Covid-19 Pandemic: Challenges And Responses Of Psychologists From India by Leister Sam S. Manickam - HTML preview

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CONTRIBUTIONS AND CHALLENGES OF PSYCHOLOGISTS IN PRIVATE PRACTICE IN INDIA AND THEIR RESPONSES TO

COVID-19

DR. DHERANDRA KUMAR

Consultant Clinical & Child Psychologist

Founder, Psyindia & LRS World College

Consultant, Apollo Hospitals, Noida & IIT, Delhi

Pandemics are testing times for all, including mental health professionals. The very fact that mental health professionals have to provide the services while dealing with the same challenges at the personal level which society is facing en masse, compounds the challenges. In the wake of the COVID-19 pandemic, mental health professionals have extended their unconditional support to the people in need, and most of it has been voluntary without any financial burden to the help seekers.

Mental health professionals in private practice moved in first to respond to the psychological distress caused by the spread, the impact of novel coronavirus infections and to the subsequent lockdown. Many private practitioners informed their patients that they were reachable over the phone. They took to social media to make themselves available to the public at large without any fee and mentioned their time slots.  Later, they formed small groups with rosters to make mental health services accessible for longer hours, and some groups even started to run 24X7 helplines. It is vital to note the altruistic behaviour of private practitioners as they shut their source of earning by running the free helplines.

After this phase, government institutes, private medical colleges, and different associations started their helpline. Private practitioners formed a large chunk of the helplines run by IACP, RCI, IAHP, TNACP and other similar organizations. In addition to these helplines, private practitioners ran public awareness and educational webinars for the general public, fellow professionals, and corporates. They participated in several shows related to mental health and wellbeing in radio and TV and  reached out to a large section of the population to allay their fears and provide tools to handle their distress in a  simpler language.

The following types of problems were seen by private practitioners while working in helplines, telephonic consultations, and video consultations-

1. Anxiety related to COVID 19: how harmful is it, will we be able to control it, feelings of uneasiness, vulnerability and similar concerns.
2. Emotional and Behavioural manifestations related to the lockdown: feeling down, feeling trapped, disconnected, disoriented, irritability, anger, aggressive behaviour, etc.
3. An aggravation of physical and mental health problems as a result of reduced physical activity.
4. Relationship issues came to the front, and there were significantly increased instances of abuse and harm as members of the family had to spend most of the time together.
5. In children, feelings of boredom, longing for open spaces, troubling parents as there were almost no channels of releasing the energy.
6. Some home makers were quite frustrated as they were not getting personal time. For work from home parents, it was not easy to maintain a work-life balance as children were at home all the time.

COVID 19 threw many challenges at private practitioners, and some of them are as follows-

1. For many professionals. working in helplines was a new experience - as in telephonic counselling/support, many sources of information were missing, e.g., eye contact, facial expressions, body language, etc. Many times, it was difficult to infer the tone because of network issues resulting in poor call quality. There were challenges related to call drop, also. 
2. The shift from offline to online practice was not smooth, especially for the not so tech-savvy professionals. It posed challenges even for tech-savvy professionals as they were not exposed to the intricacies of online practice. Adopting this new mode posed challenges for behavioural adaptation and adaptation with technology. Many private practitioners were not familiar with the software interfaces and had poor knowledge of hardware requirements. It demanded new learning related to the hardware and software for service delivery. Even these modes of telephonic and video consultations resulted in higher analysis and reflection on the skill set that these professionals already had. It resulted in sharpening their skill sets even for offline interventions. Thus, it resulted in the self-growth of these professionals.
3. Counselling young children is a significant challenge in telephonic and video consultations, and the therapist has to rely on the parents mostly, and the therapist has to take into account both the child and parental factors. 
4. Most of the practitioners were not well aware of the ethical and legal issues of online practice. The working solution was found as following the best practices of offline or face to face work and the laws for the same. There is no separate legal framework for online practice in India.
5. In many cases, a blend of telephonic and video-based interventions had to be used, and there was a switch between telephonic and video-based modes of intervention. It was mainly because of the low internet bandwidth issues.
6. Dilemmas about recording or not recording the sessions was a common theme in government and as well as private practice. As per the Tele-counselling instructions and NIMHANS tele-therapy practice guidelines, it was resolved in favour of not recording the sessions. It helped many private practitioners in making the decision.
7. Many clients (old and new both) were hesitant in trying the online mode, and some of them rejected it outright. The exploration of the beliefs related to this showed that they thought- online sessions are not worth the money, these are not as intimate as offline ones, there are issues in using the technology, the sessions will not be effective, etc. In some cases, the clients were adamant to see the therapist in person despite the strict lockdown and the risk of being infected.
8. In the case where assessments were needed, there were concerns related to the reliability and validity of these in online or offsite settings. Another concern was the high cost of the online versions in the Indian scenario, and its limits in its accessibility for the masses.
9. IACP and NIMHANS conducted webinars to guide professionals on different aspects of online practice. The NIMHANS webinars were primarily based on NIMHANS Tele-therapy practice guidelines, and these guidelines were framed with a multi-disciplinary government set-up in mind, and these helped private practitioners to some extent. Private practitioners have to balance the service, its delivery, and the consumer aspect. Most of the government hospitals do not take the consumer angle into account, and the same is reflected in the NIMHANS guidelines. IACP has formed a committee on ‘Tele-counselling Practice Guidelines’ with Dr. Dherandra Kumar as the chairperson, and the report is expected to come within the next two months. These guidelines will also cover aspects related to private practice.
10. There has been a mushrooming of online counselling platforms, and entrepreneurs are investing money into these, and they are trying to disrupt the market. They are offering online counselling for meagre charges, and they are not much bothered about the level of training of the counsellors onboard. Their motto is to initially offer the services at a little cost to capture the market. In addition to it, they are not bothered about the ethics in marketing the mental health services as they see it like any other consumer business. It has increased the financial challenges of private practitioners further.
11. Last but not least, there is a lack of support system for private practitioners, which is highly needed in the current world of disruption.

Thus, we see that private practitioners rose to the occasion in the wake of COVID 19 and have played a significant role. They have faced significant challenges, and some of them they have addressed, and some remain to be tackled. Now, they have to address the mental health aspects of the continuing pandemic as it puts a considerable amount of stress on the society at large.