Strengthening the delivery of mental health services to the Ebola virus disease survivors

Ebola virus disease (EVD) is a rare tropical disease, with case fatality ranging from 25% to 90%[1]. As this infection is transmitted between humans via close contact, this led to the emergence of stigma against people who were diagnosed with the infection[1,2]. The latest outbreak of EVD was caused by the Sudan Ebola virus that affected nine districts of Uganda, and accounted for 164 cases and 77 deaths[3]. Even though it was declared that this outbreak has ended, the health authorities have maintained surveillance to quickly detect and effectively respond to any new cases[3]. In addition, a follow-up program has been initiated to support disease survivors and neighboring nations are instructed to be on high alert[3]. The purpose of the current article was to justify the need to extend mental health support to the survivors of EVD outbreaks, identify the existing barriers which limit the delivery of mental healthcare services, and propose remedial measures to overcome these earmarked barriers. EVD outbreaks have been linked to multiple psychological and mental health conditions (viz. anxiety, depression, sleep disorders, etc.)[3]. This can be attributed to excessive stigma which the family members of the known patients are often subjected to, which forces them to isolate themselves from the local community[4]. Further, as many victims, including healthcare professionals lost their lives owing to the disease-associated complications, there was a sense of fear among the affected population[1,4]. It is an alarming fact that healthcare professionals also suffer from a spectrum of mental health conditions, as they are constantly being working in an extremely emotionally draining situation[5]. The provision of timely mental health services plays a vital role in aiding the affected individual to cope with their loss[4,5]. As mentioned earlier, the timely provision of psychological assistance is vital for improving resilience and promoting reintegration of the affected person or their families into the community[6]. As sound mental health is a prerequisite for optimal mental health, if we succeed in improving mental wellbeing, a significant improvement in overall health can be simultaneously accomplished[5,6]. In-fact, these services can also be crucial in mitigating the incidence of substance abuse, as the majority of the survivors resort to some form of drug abuse to deal with their loss of family members[7]. The presence of all these factors establishes the need to provide mental health support to patients, their family members, and healthcare providers[6-8]. Despite the necessity to provide quality assured mental healthcare services, multiple barriers have been earmarked that prevent the health sector in delivering easily accessible and affordable services to the affected populations[6-11]. The primary concern is the limited availability of trained and qualified manpower and medications, especially in low-resource settings, because of which it becomes highly improbable to deliver timely[6,7]. To overcome this problem, the immediate solution would be to train and empower locally available health workers in basic mental health so that they can provide preliminary guidance and recognize people who require professional consultation[6]. Other potential remedial measures could be use of mobile clinics or telemedicine to enable remote consultation with mental health professionals[8]. The next major concern is the presence of other competing health priorities (viz. containment of the ongoing EVD outbreak) due to which mental health support cannot be prioritized[1,6]. The most effective and efficient approach will be to rope in psychiatrists/ psychologists as one of the members of the emergency response team, who will look after the psychological concerns of the affected populations[9]. To overcome shortage of resources and logistics, the public health sector can develop partnerships with private sector or philanthropic organizations and accordingly mobilize resources for efficient delivery of mental health services[1,7]. The next concern is the fear of acquiring the infection if they come to avail mental healthcare services, and hence even those people who acknowledge that they need assistance just don’t turn up for consultation[5]. The management of this concern will require setting up earmarked places in healthcare facilities, where no patients of EVD are managed and thus the risk of acquiring the infection is negligible[10]. Simultaneously, there is an indispensable need to strengthen infection prevention and control measures, and all these precautionary measures taken for the benefit of the general population must be communicated to the masses[10]. Furthermore, the scope of extending mental health support via home visits can also be explored, as this will neutralize any form of exposure to high-risk atmosphere[7]. In these difficult times, where people are stigmatized, which not only results in the development of mental health problems, but also discourages people from seeking timely psychological assistance[5,7]. The best possible approach to overcome this barrier is by creating awareness about the disease among the affected population groups, and to simultaneously address the issue of stigma and the need to avail mental healthcare services for improved resilience[6,11]. These awareness activities must be also used to clarify the prevailing myths and encourage people to be proactive in seeking psychological assistance[11]. It is quite essential that all these awareness activities are culturally relevant, as this will significantly improve acceptance among the affected population groups[1,11]. However, the sustainable approach would be to merge mental healthcare services with delivery of primary healthcare, and this will significantly ensure holistic health[9,10]. Amid the circumstances where people often lose their employments, it becomes quite difficult for the affected people to afford mental healthcare services[7]. This will require delivery of free or subsidized mental health support to the patients, with the intention that monetary factors should not be the reason for not availing desired healthcare[1,5,7]. In conclusion, the EVD outbreaks have played a significant role in the emergence of multiple psychological effects, which justifies the need to strengthen mental health services. However, the timely delivery of mental health services can be accomplished by overcoming the existing barriers and improving the reach of mental health services to improve community resilience. Conflict of interest statement The authors declare that there are no conflicts of interest. Funding The authors received no extramural funding for the study. Authors’ contributions SRS contributed in the conception or design of the work, drafting of the work. PSB and GB contributed in the literature review, revision of the manuscript for important intellectual content, and agreed for all aspects of the work. All authors approved the final version of the manuscript, and agreed for all aspects of the work. Publisher’s note The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Edited by Zhang Q, Lei Y, Pan Y