Kwobah Edith, Jaguga Florence, Robert Kiptoo, Ndolo Elias, Kariuki Jane
Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya.
Mental Health and Rehabilitative Services, Moi Teaching and Referral Hospital, Eldoret, Kenya.
Front Psychiatry. 2021 Jan 14;11:588216. doi: 10.3389/fpsyt.2020.588216. eCollection 2020.
The rising number of patients with Covid-19 as well as the infection control measures have affected healthcare service delivery, including mental healthcare. Mental healthcare delivery in low and middle income countries where resources were already limited are likely to be affected more during this pandemic. This paper describes the efforts of ensuring mental healthcare delivery is continued in a referral hospital in Kenya, Moi Teaching and Referral hospital, as well as the challenges faced. These efforts are guided by the interim guidelines developed by the Kenyan ministry of health. Some of the adjustments described includes reducing number of patients admitted, shortening the stay in the inpatient setting, using outdoors for therapy to promote physical distancing, utilization of electronic platforms for family therapy sessions, strengthening outpatient services, and supporting primary care workers to deliver mental health care services. Some of the challenges include limited ability to move about, declining ability for patients to pay out of pocket due to the economic challenges brought about by measures to control Covid-19, limited drug supplies in primary care facilities, inability to fully implement telehealth due to connectivity issues and stigma for mental health which results in poor social support for the mentally ill patients. It is clear that current pandemic has jeopardized the continuity of usual mental healthcare in many settings. This has brought to sharp focus the need to decentralize mental health care and promote community based services. Meanwhile, there is need to explore feasible alternatives to ensure continuity of care.
2019冠状病毒病患者数量的增加以及感染控制措施已经影响了医疗服务的提供，包括精神卫生保健。在资源本就有限的低收入和中等收入国家，精神卫生保健服务在此次大流行期间可能受到更大影响。本文描述了肯尼亚一家转诊医院——莫伊教学与转诊医院为确保精神卫生保健服务的持续提供所做的努力以及所面临的挑战。这些努力以肯尼亚卫生部制定的临时指南为指导。所描述的一些调整措施包括减少收治患者数量、缩短住院时间、利用户外空间进行治疗以促进身体距离、利用电子平台进行家庭治疗、加强门诊服务以及支持基层医疗工作者提供精神卫生保健服务。一些挑战包括行动受限、由于控制2019冠状病毒病措施带来的经济挑战导致患者自付能力下降以及基层医疗设施药品供应有限、由于连接问题无法全面实施远程医疗以及对精神疾病的污名化导致精神病患者获得的社会支持不足。显然，当前的大流行已经危及许多环境中常规精神卫生保健的连续性。这凸显了精神卫生保健去中心化和推广社区服务的必要性。与此同时，需要探索可行的替代方案以确保护理的连续性。
