencies. The Chinese government has implemented a number of mental health care measures, including an issue of national guidance on the COVID-19 response in mental health management. We propose that the government should set up a national platform for remote psychological services, increase the number of psychological rescue personnel, and built a joint psychosomatic rescue system for disasters, accidents, and epidemics. Establishing a psychological service system and developing a pool of multidisciplinary mental health service teams are essential to improve the capacity for crisis intervention. Strengthening the interactive system of popular science and health education may mitigate potential negative psychological impacts. We suggest priorities the needs of vulnerable groups with developing mental illness, including depression and posttraumatic stress disorder in longer-term strategic programs.
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The Austrian Perspective on the COVID-19 Outbreak through a Social Psychiatric Lens p. 112
Eleonore Miller-Reiter, Alexander Kaltenboeck, Johannes Wancata
DOI:10.4103/WSP.WSP_31_20  
In Austria, rather drastic measures such as travel restrictions and shutdown were implemented earlier than in other countries to contain the coronavirus from spreading. Due to this fact, the curve of new COVID-19 cases flattened successfully. After only 7 weeks, Austria started to gradually reduce restrictions step by step. While the overall number of psychiatric hospital admissions was lower than usual, the number of severe cases among inpatients increased. In the general population, an increase of alcohol consumption and substance abuse was observed. For some weeks, there was a shortage of protective clothing for medical staff and of lithium medication. Frequently, psychiatric treatment changed from personal meetings with patients to tele- or videophone appointments. To separate people with psychiatric illness and COVID-19, some services were dedicated exclusively to this group, whereas other psychiatric services treated only those without COVID-19. Overall, psychiatric services were able to deliver treatment undisrupted throughout the whole shutdown.
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Impact COVID-19 and Mental Health p. 115
Rachid Bennegadi, Boris Cyrulnik
DOI:10.4103/WSP.WSP_59_20  
In the face of the violence and terror generated by this corona virus, each of us needs to protect ourselves with the means at our disposal. In terms of personality structure, we are all equal thanks to the psychological development supported by our domestic environment within the framework of a secure attachment, and all our social and societal supports. The difference lies in the defense mechanism that will be privileged to fight against the fear of being annihilated, against the terror that this virus may take away the people we love and want to protect. The authors analyze the impact on society and on the person with the eyes of anthropology and on the importance of the process of resilience which should be the priority of the action of mental health professionals to avoid any process of search for scapegoat. Getting out of posttraumatic stress is a real psychotherapeutic process which will have to take into account the place of social determinants and cultural representations to avoid any untimely stigmatization.
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Psychosocial Impacts of COVID-19 Pandemic: The Italian Perspective p. 120
Antonio Ventriglio, Antonello Bellomo
DOI:10.4103/WSP.WSP_39_20  
The COVID-19 pandemic has challenged mental health globally. Feelings of fear, isolation, restrictions, and quarantine, all are impacting on population's well-being, above all for those vulnerable individuals with preexisting health and mental health problems. In Italy, as in the rest of the world, data on socioeconomic consequences as well as regarding the impact of COVID-19 on population lifestyle and public opinion are emerging. This commentary reports on the Italian perspective of the current emergency.
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COVID-19: Spain is Not Different p. 122
Maria Ines Lopez-Ibor
DOI:10.4103/WSP.WSP_27_20  
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Romanian Perspective of COVID-19 Outbreak from a Social Psychiatric Lens p. 124
Doina Cozman, Roxana Stoean, Andrei Buciuta, Claudia Dima
DOI:10.4103/WSP.WSP_36_20  
The COVID-19 pandemic brought multiple changes in everyday life and healthcare assistance, including psychiatric healthcare. With the purpose of preventing infections, on March, 16, 2020, the Romanian government established the state of emergency and issued several restrictions regarding the free movement of persons and regulations for the health-care system, thus increasing the difficulty of healthcare access, both in the public health-care system and the outpatient services. One of the measures was the suspension of nonurgent hospitalizations and consultations in outpatient setting, which, associated with the increase in referrals for anxiety and depressive symptoms generated an abrupt increase in presentations in the emergency rooms. The resulting new needs were addressed by issuing the legislation for telemedicine consultation in the outpatient network and removing some requirements in the drug prescribing procedure. Despite the lack of dedicated resources, the resilience of the health-care system was outstanding.
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COVID-19 Pandemic: Reflexions from East Europe p. 126
Dusica Lecic-Tosevski
DOI:10.4103/WSP.WSP_56_20  
The pandemic of severe acute respiratory syndrome CoV-2 affected most countries and united the polarized world. In spite of sharing the experiences, the data show there are differences and specificities across regions. The number of infected persons and death toll show that wealthy, developed nations were not more prepared than low income, developing countries, to deal with major stress of the pandemic. The aim of this paper is to reflect on possible psychosocial causes of these differences. The emergency states were introduced rather early in countries of East Europe, with strict restrictive measures that seem to be critical. Mental health care considerably changed during the pandemic and was mostly neglected as was the usual somatic care of people, with intention to prevent collapse of not well-developed health system. There are many lessons to be learned from the pandemic. A long-term planning and management measures should be prepared for a possible second wave as well as for new outbreaks that might affect humanity. A particular emphasis should be paid on the importance of preservation of mental health, widely neglected during the pandemic, as well as to a comprehensive psychosocial approach to affected communities.
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Psychosocial Aspects of Covid-19, the Indian Way p. 129
Santosh K Chaturvedi, Manoj K Sharma
DOI:10.4103/WSP.WSP_32_20  
The psychosocial impact of the Covid-19 pandemic has been related to not only the viral epidemic but also by the sudden and extended lockdown. The prominent psychosocial issues are related to the stigma, changed lifestyle, impact on persons with mental health problems and mental illnesses including alcoholism and substance use, chronic medical illnesses, and this being one or more major life event. Social issues due to this stigma manifest as avoidance, discrimination, isolation, and seclusion of persons suspected to be anyway related to Covid-19. There are also self-stigma and fear of spreading it to the family members. However, the stigma associated with Covid-19 reduced stigma toward mental health and focused on the need of mental health support. This pandemic and its consequent lockdown to contain the spread of the viral infection will form a new health-related life event. During this period, there is a growing concern about the rise in domestic abuse and violence being reported by the media. Lockdown brought about reports in media about emotional disturbances and maladjustments within families including families of persons with mental illness. Finally, there has been a revival of cultural defenses in the form of traditional practices; people are reverting back to a folded hand “namaste” instead of a handshake, washing hands frequently, and use of a mask.
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COVID-19 and Psychosocial Issues: Israeli/Middle East Perspective p. 132
Zvi Zemishlany
DOI:10.4103/WSP.WSP_43_20  
The number of confirmed cases and fatalities in the Middle East countries has been relatively low in comparison to some countries in Europe and the United States, in spite of the economic, political, cultural, and medical differences. One explanation may be the closed borders and lack of migration in the Middle East, with the exception of Iran, largely to its close economic ties with China and mismanagement. The distribution of the infected cases in Israel reveals two distinct populations with disproportionately high infection rate: the elderly people leaving in nursery homes (like in the rest of the world) and ultra-orthodox Jews. Ultra-orthodox Jews comprise about 12% of Israel's population, but they accounted for more than one-third of the confirmed cases of COVID-19 and as much as 60%–70% of Israel's COVID-19 cases in major hospitals. Ultra-orthodox communities initially resisted physical-distancing measures regarding the closure of synagogues, religious schools, and prayer services, due to their shared belief that practicing the religious services and rituals as usual will protect them from harm. This seemed to be helpful in alleviating feelings of stress and anxiety from the pandemic on one hand but placed people in harm on the second hand. Thus, social factors such as sense of belonging, social support and religious beliefs, known to increase resilience, and coping with adversity in uncontrolled disasters turned to have a harmful effect on coping with the COVID-19 pandemic, a disaster that its consequences can be partially controlled. This is an interesting social phenomenon worth further study.
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The COVID-19 Pandemic and Social Psychiatry: Lessons Shared, Lessons Learned – A Japanese Perspective p. 134
Masafumi Mizuno, Chiyo Fujii, Tsutomu Sakuta
DOI:10.4103/WSP.WSP_33_20  
It seems that Japan is succeeding in overcoming the COVID-19 pandemic, with the minimal sacrifice. The long-term confinement to one's home exposes the behavioral characteristics and mentality of each country. Authoritarianism, which depends on the government, and collectivism, in which groups take precedence over individuals, still remain in Japanese society. This creates synchronized pressure and mutual monitoring. We mental health professionals are needed to help people recover from injuries to their mental health, but this does not mean a simple return to the past values and styles.
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South-East Asian Perspective of COVID-19 Outbreak from a Social Psychiatric Lens p. 137
Chawanun Charnsil
DOI:10.4103/WSP.WSP_38_20  
The emergence of novel coronavirus disease (COVID-19) is disproportionately impacting the population worldwide. The impacts are not only limited in physical health but also mental health, economic status, and life style. All South East Asian countries use lockdown method to control spreading. However, coronavirus (COVID-19) outbreak affected more than physical illness. It also affected mental health, economic status, and life style. This article aims to demonstrate the effects of coronavirus (COVID-19) in South-East Asia.
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The Malaysian Perspective of the COVID-19 Outbreak from a Social Psychiatric Lens p. 139
Richard Rother, Hazli Zakaria, Firdaus Abdul Gani
DOI:10.4103/WSP.WSP_37_20  
The pervasive spread of the novel coronavirus known as COVID-19 has resulted in a global pandemic. The virus arrived in Malaysia in January 2020 but only started to significantly spread in March after the country hosted a large international religious gathering. The government response to the outbreak was effective, resulting in a high recovery rate of the afflicted. This response included the enactment of a “Movement Control Order” (MCO), which saw gradually increasing restrictions on public movement, leading ultimately to a lockdown. The MCO has been a cause of psychological unrest in the population due to social isolation, financial stress, and the limitations placed on cultural practices. This increase in psychological unrest has manifested quantifiably, specifically in the observed 57% spike of domestic violence following the enforcement of the MCO. The initiatives that were implemented to curb the public decline in mental health included a hotline offering psychological first aid, which saw reasonable success. However, it is suspected that a large proportion of those suffering from mental health issues is not coming forward to use the available services due to the prevalent mental health stigma in the country. On May 1, the MCO was drastically relaxed, and public movement was again allowed despite a considerable number of new infections being reported daily. This, in turn, inspired more psychological anxiety in the population, and it is speculated that the feelings of unease and uncertainty due to the coronavirus outbreak and resulting MCO will carry forward into the following months.
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Reflections on the Psychosocial Impact of COVID-19 in Latin American Countries p. 142
Renato D Alarcón, Johann Vega-Dienstmaier
DOI:10.4103/WSP.WSP_41_20  
The Latin American subcontinent, with more than 600 million inhabitants, is facing different periods of the COVID-19 pandemic, with a spectrum of social responses to the virus aggression and the governments' actions in the crisis. A rapid review of these realities in various countries includes more or less effective measures in Argentina or Colombia, uneven (and unexpected) responses to seemingly adequate management decisions in Peru, and chaotic evolution in countries that ignored the risks, such as Brazil. The economic cost of the pandemic will be large and, together with internal migration phenomena, modulatory impact of governmental decisions, breakouts of social rebelliousness, role of religious practices, risky habit transformations, and negative behavioral changes, and a variety of physical and mental health challenges as part of a “new normality”, constitute important future sociopsychological and psychiatric research topics in the subcontinent.
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A USA Perspective on the COVID-19 Pandemic p. 145
Renato D Alarcón, Dante Durand
DOI:10.4103/WSP.WSP_40_20  
The significant sociopolitical and economic position of the USA in the global scene makes the occurrence, management, and impact of the COVID-19 pandemic in the country, a relevant study topic. This brief analysis follows the reactions of the American public and the country's political body about the different aspects of the pandemic from an alarming, ambivalent, and confusing initial perspective to a variety of psychosocial responses in the course of the crisis. Negative phenomena have been observed: anger reaching xenophobic features, contradictions between health researchers and authorities versus politicians, criticisms, stigmatization, and discriminatory behaviors against minority subpopulations. On the positive side, accentuation of solidarity, gratitude to frontline health-care workers and professionals (the journey's “heroes,”) abundant information, religious strength, etc., can be counted. The world society's future will be undoubtedly different.
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PERSPECTIVE/VIEWPOINT - SPECIAL POPULATIONS Top

Growing up in a Pandemic: Biomedical and Psychosocial Impacts of the COVID-19 Crisis on Children and Families Highly accessed article p. 148
Vincenzo Di Nicola, Nadia Daly
DOI:10.4103/WSP.WSP_52_20  
The COVID-19 pandemic creates a cascade of social and mental health consequences for children, adolescents, and their families. After reviewing the known pediatric and epidemiological data on children, we discuss key features of children's mental health in response to this crisis, their specific needs, and the impacts of social distancing, confinement, and adverse childhood events. While acknowledging potential long-term consequences in this psychosocially vulnerable population, we also caution health and social care workers against pathologizing normal reactions to an abnormal global crisis.
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The Elderly: “Age in the Time and Aftermath of Corona.” Some Personal Reflections and a Plea p. 152
Wolfgang Rutz
DOI:10.4103/WSP.WSP_30_20  
The situation and societal positioning of the elderly are specifically affected during the ongoing Covid-19 pandemic situation related to down regulations of social contact within societies, families, and next of kin. This is related to the elderly's specific demand to social contact and respect for their identity but also their specific sensitivity to matters of helplessness, self-determination as well as identity and dignity. In addition, people of higher age are often getting increasingly diverse in personality traits, interests, and functional capacity, demanding individual person-centered respects to their needs. In Europe, different attitudes are brought forward when it comes to treating and respecting elderly people, from gerontocracy attitudes of high appreciation to tendencies to see the elderly as a burden in the society. These differences are often illustrated by, for example, reported figures of completed suicides in this risk population. According to this, even the structural societal responses to, for example, health problems and existential needs of the elderly might decisively be influenced by these attitudes. Sweden had one of the highest Covid-19-related morbidity and mortality figures in the older population. In the article, this unacceptable situation is elaborated on, as well as the needs of paying person-centered attribute to the elderly's specific needs and capacities in analysis, resilience, and sustainable long-term approaches. In general, this seems decisive to formulate a plea to cope with the risk for future societal and global challenges lying ahead of us – future viral and digital pandemics, migration waves, and climatic as well as social “tsunamis”. Here, the elderly persons need to be given a significant role to contribute to the necessary solutions.
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ADVOCACY/DEBATE Top

Should the 2020s be the Psychiatric Decade of the Social? A Debate p. 156
H Steven Moffic
DOI:10.4103/WSP.WSP_12_20  
Although the biopsychosocial has been the primary model in medicine and psychiatry for decades, there has been increasing concern over whether it is comprehensive enough and/or whether each of the categories get enough attention. For example, the bio, standing for the biological, has received the most attention in the new millenium in most countries. However, the relative neglect of the social component may be causing significant omissions of understanding and interventions in providing mental health care for patients and the public. Most recently, that has become clear in the global coronavirus pandemic in its social spread, contagion of fear, escalation of various psychiatric problems, and disparities in receiving care. Indeed, this journal is a crucial globally social way to communicate to our colleagues and reverse this trend.
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CASE SERIES Top

COVID-19, Social Distancing: Mental Health Implications for Children, Adolescents, and Families – Pediatric and Psychiatric Perspectives p. 159
Shobha Chottera, April M Douglass-Bright, Karim Sedky, Rama Rao Gogineni, Anthony L Rostain
DOI:10.4103/WSP.WSP_55_20  
COVID-19 is creating a mental health crisis among children and youth around the globe. At the time of this writing, more than 1.5 billion, i.e., 91% of the world's students are out of school. The pandemic is raising fears, and causing clinginess, distraction, irritability, anxiety, depression, lethargy, impaired social interaction, and reduced appetite. Adolescents are at higher risk for depression, anxiety, distress, low self-esteem, substance use disorder, and suicide. Mental health consequences of the pandemic can be categorized as adjustment disorders, reactions to social isolation, reactions to family and family events, violence against women and children, and intensification of preexisting mental health conditions. Major challenges are being experienced by those struggling with attention-deficit hyperactivity disorder, autistic spectrum disorders, medical complications, posttraumatic stress disorder, and other conditions. After a short description of each category, we provide case examples, which, though fictitious, bear sufficient resemblance to real-life situations encountered in our daily practice to serve as useful vignettes. The mental health community, social psychiatrists and pediatricians, and other health-care providers should take an active role to address these serious issues.
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REFLECTIONS Top

Organizing Mental Health and Psychosocial Support Services for COVID-19 at a Tertiary Care Center in India p. 163
Rakesh Kumar Chadda
DOI:10.4103/WSP.WSP_23_20  
Coronavirus disease 2019 (COVID-19) pandemic is associated with mental health consequences in patients diagnosed as having the disease, their contacts, healthcare workers, and also in the general community because of fear of getting the infection. Organizing mental health services in a big general hospital, especially in the background of diversion of many services including the workforce for pandemic-related services is a big challenge. The paper discusses the personal experience of the author in organizing mental health and psychosocial support services at a tertiary care teaching medical institution in India in the background of the COVID-19 pandemic. The services were targeted at the population visiting the hospital, healthcare workers, persons being quarantined, caregivers of patients with COVID-19 and the community in general. Some guidance notes were also developed for the physicians dealing with persons with COVID-19-related concerns and for psychiatrists in dealing with their patients. The strategy employed has a scope of being used at other similar institutions and also in similar situations arising in the future.
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SHORT COMMUNICATION Top

Coronavirus Disease 2019: The Success Story from Kerala, India p. 167
Roy Abraham Kallivayalil, Arun Enara
DOI:10.4103/WSP.WSP_42_20  
Kerala, a state in the southern part of India, has recently been in the news for its successful handling of the coronavirus disease 2019 pandemic. Here, we briefly share the various factors leading to this success so that these can be learning points for others. The successes of the State's strategies are attributed to a multitude of factors. A firm rooting on evidence-based public health, the high rate of literacy among its population, the investment in universal health care, the unique sociocultural and political fabric, and the strict but humane approach of the bureaucrats and civilians alike are some of the factors that played a key role. It is a reflection of the consistent efforts of the State in diverting significant resources every year toward building public health infrastructure, trusting village-level bodies with autonomy and funds, and promoting shared values that encourage social cooperation. The multidisciplinary teams provided counseling and psychosocial support for people in isolation and quarantine. The focus was also on tackling the stigma surrounding the virus. There are also lessons to be learned from how Kerala treated its migrant population of workers, rechristened as “guest workers.” Thus, a multipronged approach, based on a combination of science and social–humanitarian values, was successful in meeting this challenge.
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LETTERS TO EDITOR Top

The Need for Social Psychiatry Research on the Current COVID-19 Crisis p. 169
Alexander Kaltenboeck
DOI:10.4103/WSP.WSP_34_20  
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Digital Burnout: COVID-19 Lockdown Mediates Excessive Technology Use Stress p. 171
Manoj Kumar Sharma, Nitin Anand, Shikha Ahuja, Pranjali Chakraborty Thakur, Ishita Mondal, Priya Singh, Tavleen Kohli, Sangeetha Venkateshan
DOI:10.4103/WSP.WSP_21_20  
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OBITUARIES Top

In Memoriam: Julio Ernesto Arboleda-Flórez, MD, FRCPC, DABFP, PhD, DFCPA, DFAPA p. 173
Vincenzo Di Nicola
DOI:10.4103/WSP.WSP_35_20  
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In Memoriam: Professor Tsutomu Sakuta (1943–2020) p. 175
Driss Moussaoui, Masafumi Mizuno, Roy Abraham Kallivayalil
DOI:10.4103/WSP.WSP_44_20  
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