Integral Care for Better Mental HealthBy Rodrigo Brugada | Wed, 07/14/2021 - 15:43
Q: What have you observed regarding the decline of mental health during the pandemic?
A: Mental health teams were able to react more quickly during the pandemic because psychiatrists could easily transition to teleconsultation. We had to react quickly to address events that required the intervention of mental health experts, which led to the implementation of lines for psychological support, first aid and crisis intervention.
At the start of the pandemic, there were acute stress events, sleep disturbances and anxiety crises. Now, WHO is expecting a "fourth wave," which will cause mental health issues. During the pandemic, we have seen people with post-traumatic stress disorder, pathological grief and depression. We also saw worse outcomes for children with ADHD in virtual schools and for elderly people with dementia living in confinement and having no follow-up. Regarding addictions, almost 35 percent of the population increased their substance use. Domestic violence also increased significantly.
We have been slowly returning to face-to-face and hybrid attention but teleconsultation is now prevalent. Teleconsultations have made it possible to cover more ground and more people.
Q: How have you handled acute crises during the course of the pandemic and how was that impacted by mobility restrictions and patients’ fear of contagion?
A: Fear amid the pandemic and the restrictions imposed by the government were predominant during the first months of the pandemic and compelled an increase in teleconsultation services. Healthcare professionals adapted by using free platforms.
We have been working with multiple agencies, including national and international agencies and universities, to manage acute crises. We have been providing psychoeducation to help untrained people manage a crisis and we have formalized the care pathways for cases where specialized intervention is required. For cases that required emergency care or hospitalization, services continued while observing sanitary precautions.
Q: How do you ensure you provide an integral approach and what benefits does that provide to the patient?
A: The development of an integral approach began before the pandemic because the population demanded it. Homecare initiatives were created because inpatient mental healthcare is difficult due to the lack of adequate space and training, as well as coverage by insurers, among other gaps in healthcare services. Due to these problems, we established partnerships to "hospitalize" at home, which would allow patients to receive care from staff trained both in standard care and for some psychological interventions.
Keeping the patient in a safe and comfortable environment supports their care. Ultimately, crises happen where the patient lives and through home-based care it is possible to raise awareness among the patient and their family. Also, direct observation of care provision can decrease stigma.
Multidisciplinary work is key to patient success as there are few diseases that fall within the scope of a single area. Almost all diseases require collaboration.
Q: How do you approach psychogeriatric patients, people with other neurodegenerative disorders and their support networks to ensure well-rounded care?
A: The main risk factor for these diseases is age. Demand has increased and will only continue to do so and we need to move away from the regular model of care, in which complications have to occur before care is provided. Care must be provided much earlier. The general public must be aware of diseases caused by old age and establish links and support networks to prepare as much as possible.
We have established liaisons with hospitals and centers where older individuals can interact and be active. This has a positive impact because it improves their general health and reduces the need for hospitalization.
Q: How has the adoption of new technologies, such as neuromodulation, impacted mental healthcare?
A: Decades ago, many believed that there was little advancement regarding mental healthcare when compared to other areas of medicine. But since the 1980s, new therapies have been developed that incorporate technologies that allow the modification of the nervous system. These treatment options now exist for many diseases. It is now possible to recognize the areas in the brain that might be malfunctioning and to use these technologies to modify those areas.
Q: How do you ensure all your care providers are up to date with the latest industry developments?
A: In short, through continuing medical education. Health professionals must keep up to date on the developments in their field. We have partnerships with associations that provide courses and we participate in congresses. We provide continuous training based on the guidelines from the American Psychiatric Association.
Q: Mexico is in the midst of a crisis of silence regarding mental health. What would primary prevention in mental health look like in an ideal setting?
A: The pandemic has enabled the technological changes necessary to provide care. For example, teleconsultations were used in psychiatry but they became more relevant as a result of the pandemic. One of the changes we have seen is the adoption of pre-screening protocols, which allow doctors to provide appropriate consultations and facilitate their work.
It is no longer possible to go back to a world where mental health is not a priority. Many of us have witnessed or had a crisis during the pandemic and it is hard to believe that these services will not be needed after these experiences.
Q: How should academic programs adapt to ensure better training and avoid the stigmatization of mental disorders?
A: This is a multi-axial issue. There are increasing efforts to adopt multiple platforms and provide appropriate communication on mental health issues. In this age of intercommunication, it is increasingly easier to access relevant information and generate change.
Curricular changes must also be made in universities to adapt to these changes. Mental illnesses are more prevalent than almost any other disease and represent the leading cause of disability in the world, so there is an ever-increasing need for these services. Universities are now providing professionals, even those who are not specialists, with training in mental health disorders. There is great demand for mental health services and it will only continue to increase.
The Nervous System Research Center (CISNE) is a highly specialized clinic at the forefront of mental healthcare.