The COVID-19 pandemic has swept into over 200 countries with considerable confirmed cases and deaths, and, has caused public panic and mental health stress. In order to deal with psychological problems triggered by COVID-19, National Health Commission of China has released several guidelines to promote psychological assistance and social work services for patients, medical personnel, and general public during the outbreak of COVID-19. As a leading mental health institute and WHO Collaborating Center for Research and Training in Mental Health, we translated some of the guidelines to share our experiences with global colleagues.
Guideline for Psychological Assistance and Social Work Services in Designated Hospitals for COVID-19
1.1 Provide psychological support, humane care and psychological counseling for COVID-19 patients in designated hospitals, meanwhile to conduct psychological crisis intervention and psychiatric diagnosis and treatments for people with psychological problems to help them stabilize their mood, actively cooperate with treatment and enhance confidence in rehabilitation.
1.2 Provide psychological support for people working in designated hospitals including medical staffs, public health workers etc (hereinafter referred to as medical staffs) to cope with pressure and burnout, maintain health, and ensure the ability of fighting against the COVID-19 epidemic.
2.1 Psychological assistance and medical social work services should be integrated into the the epidemic prevention and control work of designated hospitals in order to reduce psychological problems of the epidemic to patients and medical staffs and maintain social stability.
2.2 All designated hospitals shall coordinate with mental health professionals and local medical social workers from all counterpart support areas, formulate a unified service plan, and provide psychological assistance and medical social work services.
2.3 Psychological assistants and medical social workers should cooperate with the medical team in designated hospitals, and do not answer medical-related questions .
2.4 Psychological aid workers and medical social workers should make a commitment to strictly protect the privacy of the recipients.
3.1 Create a comfortable environment conducive to maintenance of mental health.
3.1.1 Adjust the lighting according to the treatment requirements. Hospitals can try to keep the ward lights in acertain circadian rhythm and dim the lights at night.
3.1.2 Assist patients to keep intouch with family and friends via mobile phone or internet and strengthen their confidence to overcome the disease with family and society supports.
3.1.3 Provide online lectures on infectious diseases and health education to the patients with mild symptoms .
3.1.4 Distribute booklets of mental health knowledge according to patients' disease conditions. Provide government-recommended online health education platform. Encourage patients to self-study and help each other, obtain scientific epidemic information andmental health knowledge, carry out self-psychological evaluation and adjustment, and seek online professional help, etc.
3.1.5 Recommend a daily activity schedule for mild patients. Help them to develop an orderly daily activity plan,and establish a regular routine in an unfamiliar environment.
3.2 Deliver psychological assistance and crisis intervention to patients.
3.2.1 Identify patients who is inneed of psychological assistance and help them with self-adjustment.Participate in medical care shifts and ward rounds to identify patients who need psychological assistance and help them adopt psychological assessment, and develop specific plans based on the patient's mental status. If necessary, perform rapid psychological interventions and help patients do self-adjustment such as relaxation training.
3.2.2 Identify patients with psychosocial problems, provide crisis intervention and psychiatric medication.
Organize psychiatric consultation in time for patients with emotional agitation, difficulty in treatment and management, and mentaland behavioral problems, such as delirium, impulse, anxiety, depression and suicidal tendency. Provide crisis intervention and psychiatric drug treatment, mainly symptomatic treatment, rapid relief of symptoms, pay attention to the drug interactions between the patient's physical condition and psychiatric treatment.
3.2.3 Keep the files of patients with psychological assistance.
For discharged patients who need continuous psychological assistance or psychiatric drug intervention, the information handled by the psychiatric department should be recorded in medical documents and referred to the corresponding isolation places, so as to continueto provide psychological assistance and social work services, to avoid extreme events.
3.3 Provide psychological support and crisis intervention for medical staffs.
3.3.1 Meet the actual needs ofmedical staffs in time and make appropriate suggestions about physical and mental health,including:
(1) Join the WeChat groups with front-line medical workers,be familiar with front-line staffs, find out those in need of psychologicalassistance in time, and provide individual psychological support.
(2) Make a reasonable shifting schedule according to the situation. Plan ahead, so that everyone has a full psychological expectation oftheir own work.
(3) Use workgroups to encourage more connections and supports among colleagues.
(4) Notice the worries of the front-line medical staffin time. If there are some difficulties in the families of the front-linemedical staff identified, it is necessary to report to the coordination management staff in order to solve the family difficulties and make the medical staffs feel at ease to work.
(5) Provide self-mental-health-care skills for front-line medical staffs, take the initiative to help medical staff reduce psychological stress, and improve their psychological adjustment ability.
3.3.2 Provide psychological supportand psychological crisis intervention for medical staff. Including:
(1) in the medical staff rest area, set up a spiritual post station, including two rooms. A room contains some snacks, beverages, books or brochures, and is equipped with TV or computer playback equipment to play audios and videos, such as relaxation training audio, instructions on how to do self-relaxing, how to use the relevant psychological network platforms and so on. Designated hospitals can also be equipped with some relaxation equipment, such as biological feedback device, music therapy chair and so on. Pay attention to limit the number of people who can operate at the same time at the mind station, and keep physical distance at least 1 meter. The other room can have a certain degree of privacy and is used for one-on-one psychological assessment and intervention,which is recommended for no more than 10 minutes at a time. Pay attention to the safety and comfort of the hardware facilities in the room. The hospital-based psychological broadcasts can be well utilized throughout the hospitals to increase the sense of security of medical staff and the sense of being caredfor. The online psychological broadcasts can also be used to carry out work. Do a good job of disinfecting the soul post station in accordance with the regulations.
(2) Make videos or reading materials on psychological assistance for typical problems, such as poor communication after wearing PPE, patients' not cooperating with treatment, fear of infection, sense of healthcare exhaustion, guilt and even self-worth and professional negation. After the videos or text materials are made, they can be distributed by WeChat or other possible channels to the medical group, and can be broadcasted in the hospitals.
(3) If there are mental and psychological symptoms that persist and cannot be alleviated, which affect daily work, one-to-one psychological crisis intervention can be carried out or be transferred to otherpositions with less pressure. Indeed, psychiatric treatment should be provided if necessary.
(4) Given the condition, group support activities such as group psychological counseling and Balint group work can be carried out in the medical staff accommodation area or rest area.
(5) One-to-one psychological assessment and psychological crisis intervention should be carried out for medical personnel whose relative has recently died or in a serious condition.
Organization and implementation
4.1 Make every effort to organize and manage psychological assistance and medical social work services.
Designated hospitals are responsible for the organization and leadership of in-hospital psychological assistance and medical social work services, incorporate it into epidemic prevention and control work for unified management and establish a psychological assistance and medical social work service group including counterpart support mental health professionals and in-hospital medical social workers equipped with commonly used psychiatric drugs and guaranteed with necessary supplies and workplaces.
4.2 Establish working mechanism with overall planning and coordination, a clear division of labor and everyone is responsible for their own tasks.
Designated hospitals should appoint special personnel to coordinate psychological assistance and medical socialwork services in the hospital. The work of mental health professionals should be integrated into daily medical work, participate in regular medical work meetings and daily shifts, provide psychotherapy services for patients, andprovide crisis intervention and psychiatric diagnosis and treatment services for people with psychological crisis. Medical social workers provide social work services for patients and their families through "online" psychological counseling, emotional support and "offline" social resource chain connection, security support and other methods. If they find serious psychological or mental behavior problems, refer them to mental health professionals in a timely manner.
4.3 Train medical staffs to assist in delivering psychological services.
The psychological assistance and medical social work service group provides training to medical staffs, enable them to observe patients' emotions, identify psychological issues, use simple psychological support techniques, refer to the patient to mental health professionals in time, and report on key patients during work meetings and handovers.
(The English version is translated by Peking University Sixth Hospital/Institute of Mental Health. If you have any questions, please refer to the original version in Chinese issued by the National Health Commission of China.)