The Punjab health and family welfare department wants counsellors, psychiatrists and psychologists to carry out counselling of novel coronavirus patients and their families through ‘Zoom’, a web-based video conferencing tool, which was red flagged by the Centre recently over security issues.
Though the Punjab health department issued these orders on April 8, before Union Ministry of Home Affairs issued an advisory on how to safely use the app, the copy of these orders has reached the district hospitals and civil surgeons now. Many of the counsellors that The Indian Express spoke to, said that they are only depending on voice calling, WhatsApp and video calls for counselling the patients or their family members. They said they are not using Zoom because most of patients and their kin aren’t comfortable with the app and don’t know how to use it.
The orders issued by the mental health branch of State health department, addressed to all civil surgeons, states: “In view of COVID-19 pandemic, all psychologists, counsellors and psychiatric social workers should counsel COVID-19 patients and their families as per the guidelines attached. For the patients who are admitted in isolation wards, they should be counselled either via Zoom App or video calling. Mass media wing should also be roped in. If COVID-19 patients have to be counselled face to face, then PPE kits must be used”.
Speaking to The Indian Express, Dr Balwant Singh, deputy director, mental health branch, said, “The need to issue these orders was felt as some patients hid their drug addiction history and started showing withdrawal symptoms. This led to change in their behavior and doctors started facing issues in handling them. Then there were instances when families refused to perform last rites of coronavirus patients due to stigma and fear of infection. Hence we issued orders for their counselling via Zoom App or video calling. This app was recommended after taking suggestions from experts of our branch and to ensure the convenience for both counsellors and patients”.
Dr Singh was “still not aware of the MHA advisory” as he had “been keeping busy with other works” and said he “will go through it”.
Dr Sandeep Bhola, senior psychiatrist and de-addiction incharge at Navkiran Kendra, Kapurthala, said that most of patients or the people quarantined at home do not feel comfortable with face to face counselling via video calls or any other platform. “Our team is mostly depending on voice calls. People who are home quarantined do not want to reveal their identities. Stigma related to coronavirus is very deep. In case of patients who are admitted, we use PPE kits and counsel them face to face. But via phone, it is mostly through voice calls or WhatsApp. There is always a risk of patient’s personal details such as names and phone numbers getting leaked while using apps such as Zoom,” said Dr Bhola.
The counseling guidelines issued for coronavirus patients issued by Punjab say:
There is fear and anxiety among people and they look for psycho social support. There is need to address concerns of each person/family and to listen to their problems with patience.
For persons in isolation wards (suspected or confirmed cases): Counselling should be provided through audio visual aids. Keeping the person engaged in recreational activities such as reading newspapers, magazines, yoga, meditation etc. Proper diet and medication.
Patients with drug abuse: Detailed history needs to be taken including type of substance abuse, job profile and medication for de-addiction. Such patients must be given treatment for substance abuse along with medication for COVID-19 to prevent withdrawal.
Counselling for families of COVID-19 deceased: There is an urgent need to counsel family members of persons who die due to Covid-19. The family members have been refusing to perform last rites of the deceased. Crematorium/burial ground staff should be sensitized that body of covid-19 positive patient does not pose any additional risk if it is disinfected and packed as per guidelines.
Counselling programmes must be based on Indian Council of Medical Research (ICMR) guidelines.