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Table 2 Recommendations relevant to service providers and other stakeholders by available resources during the pandemic

From: Roadmap to strengthen global mental health systems to tackle the impact of the COVID-19 pandemic

Recommendations relevant service providers and other stakeholders Low resource settings with few mental health resources and infrastructure Medium resource settings with some mental health resources and infrastructure
(includes recommendations in addition to those in low resource settings)
High resource settings with good mental health resources and infrastructure
(includes recommendations in addition to those in low and medium resource settings)
Develop or strengthen equitable, accessible and appropriate community-based mental health services and clinic-based services for those needed special care *Enable communities to identify common mental disorders and severe mental disorders; develop routine mechanisms to collect such data during the pandemic
*Make care provision inclusive especially for those most affected such as migrants, women, elderly populations, children and adolescents, who may be affected more during this pandemic
*Connect community, primary, secondary and tertiary care systems using innovative care models that are accessible and equitable; secondary and tertiary level should be able to provide care to those with more severe mental health problems
*Telemedicine using integrated health information systems is actively pursued to ensure remote monitoring and followup.
*Robust supply chains are in place to ensure availability of all psychotropic medications listed on a countries’ Essential Drugs List; this becomes more important during the pandemic as accessibility and movement is restricted thus compromising ability to purchase medicines from private pharmacies which may be few especially in rural communities
The care model centres around protection of human rights
*Upgrade the primary and secondary health system to manage mental health problems; have provisions for basic counselling at primary level; enhance community-based services to support those needing support for daily living such as groceries, laundry, etc.
*Address specific needs of populations who may be particularly affected such as women facing domestic violence, children or adolescents facing abuse, individuals at high risk of suicide or self-harm, those with substance use disorders, elderly with dementia
*Secondary care level has the capacity to manage complicated cases with multimorbidity which would be more common among those infected with COVID19, only the more severe cases are referred to tertiary level; electronic medical records systems are enabled for appropriate follow-up
*The health information system allows patients to routinely track symptoms and link them to the medical records so that health care providers can track them easily and prioritize followup
Specific programmes for those needing institutional care or elderly support are not compromised
* Integrate mental health services within care for COVID infection at each level
*Health information systems are linked across different health conditions so that health providers can easily track multiple conditions and the patient can tack their health too
Support is available for carers of persons with mental illnesses
Care for special population such as elderly, child and adolescents are ensured
Multiple medication options are available with clinicians to treat complicated cases
Health system has the capacity to reach out to low or medium resource settings and enhance their capacities to provide human rights centred care
Train adequate primary care staff to cater to the increased mental health needs at the community level *Awareness is provided about stigma related to mental disorders using multimedia strategies, with a specific focus on the increased risk of stigma associated with COVID infection
*Train primary health workers on mhGAP and especially focus on the modules of depression, emotional stress, alcohol use disorders, suicide risk; primary care doctors should be able to identify psychotic symptoms and manage common mental disorders efficiently; fear or anxiety related to infection and death and bereavement should be managed through basic counselling skills
*Psychological therapies are more advanced than basic counselling to manage mental health issues related to COVID infection and overcoming death of loved ones
Primary health workers are trained on the full mhGAP and manage most cases as per guidelines; linkages with mental health professionals should be enabled using e-health or m-health platforms
Community based programmes to raise awareness about mental health and reduce stigma are implemented by health staff and other stakeholders
*Stigma campaigns are tailored to specific communities such as young or old, jobless, men or women, schools, workplace; campaigns should specifically address stigma associated with COVID infection
Primary care staff supported by paramedical staff including ambulance services can identify and care for most mental disorders outlined under mhGAP; support from trained mental health professionals are sought as needed
Implement mental health promotion and prevention programmes *Evidence-based and preferably culturally relevant prevention and promotion programmes to reduce stigma, raise awareness about common mental disorders and need for addressing mental health needs arising out of the COVID crisis are implemented across different settings to the extent feasible
* Even if the programmes are basic in structure they should be implemented as widely as possible, and all health promotion activities are based on sound behaviour science principles; programmes are integrated as much possible within other programmes addressing COVID infections
Government backed pan-regional programmes with support from local non-governmental partners are implemented
*Culturally relevant programmes addressing stigma for special populations such as health workers, child and adolescents, women are developed and implemented
Non-governmental organizations partner with government agencies to implement programmes in different settings and population groups
Programmes are developed for special settings like factories, prisons, schools that need different implementation pathways
*Mental health needs of special populations such as elderly, prisoners, women, LGBTQIA communities, institutionalized communities, poor and marginalized migrant workers, refugees, etc., are specifically tailored and include measures on how to address specific issues of COVID 19 related mental illness
Suitable programmes are available for families and carers of persons with mental illnesses
Strengthen civil societies *Civil societies identify key areas where they can contribute and pitch into support the overall government plan to manage mental health problems during the COVID pandemic
*Civil societies involved in mental health service delivery or research or advocacy are identified and integrated within a government database; especially those with the ability to support multiple health conditions including mental health should would be beneficial
The databases of civil societies allow the administrators to identify strengths of each organization, its reach, focus, and key resource person(s)
Government plans their mental health alleviation programmes keeping civil societies in the loop and takes their opinions
Government allocates ring-fenced funds to support activities undertaken by civil societies where it by itself cannot function effectively, be it research, program implementation, or advocacy
*A registry of civil societies is advanced enough to allow for an easy two-way communication between them and the government
*Appropriate funds to support civil societies led programmes are present and those are planned in consultation with the government
Civil societies per se can access resources and roll out programmes as per their strengths while keeping the overall focus on managing the impact of the pandemic
The collaborations between civil societies and government is streamlined; the government provides oversight to local and regional programmes that are essentially implemented by civil societies
*Civil societies and government are equal partners in delivering care or conducting research during this pandemic
*Civil societies working at national, regional or local levels are adequately funded to support not only their own activities but support government efforts to overcome the COVID pandemic
Enable employers to manage stress at workplace *Suitable communication packages are present to engage with employers to discuss workplace stress, COVID related mental health issues, stigma
*Initiate a dialogue with different employer’s associations to understand specific challenges related to COVID and how they can affect mental health
*Specific interactions with employers in health care sectors, police, civil administrations who are at the forefront of managing the crisis are initiated; programmes are in place to address fear and anxiety related to being infected or death of loved ones
*Labour laws are revisited or redrafted to ensure employee welfare during this pandemic
*Interaction with employer’s associations are better integrated and builds on existing models of such interactions with specific focus on managing the pandemic *Specific programmes are developed to support needs of niche employers who are at the forefront of managing the COVID crisis, and these need to be tailored to local needs
Welfare programmes for employers focused on reducing stress are in place and the staff are actively engaged in those; employers also help the programmes to grow organically through their active inputs
  1. *Recommendations that are particularly relevant for managing mental health issues during COVID infection