Jayarajan Deepak, Sivakumar Thanapal, Torous John B, Thirthalli Jagadisha
Psychiatric Rehabilitation Services, Dept. Psychiatry, NIMHANS, Bengaluru, Karnataka, India.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Indian J Psychol Med. 2020 Nov 1;42(5 Suppl):57S-62S. doi: 10.1177/0253717620963202. eCollection 2020 Oct.
The COVID-19 pandemic has interrupted the usual mechanisms of healthcare delivery and exacerbated symptoms of mental illnesses. Telemedicine has morphed from niche service to essential platform, with newly released guidelines that cover various aspects of tele-mental health delivery. Rehabilitation services, which incorporate a range of psychosocial interventions and liaison services, have been significantly impacted too. They are currently more institute-based than community-based in India. However, recent legislation has mandated that community-based rehabilitation options be available. While a large treatment gap for mental health issues has always existed, telemedicine provides an opportunity to scale services up to minimize this gap. Community-based rehabilitation can be delivered over various platforms, from text to phone to videoconferencing, and various devices. Telemedicine is cost-effective, and enables delivery of services where existing services are inadequate. The recent guidelines allow other healthcare workers to be involved in mental health service delivery. Hence, in addition to direct delivery of services, telerehabilitation can facilitate task-shifting, with mental health professionals mentoring and supervising existing human resources, such as ASHA workers, VRWs, DMHP programme staff, and others. Tele-rehabilitation also poses challenges - not all needs can be met; access and privacy can be a problem in resource-scarce settings; liaison with existing services is required; and organisations need to plan appropriately and re-allocate resources. Digital access to welfare benefits and interventions must be expanded without disadvantaging those without internet access. Yet, many rehabilitation interventions can be adapted to telemedicine platforms smoothly, and task-shifting can broaden access to care for persons with disability.
新冠疫情扰乱了常规的医疗服务机制，加剧了精神疾病的症状。远程医疗已从小众服务转变为重要平台，新发布的指南涵盖了远程心理健康服务的各个方面。康复服务也受到了重大影响，康复服务包含一系列心理社会干预和联络服务。目前在印度，康复服务更多地以机构为基础，而非以社区为基础。然而，最近的立法规定必须提供基于社区的康复选择。虽然心理健康问题的治疗缺口一直很大，但远程医疗提供了扩大服务规模以尽量缩小这一缺口的机会。基于社区的康复可以通过各种平台提供，从文本到电话再到视频会议，以及各种设备。远程医疗具有成本效益，能够在现有服务不足的地方提供服务。最近的指南允许其他医护人员参与心理健康服务的提供。因此，除了直接提供服务外，远程康复还可以促进任务转移，由心理健康专业人员指导和监督现有人力资源，如阿莎工作人员、乡村康复工作者、地区精神卫生项目工作人员等。远程康复也带来了挑战——并非所有需求都能得到满足；在资源匮乏的环境中，获取和隐私可能成为问题；需要与现有服务进行联络；组织需要进行适当规划并重新分配资源。必须扩大数字福利和干预措施的获取渠道，同时不能使那些无法上网的人处于不利地位。然而，许多康复干预措施可以顺利地适应远程医疗平台，任务转移可以扩大残疾人获得护理的机会。
