Correspondence Address:
N A Uvais
Department of Psychiatry, Iqraa International Hospital and Research Centre, Kozhikode, Kerala
India

Full Text



To the Editor,

The Coronavirus Disease 2019 (COVID-19), a pandemic that emerged in Wuhan, China, has infected >500,000 globally, with most cases currently in the United States. While writing this letter, the total number of COVID-19 infections in India inched closer to the 6000-mark and the country entered day 16 of the 3-week lockdown. Both the pandemic and the lockdown has affected everyone, but its effects on the marginalized populations, especially people with mental illness has been disproportionately severe in India.

A recent survey revealed that there are 197.3 million people living with mental health disorders in India, and the treatment gap of any mental health disorder in India was as high as 83%.[1],[2] Moreover, stigma, discrimination, and unequal access to care still exist in most of the rural parts of the country. Apart from the general concerns such as the higher risk of infections and the potential risk of exacerbation of the primary psychiatric disorder due to the fear associated with the COVID-19 pandemic, the lockdown posed additional risk of difficulty in accessing treating doctor and routine medications to this population.[3] Most of the government and private psychiatry outpatient services were closed to reduce the spread of the infection. Considering the need of our patients, our hospital continued outpatient psychiatry clinics and consulted patients after screening them properly and taking adequate precautions. However, most of our patients could not reach the hospital and they were advised over the telephone during the initial part. Later, government-issued permission to establish teleconsultation services and few patients are being consulted through audio and video consultations. However, many of our patients with severe mental illness could not access care due to the travel restrictions and difficulties in using telepsychiatric services due to severe cognitive and social dysfunction. Moreover, patients found it difficult to get psychotropic medications from medical shops in rural areas due to unavailability. Our local experience made us aware that hospital psychiatry units based in urban areas cannot provide effective mental health care during an extended period of lockdown, even with an established telepsychiatry unit. However, the community psychiatry units, with which we are associated, could provide better mental healthcare during this period. This clinics are run by the local palliative care organizations and provide multidisciplinary services to patients with severe mental illnesses and their families through professionals and community volunteers. These clinics accept adult patients with poor financial resources and provide regular medical and rehabilitative services free of cost. Even with travel restrictions, most of the patients or their caregivers could reach the local community psychiatry clinics as the clinics are located near their home, and received their regular medications. Those patients with exacerbation of their symptoms were consulted by treating psychiatrists over the telephone and prescribed accordingly. Moreover, community volunteers and clinic staff also helped to deliver regular medications to those patients who could not reach the clinic by doing home visits. The effectiveness of mental health-care delivery through community psychiatry clinics with the help of community volunteers during the COVID-19 pandemic highlights the importance of community initiatives in psychiatry, and policymakers should support such initiatives in a post-COVID-19 world.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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