In your experience, what has been the effect on the mental health of the general population (or the people you are treating if a clinician), and of health care and other sector workers delivering care (including you)?
I am Dr Lee Sze Chet, a psychiatrist at a mental institution, Hospital Mesra Bukit Padang, in Kota Kinabalu, Sabah. During Covid-19, the Malaysia government had implemented the Movement Control Order to prevent the further transmissions of disease.
The 2020 Malaysia Movement Control Order (MCO) refers to a cordon sanitaire implemented as a preventive measure of the federal government of Malaysia on 18 March 2020, thus a “movement control” was implemented throughout the country.
The incident is commonly referred by some local and international media as a “Malaysia partial lockdown” or “Malaysia lockdown” that implemented a general prohibition of mass movements and gatherings across the country, including religious, sports, social and cultural activities.
During the order, police officers and Malaysia’s military forces conducted roadblocks throughout the nation to ensure and warn Malaysians to stay home and abide by the order. The national government designated that all businesses, such as supermarkets and restaurants, including food delivery services, operated from 8am to 8pm, a person must not be accompanied by other people during travel, a 10km travel radius for all travelers, and a ban on all types of gatherings. People who travel for medical purposes are exempted from the no-companion rule and the travel radius.
The outbreak of Covid-19 in Sabah caused feelings of stress and fear, which may cause anxiety, sleep disturbances, and physical symptoms such as dizziness or headache. Stress has been affecting all levels of society, from children, adolescents, and adults to senior citizens. Once the Movement Control Order started, some of the staff and the public started to become panicky, anxious, and developed panic attacks.
Our regular patients at Hospital Mesra Bukit Padang from other districts were facing difficulties to come to our hospital to seek treatment and medications.
What are the challenges you are experiencing with regards to delivering mental health care?
There are a few challenges we are facing in delivering mental health care. Because of the Movement Control Order and current situation in Malaysia from 18 March 2020 onwards, which does not allow traditional psychological support, we launched virtual psychological support and helpline support.
What are the innovative activities you and others are conducting to address mental health needs and to provide support during the outbreak?
In Sabah, the Land Below The Wind in Malaysia, my team members and I started a virtual psychological support initiative via Facebook Hospital Mesra Bukit Padang. We provide psychoeducation, mental health promotion. The team members consist of psychiatrists, clinical psychologists, paramedics, medical staff, and therapists who are deeply concerned with the psychological and mental health of the local community.
There will be two forms of psychological support: one traditional helpline via a telephone line that operates daily from 8am to 5pm.
To reach out to the public, we started to provide virtual psychological support via Facebook Page Messenger. The team members can provide psychological support to the public via text. This includes compassionate listening and linking the public to an appropriate resource if needed.
Deep breathing exercise, progressive muscle relaxation technique videos, and DASS-21 screening are also provided via links provided in the chatroom. Each conversation is private and peer supervision among team members was conducted to maintain ethical boundaries.
We launched the virtual mental health and psychosocial support on the first day of the Movement Control Order in Malaysia on 18 March 2020. We started with a video of our Hospital Director’s speech, Dr Ahmad Qabil bin Khalib consultant psychiatrist, and posted it on our Facebook page. This video received positive responses from the public and created awareness on mental health support during this pandemic.
At the same time, team members created multilingual positive quotes and relaxation posters to help multi-racial communities in Malaysia.
Besides, we also have an inhouse operation room that provides a helpline to the public daily from 8am to 5pm. The team members would also provide resource links and contact confirmed positive cases, patients under investigation or patients under surveillance to provide psychological support.
Our mental institution also went to the state laboratory department to provide psychological first aid to our laboratory staff who have been running the tests daily for hospitals. We found that the laboratory health staffs were experiencing fatigue and stressful moments, similar to frontline health care providers. They were unseen heroes helping doctors and nurses in diagnosing patients with Covid-19.
What are you currently doing to continue running your mental health services for people with pre-existing mental health conditions or psychosocial disabilities?
For Hospital Mesra Bukit Padang, we are all trying to continue to run our mental health services for people with pre-existing mental health conditions or psychosocial disabilities. We are aware of the roadblocks and patients’ logistic issues.
The infection control unit in the hospital started to implement screening for each person before entering the hospital compound. This could be done via a drive-through manner, e.g one driving his or her car stopped at the pit stop area to examine his or her body temperature.
The on-duty triage health care provider with personal protective equipment checks everyone’s temperature. If one presented with fever and history of recent travel or contact, he or she will be examined in the designated area by health care providers with protective personal equipment.
We started our social distancing in our outpatient clinic. For example, chairs in the waiting area were labeled to maintain social distancing boundary.
We also started our phone consultation on 16 March 2020 to prevent the disruption of services. Doctors and paramedics performed the phone consultation and, together with pharmacists, arranged and posted out the psychotropic medications to a nearer district hospital or health care centre. Patients or family members may choose the nearer hospitals or health centres to collect medications.
What are the recommendations you would like to provide to other mental health and social care providers during Covid-19 outbreak?
The recommendations that I would like to provide to other mental health and social care providers during Covid-19 are:
- Be proactive and especially the groups that we seldom see, e.g laboratory personnel, cleaners, drivers.
- Earlier action and any form of psychological support will be useful for this pandemic.
- The people are worried, anxious about the outbreak.
- Social media is good tool to be fully utilised for psychological support.
- It is vital to ‘look’ via a Facebook status, Twitter, Instagram to find health workers needed for psychological support. It could be an informal or formal form of support. May just check on them by dropping: Hi, how are you?
- Facebook, Zoom, Telegram may be good tools to psycho-educate the public on their normal psychological reactions.
- For administrators, be transparent to health care workers and your subordinates.
- For those with fears of going home because of fears that they will bring the virus home, turn the working office as your temporary home for this difficult period to ensure adequate rest and to create a sense of security.
- Compassionate listening in this outbreak is useful.
- Woebot, a free self-help Playstore app is useful for those not keen to seek formal psychological support.
- We are all new to this pandemic, but we are learning and improving. Together, we will win this war.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.