There is no strict regulatory authority to check the quality of telepsychiatry services and whether ethical standards are maintained at the only psychiatric disease hospital in Kashmir
The number of confirmed cases of Covid-19 in India has transcended around to over 2,214,137 including 44,466 deaths reported by World Health Organisation (WHO). The numbers appear to be continuously increasing throughout the world.
The infected cases in Jammu and Kashmir stand around over 24,390 and 459 deaths. In the wake of this global health crisis, stringent public health measures have been implemented to curtail the spread of virus. There is strong evidence that Covid-19 affects not only physical health but mental health and well-being as well.
Unfortunately, the disproportionate focus of global attention has been on infected patients and frontline respondents, ignoring other vulnerable sections of society.
The pandemic affects everyone but the effect could be greater on certain groups as is normally the case where pre-existing health disparities and social isolation and stigma are linked to chronic conditions such as schizophrenia or depression or general mental illnesses.
People with mental health problems are typically more vulnerable to infection due to several factors such as cognitive disability, poor risk perception, and decreased personal safety measures in patients as well as confined conditions in psychiatric wards.
People with mental illness are also grappling with poverty, access to education, jobs, and social relations, especially if their illness affects communication and relational skills in a highly disabled way.
Thus, it may well be expected that a pandemic will affect them even more than patients without psychiatric conditions. With this unexpected epidemic, the global health system faces a significant problem, with a potentially detrimental effect on mental health services.
The available healthcare infrastructure and manpower to provide mental health care services to patients are already inadequate, with only psychiatric disease hospital (IMHANS), in Kashmir. While there is less workforce for intensive care and medical care itself, there is a staggering shortage of mental health workers.
Our country needs about 15,000–17,000 psychiatrists to achieve an optimum ratio of 1:6000 to 1:8000 psychiatrists to the population, reported by the Indian Union Ministry of Health and Family Welfare.
The current situation with only 6000 psychiatrists (one psychiatrist for more than 1,25 lakh people) is appallingly bad. Due to potential infection of health workers with a need for self-quarantine, staff numbers of mental health workers could further decline, which will also impact serious psychiatric patients who require urgent treatment.
People with mental disorders experience barriers in assessing timely health services during a pandemic atmosphere because of discrimination associated with mental illness in health-care settings. Besides, curtailing transportation during lockdown also makes it difficult for psychiatric parents to reach hospitals in the event of an emergency.
A parallel pandemic of fear, anxiety, and depression is caused by Covid-19. Patients suffering from mental illness are often at home alone as their families work through the day. This lifestyle has changed because caregivers and the patient have to remain locked in together because of the imposed lockdowns and many patients will become irritable and frustrated due to lack of mobility and independence.
These people are already prone to depression and anxiety, they may get further affected by the emotional reactions triggered by the Covid-19 outbreak, contributing to relapses or deterioration of an existing mental health disorder due to high susceptibility to stress compared to the general population.
Furthermore, mental health care providers could be burnout, as they might be deployed to care for Covid-19 patients. Rightfully, the focus of health services has primarily been placed on Covid-19. However, we need to ensure that psychiatric services are not ignored in the current pandemic. IMHANS Srinagar has recently started telepsychiatry services providing free mental health services during the Covid-19 pandemic.
Although the services are available, there is no strict regulatory authority to check the quality of such services and whether ethical standards are maintained. Professionals providing telepsychiatry services must be well qualified to do the same.
Another problem is the judicious use of telepsychiatry, its management, and the right understanding of when to refer the patient to a hospital remains a challenge. Psychiatric patients in the Covid-19 pandemic should be considered an extremely vulnerable population.
Consequently, incorporating psychiatric care and mental healthcare in general into the response to Covid-19 must, therefore, be considered a significant public health imperative; any official response to a pandemic such as Covid-19 without a psychiatric aspect will breach the primary duty of a government to ensure the health and safety of society.
Author is a Research Scholar, Department of Psychology, University of Kashmir