National Institute of Mental Health and Neuro Sciences

(Institute of National Importance)

Immediate Care for Psychological

Events and Emergencies in the Context of
COVID-19 Pandemic

Training Booklet

Editors
Meena KS
Latha K
Santosh K Chaturvedi
CONTRIBUTORS
Dr. Aruna Rose Mary Kapanee
Associate Professor, Department of Clinical Psychology

Dr. Anish V Cherian

Assistant Professor, Department of Psychiatric Social Work

Ms. Deepika V
Ph.D. Scholar, Department of Mental Health Education

Ms. Madhuporna Dasgupta

Fellowship Scholar, Department of Mental Health Education
.
Ms. Pravitha MR
Fellowship Scholar, Department of Mental Health Education

Illustrations by:
Mr. Sripathacharya S
Artist, Department of Mental Health Education

Designed by:
Mr. Rajeev V
Artist, Department of Mental Health Education
CONTENTS
Introduction to Immediate Care…..............................................................3

Why Immediate Care?...............................................................................4

Who can provide Immediate Care?...........................................................5

Who may benefit from Immediate Care?...................................................6

Major stressors leading to Mental Health Crisis........................................7

Common scenarios related to COVID-19…..............................................8

Identification of signs of need for Immediate Care…….............................9

How can one provide Immediate Care…………………............................10

Burnout among Immediate Carers…………………….............................. 13

KeyTakeaways………………………………………………………..............14

Conclusion…………………………………………………………..…...........15
The emergence of COVID-19 pandemic and its rapid spread have brought about a
huge psychosocial impact on our mental health. People in crisis have been ill prepared
to deal with the circumstances which is unexpected and thereby have become
anxious. Added to this, the pandemic has enforced Government rules like social
distancing and self-isolation which has made the person vulnerable to increased
stress. Prolonged stress and anxiety can lead to further psychological and physical
problems, and have negative effects on family dynamics, decision-making,
interpersonal relationships and their daily functioning. The mental health and
psychosocial response to a pandemic is significant. Immediate care is the humane and
practical psychosocial assistance to such people around us who are suffering from a
crisis situation.

3
WHY IMMEDIATE CARE?
All of us are facing this COVID-19 pandemic crisis situation with concerns about
protecting oneself and their families. Moreover, there is stigma and misconceptions
associated with the pandemic, which can even cause a delay in help seeking. Thus,
many individuals continue to suffer silently, which increases their risk for developing a
mental health issue. Mental health issues commonly manifest as negative emotional
states like anger, irritability, and fear, to name a few. Generally, friends and family
members can have difficulty in identifying a person who is undergoing a mental health
issue. It may be often due to lack of awareness of mental health issues and what
needs to be done. Availing mental health services may not be considered as the first
option, and delay in recognition and treatment could lead to worsening of the mental
health issue into diagnosable mental health disorders such as depression or anxiety
disorders. Thus, it is of utmost importance to gain the knowledge and skills to provide
immediate care, as a first hand support to people with mental health issues, during
pandemic crisis.

4
WHO CAN PROVIDE IMMEDIATE CARE?

It can be anyone who assists a person in need of psychosocial support, during

or after a distressing or crisis event. These include:
•Relatives or Family members
•Neighbours
•Teachers
•Community members
•Emergency medical teams
•Mental Health Professionals
•Counsellors or NGO representatives
•Police or any Government employee

5
WHO MAY BENEFIT FROM IMMEDIATE CARE?

•COVID-19 survivors and their

families
•Children and adolescents, separated
from their caregivers
•Pregnant or nursing women
•Elderly population
•People with disabilities and chronic
health conditions

•People at risk of discrimination such

as any community or religious groups
or people suspected to have COVID-19
diagnosis, people who come out of
quarantine, frontline service providers
such as health workers and police
personnel.

6
MAJOR STRESSORS LEADING TO MENTAL HEALTH CRISIS

Children: Elderly:
Cancellation or Postponement of Exams Fear of contracting illness as they are
indefinitely, Separation from parents or high-risk population,
grandparents, mother or father staying Worries of their loved ones contracting
back at hospital and providing emergency illness,
Loneliness and concerns of separation
care, Violence or sexual abuse as
from family members, if on quarantine or
perpetrator at home, Boredom and
if they stay away from their home,
Loneliness, if having working parents, Fear Lack of familial and social support,
of contracting virus by parent working in Financial issues,
hospital etc., Worries of Missing Summer Inability to socialize with friends,
Camp, missing friends and playing out. Worsening of physical health conditions,
Inability to get essential supplies or
Adolescents: medicine,
Postponement of board exams or entrance Violence and abuse
exams, Physical abuse, Unable to meet
friends, Postponement of study abroad
plans, Postponement of vacation travel
plans

Adults:
Loss of job, Financial crunch, Different work structure and schedule, Inability to perform
normal life activities, Denial of housing, Loss of status, Loss of loved ones, Feeling isolated,
Infection fears, Frustration, Boredom, Inadequate supplies, Inadequate information
Frontline workers: Greater risk of exposure, Moral dilemmas, Rapidly evolving practice
environment causing increased pressure, Extra working hours and increased workload due to
poor manpower, Pain of separation or isolation from family members for their protection
Pregnant Women or Feeding Mothers: Fear of baby contracting illness, Worry about
reaching on time to hospital for delivery
Persons Suspected or Recovered from COVID-19: Stigma and discrimination, Loss of
status, Denial of housing, Loss of job

7
 COMMON SCENARIOS RELATED TO COVID-19

Antecedent Behaviour Consequence Description

A person has travelled
It is not necessary that all those who
back from abroad travelled abroad have COVID -19. People
People in the community stop who travelled may have come in contact
He coughs once
talking to him with the virus. However, this can be
confirmed only after the quarantine period
is over

An asymptomatic person with

no travel history or no Everyone who coughs does not have
He is asked to leave the market
contact history with any He coughs once COVID-19, so don’t ostracize them
immediately
person with COVID-19 goes
to the market

To curb the spread of

COVID-19 , Government During this COVID-19 pandemic, physical
introduced lockdown People practicing social distancing
Isolation of people due to social distancing should be practiced not social
distancing instead of physical distancing. In this period of lockdown and
distancing further crisis, it is really important to stay
connected with others virtually

8
IDENTIFICATION OF SIGNS OF NEED FOR IMMEDIATE CARE

Common signs are:

Overwhelming sadness or helplessness
Anger outbursts
Altered sleep and eating patterns
Expression of negative feelings on Social Media
Unusual and unexpected behaviour

9
HOW CAN ONE PROVIDE IMMEDIATE CARE?

Communicating effectively

•Approach the person with empathy and try to establish rapport

•Be non-intrusive
•Use virtual communication methods such as video calling, if the person
cannot come to you but expresses a need to talk
•Consider the culture, gender and age of the person
•Stay attentive and listen to the person
•Try rephrasing and summarising to make sure that you have understood
their concerns

10
HOW CAN ONE PROVIDE IMMEDIATE CARE?

Promoting sense of safety and connectedness

•Ensure that the affected person is in a safe place
•Share clear and accurate information about the situation
•Reassure that it’s a normal reaction to a situation where she or he cannot do
anything
•Suggest the person to get connected with his or her loved ones by virtually

Helping responsibly
•Respect individual’s right to make decision for himself or herself
•Be warm and supportive
•Never try to solve all the problems of the person
•Know your limits
•Ensure that your relationship is well maintained
•Entrust the person to recognise his or her abilities to help oneself

11
Building up Coping Strategies
•Focus on person’s strengths to encourage positive coping behaviours
•Share information about local support groups with which he/ she can connect
•Encourage to engage in deep breathing exercises or yoga
•Suggest the person to develop a new hobby and set a daily routine

12
Encourage Seeking Professional Help
•Let the person know that help is available
•Share details of a reliable and accessible mental health professional such as
psychiatrist, psychologist, social worker, trained counsellor or a reliable helpline or
telehealth service
•Assure them that it’s perfectly acceptable for them to seek professional help

BURNOUT AMONG IMMEDIATE CARERS

If you feel that being an aider is extremely stressful, it may be a sign of burnout. You
can address your burnout by connecting with your emotions, seeking help or
mentoring from experts, understanding your boundaries and limitations and taking a
break. Acknowledge that providing care was your choice and remember to celebrate
your small successful efforts

13
 KEY TAKEAWAYS

Do’s þ Don’t’sý

•Remember that each individual is •Command the person to avail help, if

unique and has own unique response he or she does not wish to accept
for crisis help
•Keep in mind to respect the dignity, •Argue or threaten the person or be
norms, culture and traditions of the hostile
respective communities •Blame the person for his or her
•Allow the person to decide when to problems
open up about his or her concerns •Be sarcastic, over involved or over
•Be an active listener, observe the protective
verbal and non-verbal cues in •Take decision for others
communication •Force the person to lead life based on
•Ensure to provide continuous support your values
•Know your boundaries and limits •Give promises which you cannot keep
•Encourage the person to come up with up
his or her own solutions to solve their •Commit to share the person’s
problems responsibilities or offer solutions to
•Be sure to provide authentic and their problems
transparent information, appropriate to •Take any ownership of success or
their circumstances failure
•Remember that only a mental health •Share your own problems or troubles
professional can diagnose a mental •Assume that the signs you notice are
health disorder minor or diagnose the condition

14
To conclude, some people are vulnerable to develop a mental
health issue and may need extra help during this crisis
situation of COVID-19 pandemic. Therefore, Immediate Care
interventions help such people by making them feel safe,
calm and hopeful through access to social, and emotional
support and to recognize their abilities to help themselves.
Being an aider, you can go a long way to be a helping hand to
the communities during this pandemic crisis.

15
If you would like to contact the Department of Mental Health Education, NIMHANS:
Call 080-26995156 or Send a mail to [email protected]

Corresponding Address:
Department of Mental Health Education
Ground Floor, Dr. M V Govindaswamy Centre
NIMHANS, Hosur Road, Bengaluru-560029