Psychological and containment: how to maintain follow-up

March 31, 2020

As of the second day of confinement, WHO was giving advice on preserving everyone's mental health. Psychologists who have closed their offices face a 90% drop in their patient base, whereas, on the contrary, maintaining contact with their therapist is essential. During this period when anxious people, but also the sick and their loved ones need psychological support, teleconsultations make it possible to reproduce the conditions of the bond of empathy constituting the psychotherapeutic relationship.

 

Confinement and psychological distress

The impact of containment has many aspects that may last over time. This unprecedented situation radically changes the context of life, the population is disoriented and lives in fear. Panic may have now given way to deep anxiety.

In fact, more and more people are affected by the virus directly or indirectly. For all the others, trapped at health home, uneasiness or even depression are signs that can start to appear. For people who are psychologically fragile and already under the care of a professional, the symptoms may worsen. The need for psychological shelters has become significant.

According to the medical journal The Lancet 1, uconfinement longer than 10 days can lead to post-traumatic symptoms, avoidance and anger behavior. Stress due to fear of infection, worry, boredom, frustration and isolation require regular psychological reinforcements. More than ever, psychologists can explain and disseminate the behavior to be followed, and help reduce rumors and false anxiety-provoking information.

Finally, in this health context, families affected by death cannot accompany the persons concerned and the funeral is abridged. This can make it impossible to grieve. To this end, it is also necessary to ensure continuity of psychological support services.

However, the confinement limiting travel and contacts, consultations can no longer be done in the office.

The challenge of teleconsultation

One of the fundamental challenges of teleconsultations is to provide a psychological response to this health crisis situation.

A Chinese survey on the degree of psychological distress, following the covid epidemic 19, suggests behavior to be followed in terms of psychological support: the specific needs of vulnerable groups such as young people aged 18 to 30 or the elderly, require special attention. Psychological support and accompaniment sessions must therefore be organized during confinement, in the form of teleconsultations. An interrogation adapted to the specific cases of Covid-19 then allows to keep the link with fragile patients while taking into account the context.

However, despite an increase in teleconsultation initiatives, the use for psychological support does not yet seem sufficiently widespread.

Why psychotherapists should use teleconsultations

In this epidemic context, psychologists and psychiatrists must be able to guarantee continuity of care. It is essential to relieve the anxiety of those who are suffering, and to prevent decompensations from clogging up emergencies.

A flexible and simple device, teleconsultation extends the availability of professionals and allows intervention in the event of distress to prevent severe relapses. The online consultation also provides a voice space for anxious people, who may need short-term help.

Teleconsultation thus makes it possible to maintain therapeutic work in a framework that guarantees quality and autonomy, and all this without travel.

Good practices for the use of teleconsultation in psychology

EFPA (European Federation of Psychologists ’Associations2) highlights the added value and importance of teleconsultations. With use, practitioners have the feeling of being immersed in the interaction with their patient, without paying attention to the distance. With experience, teleconsultation psychotherapy sessions lead to results similar to conventional interactions.

The use of teleconsultation in psychology, however, requires a set of good practices in order to establish a communication of trust with patients.

  • Suggest and discuss this option with the patient beforehand.

  • Emphasize the importance of continuing therapy and using teleconsultations for the time being. This helps to understand the patient’s reaction to the use of technology and will also give a better view of how to respond to an emergency.

  • Ensure that the patient is able to settle in an isolated and calm room. Faced with sources of potential disturbance, patients can be invited to reconstruct the conditions of a certain intimacy. Simple rules can be reminded explicitly, when dealing with patients, such as turning off the cell phone, and getting organized so as not to be disturbed.

  • Use professional tools: do not use general public, unsecured messaging, such as Messenger, WhatsApp, Skype or Telegram. A secure platform like Hellocare is highly recommended since it is provided for this purpose.

  • Be careful not to use a public computer and use an up-to-date operating system and applications so that technical conditions are optimal.

The effects of the pandemic and containment are far-reaching and will last. The stabilization work will be long for the patients affected by the Covid 19 and their families, for the healthcare teams and for a whole section of the population. This experience will shake up individuals, the health system and public policies. Therefore, psychosocial follow-up strategies must be implemented now to combine collective approaches, and deploy the means so that everyone can quickly access a practitioner.

1- The psychological impact of quarantine and how to reduce it: rapid review of the evidence – https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext2- http://www.efpa.eu/