The World Health Organization’s press release on March 2 acknowledged that COVID-19 led to a 25 percent increase in prevalence of anxiety and depression worldwide. This alarming statistic is felt tangibly in Hong Kong, which is undergoing information confusion, panic and loneliness, among those who are isolating in a hospital, community isolation facilities, residential care homes, and now increasingly within homes.
It is also apparent that COVID-19 isolation arrangements have had unfavorable psychiatric effects on its residents. After reports of the poor living quality at the Penny’s Bay center were raised, suicide attempts at the Penny’s Bay isolation facility made the headlines. Not only is the provision of tangible needs in the facility inadequate, but there is little care for the mental health of residents.
After complaints about the Penny’s Bay isolation center living arrangements by legislators, the Civil Aid Service stepped up its services with additional communication channels such as a hotline, SMS and email. While residents can reach out to management with inquiries through these means, there are no psychosocial needs assessments and robust outreach services to at-risk groups.
Hong Kong should assess one’s fitness to be placed in an isolation facility given that now and in the near future, cases will continue to overwhelm the supply of isolation facilities
Reference should be made to the Chinese mainland’s practice, where psychological support is a core component of their anti-pandemic strategy. As early as Jan 27, 2020, the National Health Commission passed a principle to address the increased stress faced by patients, health professionals and the general public, those in isolation facilities, in hospitals and in homes. The policy called for experts in academic societies and national associations to create intervention guidelines and coordinate with health departments to station psychological professionals in hospitals for service, as well as provide psychoeducation and online mental health services to the public.
In addition, in Hong Kong, the screening of psychosocial health risks prior to admission is neglected. Such screening is important especially for people with disabilities and neuropsychiatric history, as well as for those with long-term physical illnesses, for whom their inability to access medication and their reduced help to manage health symptoms due to isolation can be distressing.
More preemptively, Hong Kong should assess one’s fitness to be placed in an isolation facility given that now and in the near future, cases will continue to overwhelm the supply of isolation facilities. For instance, prior to making isolation arrangements, the Ministry of Civil Affairs of the People’s Republic of China has instructed cities to proactively identify and report to authorities any “special groups” that include foster, “left-behind” children and the elderly, and people with disabilities among people placed under home quarantine. Tailored medical and meal support, as well as socioemotional check-ins, were offered to their homes.
Therefore, prior to deciding whether one is fit to be admitted, the mental health service needs of people should be considered. On the upcoming online self-reporting form for allocating isolation facilities, for instance, questions on conditions that make admission undesirable should include psychiatric and physical long-term care needs, and if those needs are present, the home isolation option should be a priority and tele-support be made available.
In addition, when people are admitted to the facilities, the identification of mental health and social needs must be done through clinical instruments. Outreach calls should be directed toward higher-risk groups in the facility to prevent mental health crises. Psychological professionals must be stationed on-site to provide crisis intervention.
Also, mental health support should be arranged for those who are in the community waiting for the isolation facilities. Even in a lesser-developed area of the Inner Mongolia autonomous region, the government of the Hohhot Municipality deployed mental health workers to help not only those in quarantine and isolation. Residents fill out a voluntary psychological screening questionnaire to enable health workers to assess and screen for psychiatric symptoms, such as anxiety and insomnia. For those with psychiatric history who are presenting with psychiatric needs, they will provide teleconsultation as well as medication.
However, professionals aren’t the only source of help — lay people should be deployed. In the UK, the NHS recruited volunteers to serve in various tailored programs for people in self-isolation and people with vulnerabilities, including cognitive impairment, all without necessitating medical or psychological training. For example, the Check-in and Chat Support or Plus Support volunteers provide telephone support to individuals who are at risk of loneliness as a consequence of self-isolation that can extend up to four weeks, with three calls per week. Community Support volunteers provide a collection of shopping, medication or other essential supplies to the doorsteps. Volunteers respond to inquiries and service requests in a mobile application wherever they are.
Therefore, the special administrative region government should develop targeted opportunities for members of society to fill in the gaps, such as working with NGOs that already provide mental health hotline support such as the Samaritans and the Richmond Fellowship’s Justone hotline. Volunteers can help expand the accessibility of hotline support. Not only retirees, but medical, allied health and social-work students who are unable to fulfill clinical hours could use this as a clinical opportunity. A referral mechanism can be designed so that volunteers can refer cases to family services and other community mental health services if more follow-up is needed.
We cannot speak about safety without emotional safety. The massive numbers of isolation facilities to be made available predicts the number of people who will be isolated in the hands of the administration. As stress levels and the prevalence of anxiety and depressive symptoms has greatly increased during the outbreak and will continue to rise, the government must come up with a mental well-being and crisis plan, which includes making isolation arrangements tailored to individuals’ mental health risks, and mobilizing not only mental health professionals, but eager volunteers to help.
The author is a member of the Legislative Council.
The views do not necessarily reflect those of China Daily.