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| EDITORIAL |
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| Year : 2022 | Volume
: 36
| Issue : 1 | Page : 3-4 |
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Community mental health care in the era of COVID-19 pandemic
Chang-Jer Tsai M.D., E.M.B.A
President's Office, Taiwanese Society of Psychiatry
| Date of Submission | 19-Feb-2022 |
| Date of Decision | 04-Mar-2022 |
| Date of Acceptance | 05-Mar-2022 |
| Date of Web Publication | 26-Mar-2022 |
Correspondence Address:
Chang-Jer Tsai
Floor 9-3, No. 22, Sung-Jiang Road
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/TPSY.TPSY_12_22
How to cite this article:
Tsai CJ. Community mental health care in the era of COVID-19 pandemic. Taiwan J Psychiatry 2022;36:3-4 |
| Principles for Community Mental Health Care | |  |
Community mental health care (CMHC) has been considered that CMHC should be given in the community where people live. CMHC involves a range of interventions for patients' different support needs, particularly the crisis support, ongoing treatment and care, as well as community living. The range of services may include crisis response services, services of CMH centers, hospital-based services, community outreach services, peer support services, and supported living services [1]. Although the administration of these services can be different in countries and regions, services can overlap in the care and support activities.
According to a consortium report of the University of Melbourne and St. Vincent's Health, the universal principles for CMHC consist of accessibility of mental health (MH) services, equity of MH care, protection on human rights, comprehensiveness and effectiveness in MH care, coordination and continuity of MH care, integration of MH care into primary health care through shared care, integration of MH care into general health system, multisectoral linkages (especially between the public sector and the private sector), as well as planned process of de-institutionalization [2]. The authors of this report are from various Asia and Pacific countries, including Taiwan [2].
| Public Metal Health: The Origin of Community Mental Health in Taiwan | | |
Public MH has adopted a population approach to execute evidence-based interventions, prevent mental disorders in the early stage, reduce impacts on mental disorders, as well as promote mental well-being and resilience [3]. Taiwan has developed the Taiwanese MH system since the end of the 1970s. The government granted a project to establish an MH care network for the provision and distribution of adequate MH mental health services over Taiwan and offshore islands. According to the specifications of the MH care network, the majority of the MH facilities were founded. Those facilities were CMH services that were mostly based on Eng-Kung Yeh's experience of Taipei City Psychiatric Center (now merged into Sung-De Branch, Taipei City Hospital). Yeh established community psychiatry in Taiwan, “the Taipei model [4].”
In the meantime, workforce from the public health sectors was introduced to overcome the shortage of CMH workforce. Taiwan is a rapidly changing society, and the existing MH care network has been extended to meet the various needs of CMH. MH issues which trigger sociopolitical and legislative changes, are likely to receive public attention and result in many CMH programs. Community-based MH care was embedded in the process to use different resources and empower the community for developing various programs such as programs for early intervention for children, drug abuse prevention, suicide prevention, disaster MH intervention, and a shared-care program for people with common mental disorders [2].
In recent years, Taiwan has faced significant challenges and impact on health-care system due to propensity for natural disasters (earthquake, severe drought, torrential rain, etc.), attack of COVID-19 pandemics, and changes in social and family structures (the lower birth rate and aging society). CMH services have played a crucial yet under-recognized rôle in delivering MH care in these hard times. Stigma with mental disorders and lack of community acceptance built a major barrier within Taiwanese society. Backed by advanced health and social service systems, Taiwan has begun implementing community-based services in social safety net for those with mental illness. For example, 71 CMH centers will be established in the coming three years over this country which will provide case management for patients with severe mental illness in the community, preserve the human rights of people with mental disorders, and limit the stigma of MH treatment. But Taiwan still has relative lack of investment in resources of CMH in light of key challenges such as cross-sectoral coordination, funding provision in research for CMH, as well as funding incentives for community treatment and advocacy of the mentally ill [5].
| Impacts and Consequences on Taiwan's Community Mental Health in the Era of the COVID-19 Pandemic | | |
The COVID-19 pandemic started in February 2020 or even earlier in December 2019 [6]. A severe lockdown was administered globally with the closure of essential medical services among infected countries and societies. All health resources have been diverted to address the health crisis caused by the COVID-19 pandemic. During the crisis, the only community medicine services that remained open were MH services: psychiatry. The psychiatrists were also involved in the management of COVID-19–positive patients and in the support for management of the medical staff's stress. This pandemic crisis has had significant consequences on direct and indirect psychosocial levels. Among the direct consequences, there comes trauma suffered by those who have fallen ill and have been hospitalized or have been forced into a prolonged period of quarantine and seclusion and the stress and burnout of frontline health personnel. Among the indirect consequences, serious risks exist in unemployment, loss of personal and family income, limitations to interpersonal contacts and work activities, as well as complicated bereavement in the case of loved ones who have fallen ill and died. This serious and complex psychosocial emergency poses new challenges to psychiatrists requiring the development of specific skill: telepsychiatry [7],[8].
| Telepsychiatry: The Ultimate Redemption for Community Mental Health in the Era of COVID-19 Pandemic | | |
Telepsychiatry is the process of providing MH care from a distance through technology using videoconferencing [7],[8]. Telepsychiatry can involve providing a range of services, including psychiatric evaluations, individual therapy, patient education, and medication management. It also allows psychiatrists to support medical care providers with MH care consultation and expertise. MH care can be delivered in live and interactive communication.
In February 2018, the American Psychiatric Association joined the American Telemedicine Association to give a position statement on telepsychiatry [9]. The statement has validated telepsychiatry to be an effective practice of medicine that increases access to MH care using video conferencing. The American Psychiatric Association supports the use of telemedicine as a legitimate component of an MH delivery system to the extent that its use is for the benefit of the patient, and it protects patient autonomy, confidentiality, and privacy.
Telemedicine including telepsychiatry is legally controlled and highly restricted in Taiwan before the pandemics. But in the era of COVID-19 pandemic, tele-counseling has been found its way in legal regulations in providing persons facing life stress with counseling by digital technology. The use of tele-counseling in times of the postpandemic in Taiwan remains to be concerned and whether tele-psychiatry will have a place in the post-pandemic times in providing tele-therapy to patients with mental illness is pessimistic and doubtful because of the conservative attitude of the Taiwan government to amend the medical regulations and law.
| Conclusion | | |
CMH originated from public MH in Taiwan. In the era of COVID-19 pandemic, the practice of CMH may be adjusted by digital technology, and the administration of governmental policy about CMH had been compromised. For the mental health equity of people in times of COVID-19 pandemic, CMH care is imperative and should be emphasized.
| Acknowledgment | | |
The opinions expressed here are the author's personal opinions. They unnecessarily reflect as those of any institution or society. The author is the president of the 31st Session of the Taiwanese Society of Psychiatry for a two-year term, 2021 to 2023.
| Financial Support and Sponsorship | | |
None.
| Conflicts of interest | | |
The author declares no potential conflicts of interest.
| References | | |
| 1. | World Health Organization: Guidance on Community Mental Health Services: Promoting Person-centered and Rights-based Approaches. Geneva, Switzerland: World Health Organization, 2021.  |
| 2. | Asia-Australia Mental Health: Asia-Pacific Community Mental Health Development Project: Summary Report. Melbourne, Australia: Asia-Australia Mental Health, 2008. |
| 3. | Campion J, Javed A, Lund C, et al.: Public mental health: required actions to address implementation failure in the context of COVID-19. Lancet Psychiatry 2022; 9: 169-82. |
| 4. | Yeh EK, Hwu HG: Mental health care delivery system in Taiwan: a report of the Taipei model (a chapter). In: Pichot P, Berner P, Wolf R, et al. (eds): Psychiatry: the State of the Art. Boston: Springer, 1985. |
| 5. | Ng CH: Mental health and integration in Asia Pacific. Br J Psych Int 2018; 15: 76-9. |
| 6. | Su YS, Shen WW, Lee WS: The prevention of new corona virus infection in Taiwan: a report from participants/observers (in Japanese). Jinmeikai Journal of Psychiatry (Kobe) 2020; 18: 1-10. |
| 7. | Okechukwu CE: The need for implementation of effective telepsychiatry services in the era of COVID-19 pandemic in Nigeria. Taiwan J Psychiatry 2021; 35: 44-5. |
| 8. | Allgulander C: An invited companion comment on: the need for implementation of effective telepsychiatry services in the era of COVID-19 pandemic in Nigeria. Taiwan J Psychiatry 2021; 35: 46. |
| 9. | Shore JH, Yellowlees P, Caudill R, et al.: Best practices in videoconferencing-based telemental health April 2018. Telemed J E Health 2018; 24: 827-32. |
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