Islamic Republic of Iran focuses on innovative approaches in essential mental health services amid COVID-19 pandemic

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13 July 2021 – Following the World Health Organization (WHO)'s declaration of the COVID-19 pandemic as a public health emergency, the Department for Mental Health and Substance Abuse of the Ministry of Health and Medical Education of Islamic Republic of Iran developed an evidence-based response plan as of March 2020. In line with WHO guidelines for mental health and essential services through the COVID-19 pandemic and supported by WHO country office, the plan provides psychosocial and consultation support using a wide range of approaches and implementing best practices from around the world.

As the COVID-19 pandemic continues to sweep rapidly across the world, it is stirring up a considerable amount of anxiety in the public at large, but particularly among certain groups, such as older adults, people with underlying health conditions, and care providers. New measures taken against the pandemic such as physical distancing and home quarantines have given rise to psychosocial problems as a result of loneliness and depression, leading to self-harm or suicidal behaviour. In such a context, access to and continuity of mental health services for people with developing or existing conditions remain a major concern.

To create a systematic approach, a rapid assessment was first conducted by the Ministry to identify the population’s mental health needs, as well as requirements of the mental health system in terms of human and financial resources, infrastructure, and other relevant areas. These were then prioritized and a response plan was designed to address the mental health issues of individuals affected by the lockdowns, those who contracted and recovered from COVID-19, as well as the bereaved.

Even before arriving at this approach, various training packages were developed for capacity-building among mental health care staff within the primary health care system, including manuals for teaching stress management, problem solving in crisis, dealing with stress among children and adolescents, mental health support for health managers, managing suicidal ideas, and remote counselling training.

Only 3 weeks after the first COVID-19 cases were reported in Islamic Republic of Iran, the Ministry of Health and Medical Education, with support from the Ministry of Information and Communications Technology, set up a national helpline to create access to mental health professionals for the general population with 2 extensions: one associated with automatic replies to frequently asked questions, and another for trained mental health staff to provide individualized service over the phone. Complaints of depressive symptoms have been reported to be increasing among the general population, making depression one of the most prevalent problems. According to official reports, an average of 5,130 calls were answered daily in the first 9 months of the outbreak. Therefore, efforts have also been made to improve each care provider’s knowledge and skills to address various mental and psychosocial needs, mainly focusing on problems related to the COVID-19 outbreak.

An Iranian version of the WHO regional mental health and psychosocial support platform was developed and launched to facilitate access to mental health care services. The illustrated stress management guide by WHO, Doing What Matters in Times of Stress, was also translated into Farsi and modified according to Iranian culture and made available on the WHO website.

Grieving the loss of a loved one during the COVID-19 pandemic can be overwhelming as individuals can suffer fear and anxiety alongside their sorrow. This can lead to complicated grief impacting their mental health for the worse. The Ministry has designed interventions for the prevention of complicated grief among COVID-19 survivors, including guidelines for dealing with survivors and giving bad news by trained hospital staff, guidelines for safe burials that are considerate towards emotional, cultural and religious nuances, and guidelines for people wishing to commemorate their lost loved ones in funerals.

Further, more sophisticated interventions such as regular counselling sessions to prevent complicated grief were designed to provide psychological counselling services for survivors of lives lost to COVID-19 with the contribution of the Iranian Psychiatric Association and the Iran University of Medical Sciences.

The Ministry also devised a programme to provide mental health services for those recovering from COVID-19 while considering an association between severity of COVID-19 illness and mental disorders. This intervention, mainly provided by the mental health staff and general practitioners at public health centres, aims at detection, management, and care for mental problems among individuals recovering from the disease. Within the programme, those suspected of suffering a mental health condition via a phone screening system are referred to general practitioners in public health centres for clinical management as per the WHO Mental Health Gap Action Programme (mhGAP). Others are followed up on a tri-monthly basis for a year by phone. Pharmaceutical intervention, referral to hospitals and psychiatrists, and one-year-long routine periodic follow-ups are considered when needed. Here, patients are also given the option to benefit from face-to-face psychoeducational sessions based on their diagnosis.

Due to the unknown nature of the virus, further studies are required on the psychosocial needs of the general population, different age categories, and vulnerable groups during the pandemic. In the meantime, planning and promoting the physical and mental health literacy within communities could play a crucial role in anticipating and preventing adverse outcomes.