2
REFINING PSYCHOLOGICAL SERVICES AND STRATEGIES IN INDIA IN THE WAKE OF COVID-19
ANINDYA S. NAG, M.A. DEBORA, L. S.S. MANICKAM
Introduction
COVID-19, as it is known all over the world has taken a great toll on humanity and continues its unrelenting spree. The corona virus (2019-nCoV), that originated in Wuhan, China, was reported to the World Health Organization (WHO, 2020) as a variant of influenza on December, 31, 2019. Observing the alarming rate with which it spread and the high mortality rate, what was initially recognized as a flu-like disease was soon declared a public health emergency of international concern by WHO on January 31, 2020. In India, the first case was reported in Kerala, in January, 2020 (India Today, 2020). As the spread of the virus continued at an alarming rate, the Government of India and the state governments got into action and kick started measures to contain its spread. The lockdown that was declared on March 24, 2020 has great implications on the behavior of all the people in every walk of life in our country. While it has forced a majority to face the harsh realities of life, it has brought out the creative side of many others. In this article we present the national strategies that psychologists of our country need to take in responding to the pandemic. It also focuses on how the psychology associations can play a proactive role and make use of the opportunity to help the people at large and strengthen the psychology community in India to take on the challenges, in dialogue with the policy makers.
NATIONAL STRATEGIES OF PSYCHOLOGISTS IN RESPONDING TO COVID-19
The WHO provided guidelines for health workers, team leaders and psychologists for contingency plans along with aids for psychological support in its article published on 18th March 2020 (WHO, 2020). Each member country has already enforced and put in place the National Action Plans which has implications at the national, sub- national and international levels, but there are still baseline priorities that need active focus.
Coordinated systems and contingency planning
While adapting to COVID-19 changes, the management of psychological health, public health and emergency demands structured plans that are coherent at the local, state and national levels. This in turn demands the national level psychological associations to establish connections globally and respond locally. Internally the associations have to work in coordination with government departments of Home Affairs, Human Resource, Education, Finance, Industry, Travel, Environment, Social Justice, Health and Family Welfare, National Disaster Management Authority (NDMA) and Defence. The national level psychology associations in India and regional level associations (Divyaprabha et al., 2020; Kumar, 2020) have taken steps to coordinate with government initiatives. Psychologists and mental health professionals working with institutions or independently can be encouraged to deliver their services and employed in different frontline capabilities of our country once they are trained in COVID-19 contingency strategies. Undoubtedly, it is of prime importance to work closely with the Government of India and the state governments, parliamentarians and policy makers in order to bring this elaborate idea into fruition.
DISASTER MANAGEMENT
Our country has experienced several natural and man made disasters in the past. During the past two decades we had several major natural disasters that led our country to establish a National Disaster Management Authority, as per the Disaster Management Act (2005). However, our profession does not seem to have taken it seriously and has not made attempts to develop a strategy for national level preparedness by training the people at large in Psychological First Aid (PFA), which psychologists only can take a lead. Disaster psychology or Disaster Management or Trauma Psychology as a specialization is not offered for undergraduate students of psychology. The need for introducing disaster psychology in our psychology training is a necessary take away this pandemic has highlighted (Roy, 2020). The National Policy of Disaster Management (2009) has prompted NCERT to include Disaster Management as a subject to be adapted and adopted by state level and secondary boards from classes VIII–IX. Disaster management was included as a part of the CBSE and ICSE school syllabus and other courses, but not yet as a specialization in psychology. Practice drills in combating disaster can be grouped together with sports events or Social Awareness Program (SAP project) making it a compulsory component of the syllabus and a certificate of competency can be issued on successful acquisition of mandatory skills. Volunteer organizations and volunteers who actively participate in rescue operations, can be trained in PFA to work in coordination with a mental health professional while responding to disasters of any nature.
ROLE OF PSYCHOLOGICAL SCIENCE IN RESPONDING TO COVID-19 PANDEMIC.
The current pandemic has thrust millions of people to a territory seeming to be home, but is a place of anxiety, disrupted lifestyle, uncertainty of future and financial instability, with social distancing aggravating and provoking the suppressed emotions. The social and work-life which used to be coping strategies are no more available to fulfill one’s esteem needs. Therefore, loneliness, anxiety, fear, abuse and other psychological issues that previously remained dormant in family systems and individuals, are now rearing their ugly heads (Veliyannoor, 2020). The temporary disconnect from nature can also affect the mind and general health of the public.
Using community resources to support
Pro-social and Pro-health plans can be activated within much deeper layers of segmented populations by using the available community resources. Psychological associations can connect with clubs, societies, fraternities and various other Non-Governmental Organizations (NGO) and cater to alleviation measures like enforcement, creating awareness drives, working out creative methods of community engagement, helping stabilize the unrest in communities and counter-balancing the stigma associated with COVID-19 affected individuals and risk communication. This also helps to monitor, identify, and stabilize the subclinical and home quarantined individuals by providing Psychological First Aid (PFA). Functional support groups for target populations like the active health care professionals, parents, teachers, caregivers and quarantined individuals are active in some places. It is important to engage migrants, villagers and farmers who are below the poverty line(BPL) who do not have access to such groups with culture specific and context based innovative approaches. Traditional forms of art that can bring psychological relief and were found to be helpful in dealing with anxiety, pain, fear and hopelessness may turn out to be effective (Sajani, 2017).
Research
Research on pandemic afflicted aspects of human life which will help to make mitigation processes effective and friction-free is essential (Singh et al., 2020). Along with alleviation of psychological distress due to Covid-19, the psychology fraternity needs to plan and implement systematic and large scale research through the course of the pandemic. This can help in evaluation and refinement of the current assessment and therapeutic methods, to aid better policy planning, implementation and service delivery.
Positive psychology is a blooming field with life-skills teaching methods, that can transmute the gloom of the pandemic and urge the affected minds to appreciate life with positive thinking. Research in the past had shown that several positive psychology concepts including gratitude can aid in reducing anxiety, help the recovery of persons with Post Traumatic Stress Disorder (PTSD) and relieve many from other disorders (Chen, 2017; Lies, 2014; Vieselmeyer, Holguin & Mezulis, 2017). Positive mindset may help counter the psychological issues that humanity is facing right now and research is needed to establish how these can help some people to ‘harness the stress during a pandemic for positive growth’ (Van Bavel, 2020). University of Kerala, Thiruvananthapuram had already called for innovative research proposals from different departments including the department of psychology on various aspects of the pandemic meant for different sections of people including children.
CHALLENGES TO OUR PSYCHOLOGISTS - MAJOR SHIFTS LIKELY TO OCCUR IN 6-12 MONTHS, 5 YEARS.
Psychologists today are left to face the consequences of once ignored factors that cannot afford to stay neglected anymore. Furthermore, the current challenges are perfect opportunities to re-evaluate our priorities, reset our inner resources and re-engage plans put on hold, channeling the creative mind to anchor an ideology or a philosophy deep into ground reality. The alarming number of calls to the helplines reporting domestic violence and child abuse should not come as a surprise, as these lay under wraps and were coped with ineffectively until now.
Students, adolescents and a large section of the society including the working class are now seeking professional help, which is desirable for maintaining mental health of the people (Health and Social Justice Department, 2020). However, the sudden increase in demand has become a challenge. Therefore, psychologists from India across the nation and worldwide, must now pool in their inner resources and their knowledge on human psychological processes, behavior and life skills to come up with a standardized procedure for care and support. Making the general public aware of the services that psychologists can provide is the first and foremost step that can be taken. Besides planning and organizing within psychological associations, it is time to connect with all active mental health professionals and start programs for community outreach. Coalescing with other health professionals, especially the physical health care professionals and educationists who are invested in ground level work can be of great help.
Awareness drives through media and mass communication channels regarding the services and knowledge that psychological science has to offer can help streamline the crisis support amidst the pandemic. Connecting all service providing psychologists with the active health workers in their respective geographical locations within these 6-12 months, can be challenging. However, in the upcoming years, building our own channels and networks can equip us to handle various disasters. This needs to focus on establishing sustainable helplines, assistance and support groups, legal and paralegal teams, rescue teams, shelters and supporting/reviewing legal policy groups regarding violence and abuse cases. Individuals with disability consistently need clinical assistance which needs to be maintained despite disaster or pandemic (Amatya & Khan, 2020; Venkatesan, 2020).
Prioritizing our goals
It is evident that the general public lack life skills to deal with uncertainty and maintain home- work-life balance. It was easier to adopt divergent coping techniques till the real setback in the form of a pandemic struck, to reveal the deeper void of human consciousness. So it is time to focus on making life skills the basic knowledge criteria, rather than relying on temporary solutions. Using psychology to promote self-reliance, community connection, social responsibility, group consciousness and kinship within and among various groups can act as strong anchors in the face of challenges.
Psychological assessment and Online platform
With the shift of counselling and psychotherapy being conducted through online media (Amulya, 2020; Joshi, 2020) data management and securing the data collected under the confidentiality clause is a big challenge. Along with learning necessary digital handling of data skills, there is a necessity to adapt therapeutic online communication skills to make it worthy. With online sessions, the outreach is now global. However, administration of psychological tests which require face to face contact demands thoughtful review. It is time to seek alternative methods of administration of projective tests and develop norms to interpret the tests that can be taken online (Jellins, 2015). Formulation of methods to supervise the online administration, revising the assessment protocols in online assessment, privacy and security of the data gathered are of prime importance. At the same time, unauthorized use of the tests has to be kept under check by the regulatory body that keeps a check on the development and distribution of the tests.
Experiments, testing and policy making
One of the key components of training in psychology is the experiments which took psychology from the arts domain to science. Basic and conventional time based tests like the ‘reaction time’ and similar tests probably can be better administered and recorded using the online platform (Anwyl-Irvine et al., 2020). Teaching departments of psychology have to collectively think of transforming more assessment tools to online platforms, and validate the tools. Our tests for experimental psychology are distributed by private companies who are independent of the psychology organizations. Therefore, the quality of the tests for experiments goes unchecked. Many psychologists have developed tools to be administered online even during this period (Amulya, 2020). These projects and experiments need to be indexed, categorized and compiled and the data base should be made available for researchers across the country.
OUR WISH: WHAT PSYCHOLOGICAL ASSOCIATIONS IN INDIA NEED TO DO IN THE NEXT 5 YEARS
To eradicate, mitigate or control any layer of human life wherever it is contributing, psychology can do wonders to manage the resource we currently have at our hands. Though India has more than 100,000 trained psychologists, (Manickam, 2016 b) many have not taken membership with the mainstream national psychology associations. The psychological associations in India, need to work collectively in facilitating growth in the society with the support of its members. We are highlighting some points that we expect from the psychology associations in our inner resources that come naturally to us as Indians and psychologically inclined to act as peacemakers.
Role clarity
Our psychological associations need to acknowledge and state clearly what are the roles of each psychologist with specific specialization. When it comes to the general public, people are still conflicted as to what kind of ‘mental health professional’ one can visit for what type and kind of issues. There is no clear assignment of counsellor roles and job duties and it is also denigrating to see job sites showcasing ‘counsellor’ as front-desk managers. Even among the psychology professionals, there is a constant displeasure and mistrust between psychologists with different specializations and those delivering different services, like the academicians and the professional service providers in different settings and the researchers. Either the associations collectively decide on precise role descriptions, or each association should come forward and state what each member can do and cannot do. But that does not deter one from being a member of different associations provided one has acquired the competencies required for the specific role, like a trained counseling psychologist becoming a school psychologist, after getting trained in the skills to be a school psychologist. Lack of regulation by the associations allows many unqualified people to fill up the vacuum created by the needs of the society. Once the professionals are clear about the roles, awareness drives through newspapers, media and various channels of communication can bridge this information gap to make the public access our services, for whom the psychologists are meant to be.
Training in Psychology
In the next 5 years, if psychology stakes its due claim in nation building, it will be a much sought after career. However, there are several roadblocks which need to be cleared at the earliest, some of which are already mentioned above. Unless the academics, practitioners and research psychologists come together and arrive at a consensus, it will be difficult to achieve.
The tenure of courses in psychology has to relook at the number of years of training. Students giving 7 years of their life in order to earn a commendable career in a subject that is considered as an art rather than science, creates a lot of financial stress. Psychological science needs to be standardized and grounded in more skill based training in the master level itself. The current Master in Science is more of an academic qualification in comparison to Masters in Arts of Psychology. The weightage disparity between Psy.D. and M.Phil. in clinical psychology courses that are intended for similar areas of work, varying in focus and expertise, needs serious review (Manickam,2016).
There is a need to establish psychology courses as two separate streams: academic based and practice based at the graduate level, so that psychology graduates have clarity in choosing what they intend to do and choose their career accordingly. A selection process must be formulated to select students for both academic and practice based professions at the entry level itself, which can be done by a panel of career counsellors and supervisors in respective fields. Encouraging the general public to study psychological concepts by introducing it as a common subject just like history or mathematics in the school curriculum will help dissolve the stigma and accept the science of psychology until they opt for it as a clinical or specialized subject to make a profession out of it, at the graduate level.
Streamlining organization from within.
It is heartening to learn that Indian Association of Clinical Psychologists, Indian Academy of Applied Psychology (Sharma, 2020), Tamil Nadu Association of Clinical Psychologists (Kumar, Jayaraman and Rangaswamy, 2020) and Chennai Counselors Forum (Divyaprabha et al., 2020) have initiated several programs in response to the pandemic. However, there does not appear to be any coordination among them or any collaboration with other associations like National Academy Of Psychology, Indian Association of School Psychologists, Indian Association of Community Psychology or Indian Association of Health Psychology. Several initiatives were reported in social media on regional psychology associations and private psychology groups in our country responding to the pandemic. The responses seem to be disjointed, discreetly placed and lack networking. In responding to pandemic like this, a stand alone approach will not help and what is needed is a well coordinated and collaborative effort so that we can utilize our maximum potential to help the people in need.
Since there is no strong association in India that one can lean on for support, there is a tendency among graduates, post-graduates, researchers and service providers to work independently to address the grave need of the community without being affiliated to any psychology association or even with the institute to which one belongs. Re-evaluating the values and priorities of the profession and self- reflection are of paramount importance as it can help the psychology community in India to move forward by picking up the pieces left behind. Psychology needs to be re-invented beyond its established identity as a commercial subject, or an elite subject where skills and its applicability are shoved under piles of certificates. This is the time to encourage and mentor psychology students to affiliate themselves with various associations to help bring their talents together, to impart the skills to collectively respond to the challenges that are in front of us.
Standardization and Collaboration
In our country, where most sectors are interdependent, professionals like us need to be connected in more ways than one. Our psychology associations as non governmental organizations (NGO) need to make conscious effort to collaborate with other NGOs, and those in the private sector at an association level to achieve our common goals. Affiliating with schools (Duggal & Bagarswala, 2020), community clubs, Community Social Responsibility (CSR) of corporates and other organizations should be given priority to cater to the pandemic mitigation plans that WHO and the Ministry of Health and Family Affairs of our government have proposed.
The Paradigm shift: Aligning with the values of our cultural context
India is a country with unique values, diverse systems and groups. Post-independent India has seen the youth from metropolitan cities gravitating towards individualistic values. Our education system is directed towards goals pertaining to employment, which is an individualistic approach and psychological sciences followed suit. However, seeking professional help for psychological problems is still a stigma. We need to keep the profession grounded in our values and in the Indian reality (Manickam,2016b). Mindfulness based techniques, self-help techniques like chanting and different yogic asanas including pranayama based on Indian philosophical psychology that had shown significant improvement in psychological well-being, melatonin secretions, and cardio respiratory response (Harinath et al.,2004) can be explored in the current context and may require collaborative research with other health professionals.
The COVID-19 pandemic has not only reined in the erratic pace of the world, but has also thrown all forms of normalcy off track with its strike, widening the outlook of the global population to a renewed perspective of life and a resolve to press on ahead of changing times. Psychology, as a science and community, now stands at the crossroads of a journey into wider opportunities and endless possibilities. It is time for us to seize the opportunity and unite as a collective body that plays an active role in the mental health of our society. We seem to lack a collective Indian connect while addressing ‘emotional aspects’ of human life. Hostility is a natural consequence of lack of shared connection. Integrating psychological concepts from the Indian philosophical psychological framework of operation will help to connect with more people in stigmatized sections of our country.
Conclusion
A paradigm shift in priorities has taken place amidst this unfortunate pandemic. Normalizing the conditions in purview of creating a ‘new norm of living’ has gained prime importance (Tugade, 2020). The psychological distress has taken centre stage and it is of paramount importance to highlight that it is a consequence of earlier neglected or disorganized plans of the psychology community to which we belong. Lack of community outreach, lack of connectivity within and scarcity of skilled professionals had caused enormous damage to the profession. Keeping the past aside, it is a perfect opportunity to establish a firm foundation, as psychological science is an integral part of human life and growth. It requires conscious, concerted and collaborative efforts in reviewing what we have done to the profession of psychology during its existence in India for more than a century and what is yet to come.
References
Amatya, B., & Khan, F. (2020). Rehabilitation response in pandemics. American Journal of Physical Medicine & Rehabilitation. 2020;10.1097/PHM.0000000000001477. doi:10.1097/PHM.0000000000001477
Amulya, D. S. L. (2020). An experiment with online group counseling during COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp. 182-197). Thiruvananthapuram: The Editor.
Anwyl-Irvine, A. L., Massonnié, J., Flitton, A., Kirkham, N., & Evershed, J. K. (2020). Gorilla in our midst: An online behavioral experiment builder. Behavior research methods, 52(1), 388-407
Chen, G. (2017). Does gratitude promote recovery from substance misuse, Addiction Research and Theory, 25, 1–8.
Disaster Management Act, (2005). https://www.ndmindia.nic.in/images/The%20Disaster%20Management%20Act,%202005.pdf
Duggal, C., & Bagarswala, L. (2020). Promoting well-being and resilience of young people during COVID-19: An initiative with schools. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.63-75). Thiruvananthapuram: The Editor.
Divyaprabha, S., Nerur, G., Suryakumar, K., Raman, N., Bhaskar, S., Suryakumar, R., & Uma, T.R. (2020). A paradigm shift: Changes, challenges and way forward. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.209-217). Thiruvananthapuram: The Editor.
Harinath, K., Malhotra, A. S., Pal, K., Prasad, R., Kumar, R., Kain, T. C., & Sawhney, R. C. (2004). Effects of hatha yoga and omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. The Journal of Alternative & Complementary Medicine, 10(2), 261-268.
Health and Social Justice Department. (2020, May 4). Press Release retrieved From https://prd.kerala.gov.in/pressrelease
Jellins, L. (2015). Assessment in the digital age: An overview of online tools and considerations for school psychologists and school counsellors. Journal of psychologists and counsellors in schools, 25(1), 116-125.
Joshi, S. (2020). Telepsychotherapy: The bridge to continuity in care and mental health services in COVID-19 and post Covid era. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.170-181). Thiruvananthapuram: The Editor.
Kumar, D. (2020). Contributions and challenges of psychologists in private practice in India and their responses to COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.166-169). Thiruvananthapuram: The Editor.
Kumar, N. S., Jayaraman, S., & Rangaswamy, K. (2020). Tamil Nadu Association of Clinical Psychologists (TNACP) responding to COVID-19 pandemic. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.204-208). Thiruvananthapuram: The Editor.
Lies, J. (2014). Gratitude and personal functioning among earthquake survivors in Indonesia, Journal of Positive Psychology, 9, 295–305.
Manickam, L. S. S. (2016a). Challenges of professionalizing psychology in India: Where do we go from here? Indian Journal of Psychology, Centennial issue. 243-252.
Manickam, L. S. S. (2016b). Towards formation of Indian Federation of Psychology Associations: Let us wake up for our causes. Journal of the Indian Academy of Applied Psychology, 42, (1), 40-52.
National Policy of Disaster Management (2009) https://ndma.gov.in/images/guidelines/national-dm-policy2009.pdf
Roy, P. K. (2020). Role of psychologists in dealing with triple disaster situation during COVID-19 pandemic. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.141-148). Thiruvananthapuram: The Editor.
Sajani, V. (2017). Integrative Art Therapy for Adolescents with Depression. Doctoral dissertation submitted to University of Kerala. Thiruvananthapuram
Sharma, N. R. (2020). Indian Academy of Applied Psychology (IAAP): Vocal voice on local to global perspectives of psychological services. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.198-203). Thiruvananthapuram: The Editor.
Singh, N.K., Gopalan, S.V., Ahabibie, I., Rahardjo, D., & Girdhar,