The coronavirus disease 2019 (COVID-19) outbreak has raised several concerns regarding its mental health effect on patients with psychiatric disorders and the health-care workforce.1, 2 Worldwide, psychiatrists are navigating a fast, unpredictable tempest, in developing plans to respond to their own mental health needs and those of their country's population.
We are a group of 16 early career psychiatrists connected by the Early Career Psychiatrists Section of the World Psychiatric Association,3 working across different WHO regions in countries (other than China) that have been severely affected by COVID-19. The pandemic led us towards a collective endeavour to share our country-specific experiences, plans, and concerns.
Early career psychiatrists are crucial in the medical response to COVID-19. Although we are ready to provide help to those in need, we are made to count on insufficient access to WHO-standard personal protective equipment and training when trying to safely support others' mental health face-to-face. Furthermore, feelings of uneasiness or ill-preparedness arise when countries start redeploying mental health-care professionals to general medical care for patients with COVID-19 in overwhelmed health-care systems (table and appendix).
Table.
Overview of challenges and opportunities for early career psychiatrists by country
| Telepsychiatry availability | Redeployment | PPE access and training | |
|---|---|---|---|
| Nigeria | Not yet available | Not yet | Access to PPE and training in place |
| USA | Regulations restricting the use of telepsychiatry have been loosened nationwide; wide availability of online conferencing tools | Incipient | Access to PPE and training in place |
| Brazil | Regulations restricting the use of telepsychiatry have been loosened nationwide; used more in the private sector than in the public sector | Not yet | Variable training and access to PPE |
| Colombia | Bureaucratic roadblocks to deployment | Not yet | Access to PPE and training in place |
| Paraguay | Incipient and restricted; telephone hotlines already enabled | Not yet | Poor and variable access to PPE and training |
| Egypt | Telepsychiatry via online conferencing tools; predominant in the private sector | Not yet | Poor training and access to PPE |
| Iran | Online individual and group psychotherapy (including groups for health care professionals); telephone hotlines | Ongoing | Access to PPE and training in place |
| Lebanon | Restricted access | Voluntary | Access to PPE and training in place |
| Tunisia | Incipient telepsychiatry through online conferencing platforms and telephone consultation | Not yet | Poor access to PPE and variable training |
| Italy | More available in the private sector than in the public sector; mainly through telephone hotlines, conferencing tools, and social media | Variable | Variable training and access to PPE |
| Kosovo* | Emergent use of telephone hotlines and online psychotherapy | Voluntary | Poor access to PPE and variable training |
| Portugal | Emergent teleconsultation services for health professionals and patients | Incipient | Access to PPE in place with variable training |
| Spain | Telephone consultation for health professionals and outpatient services | Ongoing | Variable training and access to PPE |
| India | Informal telephone, messaging, and conferencing psycychotherapy for individuals and groups | Likelihood of imminent | Variable training and access to PPE |
| Indonesia | Use of popular online conferencing tools; online psychological first aid | Not yet | Access to PPE in place without training |
| Singapore | Use of online conferencing tools for educational, research, and clinical work; telephone hotlines widely used | Not yet | Access to PPE and training in place |
Information on telepsychiatry, redeployment, and PPE at April 1, 2020. Redeployment=transfer of psychiatrists to other medical duties in the care of patients with COVID-19. PPE=personal protective equipment.
Kosovo is not recognised as a member state by WHO.
Telepsychiatry (ie, providing mental health care remotely, using telecommunications such as telephone or video conferencing tools) in several settings is suddenly being introduced or massively expanded to serve patients with pre-existing disorders, health professionals on the frontline, and the general population, during a time of uncertainty, misinformation, and physical distancing.4 Still, telepsychiatry is scarce in several low-income and middle-income countries, posing challenges for health-care workers and patients where face-to-face care is not safe because of the risk of virus infection. We also perceive that attention given to the public's mental health during the outbreak came late, and overlooked vulnerable populations, such as refugees, people without secure housing, people living in overcrowded spaces, and patients with severe psychiatric disorders.
Apart from disrupting usual mental health care, the COVID-19 pandemic could lead to further psychological trauma. The huge toll such trauma can take on medical professionals, which can include delusional episodes and suicidality, in countries as deeply struck by COVID-19 as Italy is of particular concern. Psychiatric sequelae could be reduced by the early involvement of mental health professionals in drawing up comprehensive public health policies and in supporting the health-care workforce.
Many early career psychiatrists are part of the millennial generation familiar with technology,5 and are channelling this strength to deliver far-reaching telepsychiatry, share online mental health-promotion resources, and connect with colleagues worldwide. Thanks to social media and the internet, international associations of early career psychiatrists are providing educational resources (eg, real-time news, journal clubs, and webinars), and group emotional support for peers. Colleagues in countries with a recent history of humanitarian and public health crises (eg, the epidemics of Zika virus disease in the Americas and Ebola virus disease in Africa), bring their experience of providing mental health care during and after such disasters, and those in countries with an earlier onset of the COVID-19 outbreak share the lessons already learned there. The spontaneity, resilience, and solidarity with which many colleagues have joined forces is inspiring.
Early career psychiatrists are an essential resource in the mental health management of the COVID-19 pandemic and its aftermath. Mental health authorities are called to count upon early career psychiatrists, warranting the training and resources to enable us to safely and effectively work for our patients, colleagues, and communities. We express our gratitude to all early career psychiatrists taking risks to care for their patients, and we invite them to seek peer support and join forces both locally and across the world.
Acknowledgments
We declare no competing interests.
Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
Supplementary Material
References
- 1.Yao H, Chen J-H, Xu Y-F. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020;7:e21. doi: 10.1016/S2215-0366(20)30090-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3 doi: 10.1001/jamanetworkopen.2020.3976. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Pinto da Costa M. Early career psychiatrists—history, 2020 and beyond. World Psychiatry. 2020;19:127–128. doi: 10.1002/wps.20712. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Zhou X, Snoswell CL, Harding LE, et al. The role of telehealth in reducing the mental health burden from COVID-19. Telemed J E Health. 2020 doi: 10.1089/tmj.2020.0068. published online Mar ch 23. [DOI] [PubMed] [Google Scholar]
- 5.Bernstein CA, Bhugra D. Next generation of psychiatrists: what is needed in training? Asian J Psychiatr. 2011;4:88–91. doi: 10.1016/j.ajp.2011.04.004. [DOI] [PubMed] [Google Scholar]
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