Article from ltccovid.org



center000MENTAL HEALTH POLICY RESPONSE DURING COVID-19: SUPPORT FOR CARE WORKERSKaylee KnowlesLast updated 7 June 2020AuthorsKaylee Knowles (Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science)This document is available through the website , which was set up in March 2020 as a rapidly shared collection of resources for community and institution-based long-term care responses to Covid-19. The website is hosted by CPEC at the London School of Economics and Political Science and draws on the resources of the International Long Term Care Policy Network.Corrections and comments are welcome at info@. This document was last updated on 7 June 2020 and may be subject to revision.Copyright: ? 2020 The Author(s). This is an open-access document distributed under the terms of the Creative Commons Attribution NonCommercial-NoDerivs 3.0 Unported International License (CC BY-NC-ND 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See citationKnowles, K. M. (2020). Global mental health policy response during COVID-19: Support for care workers. Report in , International Long-Term Care Policy Network, CPEC-LSE, 7 June 2020.Follow us on Twitter@LTCcovid, @_KayleeKnowlesAcknowledgementsThe author would like to thank Martin Knapp (Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science) and Adelina Comas-Herrera (Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science) for their support identifying the need for this research.Key pointsThe need to support care worker mental health is identified using evidence following prior large-scale traumatic events.Care workers with mental health problems during COVID-19 should be identified and connected to support services as early as possible. Summary of mental health policy response to support care workers in Australia and China. Policy recommendations to support the mental health of care workers include the use of digital technologies, creating a supportive working environment, debriefing adverse events, mental health first aid training, and counselling.The recovery approach may be used for care workers to continue employment or return to work with proper support.Implementation challenges in mental health policy are due to the integrated nature of mental health, and traditionally-segmented nature of funding resulting in the complications related to ‘delayed pay-off’, ‘transmitted pay-off’, and ‘silo mismatch’.Mental health policies must be locally tailored to the needs of care workers, which will vary according to the design of health and social care systems.Introduction A health system is defined by the World Health Organization (WHO) as “all the activities whose primary purpose is to promote, restore or maintain health” ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rF56kq0H","properties":{"formattedCitation":"(World Health Organization, 2000)","plainCitation":"(World Health Organization, 2000)","noteIndex":0},"citationItems":[{"id":11,"uris":[""],"uri":[""],"itemData":{"id":11,"type":"chapter","container-title":"The World Health Report 2000","page":"2-19","title":"Chapter 1: Why do health systems matter?","URL":"","author":[{"literal":"World Health Organization"}],"issued":{"date-parts":[["2000"]]}}}],"schema":""} (World Health Organization, 2000). By this definition mental health, ambulatory care, public health, home care, hospitals, nursing homes, etc. are all part of the health system. Research, however, is conducted in hospitals more than in other settings ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PMYUFF1o","properties":{"formattedCitation":"(Goddard & Jacobs, 2009)","plainCitation":"(Goddard & Jacobs, 2009)","noteIndex":0},"citationItems":[{"id":54,"uris":[""],"uri":[""],"itemData":{"id":54,"type":"chapter","container-title":"Performance measurement for health system improvement: Experiences, challenges, and prospects","event-place":"New York, NY","page":"339-368","publisher":"Cambridge University Press","publisher-place":"New York, NY","title":"Using composite indicators to measure performance","author":[{"family":"Goddard","given":"Maria"},{"family":"Jacobs","given":"Rowena"}],"issued":{"date-parts":[["2009"]]}}}],"schema":""} (Goddard & Jacobs, 2009). There is a marked lack of research regarding staff wellbeing in health and social care settings, and even less research about the mental health of these groups during a pandemic. This paper presents an overview of policies supporting the mental health of care workers during the coronavirus disease 2019 (COVID-19) pandemic. Policy responses from China and Australia are discussed. Suggestions are presented for further policy development according to learnings from prior events of mass trauma.For the purposes of this paper a ‘care worker’ is defined as a person who is paid to provide care for individuals unable to manage without support and encompasses both health care workers and social care workers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"DGocVHsz","properties":{"formattedCitation":"(Local Government Association & NHS Clinical Commissioners, 2018)","plainCitation":"(Local Government Association & NHS Clinical Commissioners, 2018)","noteIndex":0},"citationItems":[{"id":76,"uris":[""],"uri":[""],"itemData":{"id":76,"type":"report","abstract":"Carer: \"A person who provides unpaid support to a partner, family member, friend or neighbour who is ill, struggling or disabled and could not manage without this help. This is distinct from a care worker, who is paid to care for people.”","title":"Integrated commissioning for better outcomes: A commissioning framework","URL":"","author":[{"literal":"Local Government Association"},{"literal":"NHS Clinical Commissioners"}],"issued":{"date-parts":[["2018"]]}}}],"schema":""} (Local Government Association & NHS Clinical Commissioners, 2018). ‘Health care worker’ refers to those employed within medical settings, such as doctors or nurses working in hospitals, primary care, mental health providers in medical settings, etc. ‘Social care worker’ refers to employees of adult social care settings, such as nursing home staff, social workers, paid in-home carers, etc. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"xWBubHlI","properties":{"formattedCitation":"(School for Social Care Research, National Institute for Health Research, n.d.)","plainCitation":"(School for Social Care Research, National Institute for Health Research, n.d.)","noteIndex":0},"citationItems":[{"id":77,"uris":[""],"uri":[""],"itemData":{"id":77,"type":"article","title":"Developing Evidence in Adult Social Care","URL":"","author":[{"literal":"School for Social Care Research, National Institute for Health Research"}],"issued":{"literal":"n.d."}}}],"schema":""} (School for Social Care Research, National Institute for Health Research, n.d.). Informal carers (unpaid caregivers) are excluded from this discussion. The need to support mental health for care workersOn 11 March 2020, the WHO declared COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), to be a pandemic ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"JFLL50ir","properties":{"formattedCitation":"(World Health Organization, 2020)","plainCitation":"(World Health Organization, 2020)","noteIndex":0},"citationItems":[{"id":78,"uris":[""],"uri":[""],"itemData":{"id":78,"type":"article","title":"WHO Timeline - COVID-19","URL":"","author":[{"literal":"World Health Organization"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020",4,27]]}}}],"schema":""} (World Health Organization, 2020). In early stages of the pandemic, the response to COVID-19 across most of the world was focused on wellbeing ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ZGE3tcc2","properties":{"formattedCitation":"(Knapp, 2020c)","plainCitation":"(Knapp, 2020c)","noteIndex":0},"citationItems":[{"id":83,"uris":[""],"uri":[""],"itemData":{"id":83,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 10: Enduring challenges: Translating evidence & experience into policy","URL":"","author":[{"family":"Knapp","given":"Martin"}],"issued":{"date-parts":[["2020",3,30]]}}}],"schema":""} (Knapp, 2020c). Wellbeing encompasses physical health, mental health, independence, work/education, dignity, relationships, economics, and more ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rNNOQYVp","properties":{"formattedCitation":"(Local Government Association & NHS Clinical Commissioners, 2018)","plainCitation":"(Local Government Association & NHS Clinical Commissioners, 2018)","noteIndex":0},"citationItems":[{"id":76,"uris":[""],"uri":[""],"itemData":{"id":76,"type":"report","abstract":"Carer: \"A person who provides unpaid support to a partner, family member, friend or neighbour who is ill, struggling or disabled and could not manage without this help. This is distinct from a care worker, who is paid to care for people.”","title":"Integrated commissioning for better outcomes: A commissioning framework","URL":"","author":[{"literal":"Local Government Association"},{"literal":"NHS Clinical Commissioners"}],"issued":{"date-parts":[["2018"]]}}}],"schema":""} (Local Government Association & NHS Clinical Commissioners, 2018). While the impact of COVID-19 on societal mental health has been discussed in the literature ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"kyvqGwk1","properties":{"formattedCitation":"(Duan & Zhu, 2020; Xiang et al., 2020)","plainCitation":"(Duan & Zhu, 2020; Xiang et al., 2020)","noteIndex":0},"citationItems":[{"id":86,"uris":[""],"uri":[""],"itemData":{"id":86,"type":"article-journal","container-title":"The Lancet Psychiatry","DOI":"10.1016/S2215-0366(20)30073-0","ISSN":"2215-0366","issue":"4","note":"publisher: Elsevier","page":"300-302","title":"Psychological interventions for people affected by the COVID-19 epidemic","URL":"(20)30073-0","volume":"7","author":[{"family":"Duan","given":"Li"},{"family":"Zhu","given":"Gang"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020",4,1]]}}},{"id":90,"uris":[""],"uri":[""],"itemData":{"id":90,"type":"article-journal","container-title":"The Lancet Psychiatry","DOI":"10.1016/S2215-0366(20)30046-8","ISSN":"2215-0366","issue":"3","note":"publisher: Elsevier","page":"228-229","title":"Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed","URL":"(20)30046-8","volume":"7","author":[{"family":"Xiang","given":"Yu-Tao"},{"family":"Yang","given":"Yuan"},{"family":"Li","given":"Wen"},{"family":"Zhang","given":"Ling"},{"family":"Zhang","given":"Qinge"},{"family":"Cheung","given":"Teris"},{"family":"Ng","given":"Chee H"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020",3,1]]}}}],"schema":""} (Duan & Zhu, 2020; Xiang et al., 2020), how the situation is impacting care workers has been under-represented in the research. As COVID-19 cases rose and restrictions became stricter, care workers continued through it all. Care workers regularly exposed to SARS-CoV-2 are at risk of anxiety, insomnia, stress, feelings of helplessness, isolation, and guilt related to their potential to spread the virus ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"P6guzOLc","properties":{"formattedCitation":"(Banerjee, 2020; Shultz et al., 2015; Xu et al., 2020)","plainCitation":"(Banerjee, 2020; Shultz et al., 2015; Xu et al., 2020)","noteIndex":0},"citationItems":[{"id":84,"uris":[""],"uri":[""],"itemData":{"id":84,"type":"article-journal","container-title":"Asian Journal of Psychiatry","DOI":"10.1016/j.ajp.2020.102014","ISSN":"1876-2018","journalAbbreviation":"Asian Journal of Psychiatry","page":"102014","title":"The COVID-19 outbreak: Crucial role the psychiatrists can play","URL":"","volume":"50","author":[{"family":"Banerjee","given":"Debanjan"}],"issued":{"date-parts":[["2020",4,1]]}}},{"id":122,"uris":[""],"uri":[""],"itemData":{"id":122,"type":"article-journal","abstract":"The World Health Organization (WHO) Ebola Response Roadmap declared that the affected West African countries of Guinea, Liberia, and Sierra Leone are “struggling to control the escalating outbreak” because of limited health system capacity and “rampant fear.” The WHO director-general subsequently described how fear behaviors have propelled Ebola virus transmission, citing symptomatic patients escaping from treatment units, families concealing sick relatives at home, preferential use of traditional healers, and physical contact with infectious corpses. Nevertheless, the Roadmap includes few recommendations to alleviate fear behaviors and address mental health needs in Ebola-affected communities.","container-title":"JAMA","DOI":"10.1001/jama.2014.17934","ISSN":"0098-7484","issue":"6","journalAbbreviation":"JAMA","page":"567-568","title":"The 2014 Ebola Outbreak and Mental Health: Current Status and Recommended Response","URL":"","volume":"313","author":[{"family":"Shultz","given":"James M."},{"family":"Baingana","given":"Florence"},{"family":"Neria","given":"Yuval"}],"accessed":{"date-parts":[["2020",6,5]]},"issued":{"date-parts":[["2015",2,10]]}}},{"id":131,"uris":[""],"uri":[""],"itemData":{"id":131,"type":"article-journal","abstract":"The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which appeared in early December 2019, had an atypical viral pneumonia outbreak in Wuhan, Hubei, China. And there is a high risk of global proliferation and impact. The sudden increase in confirmed cases has brought tremendous stress and anxiety to frontline surgical staff. The results showed that the anxiety and depression of surgical staff during the outbreak period were significantly higher and mental health problems appeared, so psychological interventions are essential.","container-title":"Psychiatry Research","DOI":"10.1016/j.psychres.2020.112955","ISSN":"0165-1781","journalAbbreviation":"Psychiatry Research","page":"112955","title":"Psychological status of surgical staff during the COVID-19 outbreak","URL":"","volume":"288","author":[{"family":"Xu","given":"Jian"},{"family":"Xu","given":"Qian-hui"},{"family":"Wang","given":"Chang-ming"},{"family":"Wang","given":"Jun"}],"issued":{"date-parts":[["2020",6,1]]}}}],"schema":""} (Banerjee, 2020; Shultz et al., 2015; Xu et al., 2020). These mental health conditions may negatively impact their ability to function properly at work and at home. Without supportive measures, care workers are at increased risk of absenteeism and/or providing poor care to patients/clients ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hVMKY88w","properties":{"formattedCitation":"(Banerjee, 2020)","plainCitation":"(Banerjee, 2020)","noteIndex":0},"citationItems":[{"id":84,"uris":[""],"uri":[""],"itemData":{"id":84,"type":"article-journal","container-title":"Asian Journal of Psychiatry","DOI":"10.1016/j.ajp.2020.102014","ISSN":"1876-2018","journalAbbreviation":"Asian Journal of Psychiatry","page":"102014","title":"The COVID-19 outbreak: Crucial role the psychiatrists can play","URL":"","volume":"50","author":[{"family":"Banerjee","given":"Debanjan"}],"issued":{"date-parts":[["2020",4,1]]}}}],"schema":""} (Banerjee, 2020). During COVID-19, health care workers are exposed to frequent trauma ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Tn6apbV1","properties":{"formattedCitation":"(Bao et al., 2020)","plainCitation":"(Bao et al., 2020)","noteIndex":0},"citationItems":[{"id":103,"uris":[""],"uri":[""],"itemData":{"id":103,"type":"article-journal","container-title":"The Lancet","DOI":"10.1016/S0140-6736(20)30309-3","ISSN":"0140-6736","issue":"10224","note":"publisher: Elsevier","page":"e37-e38","title":"2019-nCoV epidemic: address mental health care to empower society","URL":"(20)30309-3","volume":"395","author":[{"family":"Bao","given":"Yanping"},{"family":"Sun","given":"Yankun"},{"family":"Meng","given":"Shiqiu"},{"family":"Shi","given":"Jie"},{"family":"Lu","given":"Lin"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2020",2,22]]}}}],"schema":""} (Bao et al., 2020), and, compared to the general public, are at a greater risk of post-traumatic stress following a pandemic ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"bJ4hDVzc","properties":{"formattedCitation":"(Cheng et al., 2004; Wu et al., 2009)","plainCitation":"(Cheng et al., 2004; Wu et al., 2009)","noteIndex":0},"citationItems":[{"id":94,"uris":[""],"uri":[""],"itemData":{"id":94,"type":"article-journal","abstract":"Background. Severe acute respiratory syndrome (SARS) is a novel disease. The authors have limited knowledge of its impact on mental health. The present study aimed to examine the level and extent of psychological distress of SARS survivors following 1-month recovery, to explore patients' negative appraisals of the impact of SARS, and to evaluate the associations between psychological distress and negative appraisals.Method. The Beck Anxiety Inventory, the Beck Depression Inventory, and a newly developed measure, the SARS Impact Scale (SIS), were mailed to 453 Hong Kong Chinese SARS survivors discharged from hospital for 4 weeks or more.Results. A total of 425 patients received the questionnaires and 180 (mean age 36·9 years; 120 women) gave valid replies. The response rate was 42·4%. The participants also represented 13·6% of all adult survivors in Hong Kong. About 35% of respondents reported ‘moderate to severe’ or ‘severe’ ranges of anxiety and/or depressive symptoms. It was found that those working as healthcare workers or having family members killed by SARS were more prone to develop subsequent high levels of distress. Factor analyses extracted three meaningful factors of the SIS, namely ‘survival threat’, ‘physical impact’, and ‘social impact’. Negative appraisals at the acute phase and 1-month recovery significantly accounted for substantial portions of variances for anxiety and depressive symptoms, after the effects of other psychosocial variables were controlled.Conclusions. Psychological distress of SARS survivors at 1-month recovery is real and significant. Negative appraisals may play a pivotal role in the development of psychological distress for SARS survivors, at least in the short term.","archive":"Cambridge Core","container-title":"Psychological Medicine","DOI":"10.1017/S0033291704002272","ISSN":"0033-2917","issue":"7","note":"edition: 2004/10/21\npublisher: Cambridge University Press","page":"1187-1195","source":"Cambridge University Press","title":"Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS)","URL":"","volume":"34","author":[{"family":"Cheng","given":"S. K. W."},{"family":"Wong","given":"C. W."},{"family":"Tsang","given":"J."},{"family":"Wong","given":"K. C."}],"issued":{"date-parts":[["2004"]]}}},{"id":92,"uris":[""],"uri":[""],"itemData":{"id":92,"type":"article-journal","abstract":"Objective:We examined the psychological impact of the 2003 outbreak of severe acute respiratory syndrome (SARS) on hospital employees in Beijing, China.Methods:In 2006, randomly selected employees (n = 549) of a hospital in Beijing were surveyed concerning their exposure to the 2003 SARS outbreak, and the ways in which the outbreak had affected their mental health.Results:About 10% of the respondents had experienced high levels of posttraumatic stress (PTS) symptoms since the SARS outbreak. Respondents who had been quarantined, or worked in high-risk locations such as SARS wards, or had friends or close relatives who contracted SARS, were 2 to 3 times more likely to have high PTS symptom levels, than those without these exposures. Respondents' perceptions of SARS-related risks were significantly positively associated with PTS symptom levels and partially mediated the effects of exposure. Altruistic acceptance of work-related risks was negatively related to PTS levels.Conclusions:The psychological impact of stressful events related to an infectious disease outbreak may be mediated by peoples' perceptions of those events; altruism may help to protect some health care workers against these negative impacts.","container-title":"The Canadian Journal of Psychiatry","DOI":"10.1177/070674370905400504","ISSN":"0706-7437","issue":"5","journalAbbreviation":"Can J Psychiatry","note":"publisher: SAGE Publications Inc","page":"302-311","title":"The Psychological Impact of the SARS Epidemic on Hospital Employees in China: Exposure, Risk Perception, and Altruistic Acceptance of Risk","URL":"","volume":"54","author":[{"family":"Wu","given":"Ping"},{"family":"Fang","given":"Yunyun"},{"family":"Guan","given":"Zhiqiang"},{"family":"Fan","given":"Bin"},{"family":"Kong","given":"Junhui"},{"family":"Yao","given":"Zhongling"},{"family":"Liu","given":"Xinhua"},{"family":"Fuller","given":"Cordelia J"},{"family":"Susser","given":"Ezra"},{"family":"Lu","given":"Jin"},{"family":"Hoven","given":"Christina W"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2009",5,1]]}}}],"schema":""} (Cheng et al., 2004; Wu et al., 2009). Workers in care homes are also exposed to trauma regularly, with 16% reporting to have witnessed abuse of residents living with dementia ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"taLCuAlV","properties":{"formattedCitation":"(Livingston et al., 2017)","plainCitation":"(Livingston et al., 2017)","noteIndex":0},"citationItems":[{"id":161,"uris":[""],"uri":[""],"itemData":{"id":161,"type":"article-journal","container-title":"The Lancet","DOI":"10.1016/S0140-6736(17)31363-6","ISSN":"0140-6736","issue":"10113","note":"publisher: Elsevier","page":"2673-2734","title":"Dementia prevention, intervention, and care","URL":"(17)31363-6","volume":"390","author":[{"family":"Livingston","given":"Gill"},{"family":"Sommerlad","given":"Andrew"},{"family":"Orgeta","given":"Vasiliki"},{"family":"Costafreda","given":"Sergi G"},{"family":"Huntley","given":"Jonathan"},{"family":"Ames","given":"David"},{"family":"Ballard","given":"Clive"},{"family":"Banerjee","given":"Sube"},{"family":"Burns","given":"Alistair"},{"family":"Cohen-Mansfield","given":"Jiska"},{"family":"Cooper","given":"Claudia"},{"family":"Fox","given":"Nick"},{"family":"Gitlin","given":"Laura N"},{"family":"Howard","given":"Robert"},{"family":"Kales","given":"Helen C"},{"family":"Larson","given":"Eric B"},{"family":"Ritchie","given":"Karen"},{"family":"Rockwood","given":"Kenneth"},{"family":"Sampson","given":"Elizabeth L"},{"family":"Samus","given":"Quincy"},{"family":"Schneider","given":"Lon S"},{"family":"Selb?k","given":"Geir"},{"family":"Teri","given":"Linda"},{"family":"Mukadam","given":"Naaheed"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2017",12,16]]}}}],"schema":""} (Livingston et al., 2017). New evidence about COVID-19 continues to emerge, and the risk of common mental health disorders associated with uncertainty intolerance is a concern ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"LqfAt1Wi","properties":{"formattedCitation":"(BeyondBlue, 2020b; Dar et al., 2017)","plainCitation":"(BeyondBlue, 2020b; Dar et al., 2017)","noteIndex":0},"citationItems":[{"id":195,"uris":[""],"uri":[""],"itemData":{"id":195,"type":"webpage","title":"On the frontline: how healthcare workers can support themselves and each other","URL":"","author":[{"literal":"BeyondBlue"}],"issued":{"date-parts":[["2020"]]}}},{"id":101,"uris":[""],"uri":[""],"itemData":{"id":101,"type":"article-journal","abstract":"The present study sought to examine the indirect and moderating effects of worry between intolerance of uncertainty (IU) and symptoms of depression and anxiety. The study was a cross sectional study. Data were collected from 120 psychiatric patients, aged 22 to 37 years. A battery of self-report questionnaires was administered for tapping IU, worry, depression and anxiety symptoms. Results from indirect effects analyses revealed that even though IU, worry, depression, and anxiety symptoms correlated moderately with each other, worry carried a substantial proportion of variance in predicting symptoms of depression and anxiety. However, the relative effect was more pronounced for anxiety compared to depression symptoms. The results from hierarchical analyses supported the moderator role of worry. More specifically, a high level of worry enhanced the association between IU and symptoms of depression and anxiety. Given the potential for worry as a mechanism, and/or moderator between IU and symptoms of depression and anxiety, adults with a tendency to use this negative repetitive thought process (e.g. worry) may be at higher risk to develop psychological symptoms.","container-title":"Asian Journal of Psychiatry","DOI":"10.1016/j.ajp.2017.04.017","ISSN":"1876-2018","journalAbbreviation":"Asian Journal of Psychiatry","page":"129-133","title":"Intolerance of uncertainty, depression, and anxiety: Examining the indirect and moderating effects of worry","URL":"","volume":"29","author":[{"family":"Dar","given":"Kaiser Ahmad"},{"family":"Iqbal","given":"Naved"},{"family":"Mushtaq","given":"Arbaaz"}],"issued":{"date-parts":[["2017",10,1]]}}}],"schema":""} (BeyondBlue, 2020b; Dar et al., 2017). The fear of contracting COVID-19 may precipitate mental health decline ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"4uMAkpej","properties":{"formattedCitation":"(Kavoor et al., 2020; Xiang et al., 2020)","plainCitation":"(Kavoor et al., 2020; Xiang et al., 2020)","noteIndex":0},"citationItems":[{"id":107,"uris":[""],"uri":[""],"itemData":{"id":107,"type":"article-journal","abstract":"In the wake of the recent pandemic of Corona Virus Disease 2019 (COVID-19), with confirmed cases having crossed 750,000, health systems across the world are getting overwhelmed; making it strenuous to maintain essential health services. Several changes were implemented in our acute mental health care service using a collaborative approach to maintain a balance between preventive measures to ‘flatten the curve’ and to provide care to those who were in need. Mode of service delivery was changed predominantly to tele-medicine, amongst others. It was found to be a workable model, albeit further follow up will be required to better understand its viability and feasibility to withstand the COVID-19 cataclysm.","container-title":"Asian Journal of Psychiatry","DOI":"10.1016/j.ajp.2020.102074","ISSN":"1876-2018","journalAbbreviation":"Asian Journal of Psychiatry","page":"102074","title":"Remote consultations in the era of COVID-19 pandemic: Preliminary experience in a regional Australian public acute mental health care setting","URL":"","volume":"51","author":[{"family":"Kavoor","given":"Anjana Rao"},{"family":"Chakravarthy","given":"Kripa"},{"family":"John","given":"Thomas"}],"issued":{"date-parts":[["2020",6,1]]}}},{"id":90,"uris":[""],"uri":[""],"itemData":{"id":90,"type":"article-journal","container-title":"The Lancet Psychiatry","DOI":"10.1016/S2215-0366(20)30046-8","ISSN":"2215-0366","issue":"3","note":"publisher: Elsevier","page":"228-229","title":"Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed","URL":"(20)30046-8","volume":"7","author":[{"family":"Xiang","given":"Yu-Tao"},{"family":"Yang","given":"Yuan"},{"family":"Li","given":"Wen"},{"family":"Zhang","given":"Ling"},{"family":"Zhang","given":"Qinge"},{"family":"Cheung","given":"Teris"},{"family":"Ng","given":"Chee H"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020",3,1]]}}}],"schema":""} (Kavoor et al., 2020; Xiang et al., 2020). Work stress during ‘normal’ times may exacerbate an existing mental health condition or trigger the emergence of a new condition ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"CcSet8KM","properties":{"formattedCitation":"(Knapp, 2020a; Reid et al., 1999; The Sainsbury Centre for Mental Health, 2007)","plainCitation":"(Knapp, 2020a; Reid et al., 1999; The Sainsbury Centre for Mental Health, 2007)","noteIndex":0},"citationItems":[{"id":102,"uris":[""],"uri":[""],"itemData":{"id":102,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 1: What is mental illness? What are the impacts?","URL":"","author":[{"family":"Knapp","given":"Martin"}],"issued":{"date-parts":[["2020",1,20]]}}},{"id":130,"uris":[""],"uri":[""],"itemData":{"id":130,"type":"article-journal","abstract":"Background: High levels of both burnout and job satisfaction have been found in recent studies of mental health professionals. A qualitative methodology was used in a related study to explore reasons for these findings and to investigate staff's accounts of their strategies for coping with their work, and their views of support provided for them and how their jobs might be made less stressful and still more satisfying. Methods: A semi-structured schedule was used to interview a purposive sample of 30 mental health staff drawn from three South London geographical sectors, selected to include junior and senior members of each profession in both hospital and community settings. Interviews were transcribed and analysed using QSR NUD.IST software. Results: Informal contacts with colleagues were the most frequently mentioned way of coping with the difficult and demanding aspects of work in both hospital and community settings, closely followed by time management techniques. The main formal sources of support described by staff were individual supervision and staff support groups. Accounts of the former were generally positive, but there was great variation in opinions about whether support groups are useful. Almost all the interviewees believed that their jobs could be improved by further training. For community mental health staff the main training gaps were the development of skills in various forms of clinical intervention, whilst ward staff identified the need for further skills in diffusing potentially confrontational and aggressive situations.","container-title":"Social Psychiatry and Psychiatric Epidemiology","DOI":"10.1007/s001270050149","ISSN":"1433-9285","issue":"6","journalAbbreviation":"Social Psychiatry and Psychiatric Epidemiology","page":"309-315","title":"Improving support for mental health staff: a qualitative study","URL":"","volume":"34","author":[{"family":"Reid","given":"Y."},{"family":"Johnson","given":"S."},{"family":"Morant","given":"N."},{"family":"Kuipers","given":"E."},{"family":"Szmukler","given":"G."},{"family":"Bebbington","given":"P."},{"family":"Thornicroft","given":"G."},{"family":"Prosser","given":"D."}],"issued":{"date-parts":[["1999",6,1]]}}},{"id":134,"uris":[""],"uri":[""],"itemData":{"id":134,"type":"article","abstract":"Every organisation in Britain is affected by mental distress and ill health\nin the workforce. At any one time one worker in six will be experiencing depression, anxiety or problems relating to stress. Mental ill health is normal in every workplace in the land.\nThe total cost to employers of mental health problems among their staff is estimated at nearly ?26 billion each year. That is equivalent to ?1,035 for every employee in the UK workforce.\nThe business costs of mental ill health are shown in Figure 1. They comprise:\n? ?8.4 billion a year in sickness absence. The average employee takes seven days off sick each year of which 40 per cent are for mental health problems. This adds up to 70 million lost working days a year, including one in seven directly caused by a person’s work or working conditions.\n? ?15.1 billion a year in reduced productivity at work. ‘Presenteeism’ accounts for 1.5 times as much working time lost as absenteeism and costs more to employers because it is more common among higher-paid staff.\n? ?2.4 billon a year in replacing staff who leave their jobs because of mental ill health.","title":"Policy paper 8: Mental health at work: Developing the business case","URL":"","author":[{"literal":"The Sainsbury Centre for Mental Health"}],"issued":{"date-parts":[["2007",12]]}}}],"schema":""} (Knapp, 2020a; Reid et al., 1999; The Sainsbury Centre for Mental Health, 2007). All of this is magnified during a pandemic. Social isolation can be harmful, as experienced by care workers and the general population during COVID-19. While care workers are interacting with people at their place of employment regularly, they may not able to meet with friends and family socially. A rapid review of quarantine during previous epidemics concluded that negative psychological effects include anger, confusion, and post-traumatic stress ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"yWcFTE4L","properties":{"formattedCitation":"(Brooks et al., 2020)","plainCitation":"(Brooks et al., 2020)","noteIndex":0},"citationItems":[{"id":128,"uris":[""],"uri":[""],"itemData":{"id":128,"type":"article-journal","container-title":"The Lancet","DOI":"10.1016/S0140-6736(20)30460-8","ISSN":"0140-6736","issue":"10227","note":"publisher: Elsevier","page":"912-920","title":"The psychological impact of quarantine and how to reduce it: rapid review of the evidence","URL":"(20)30460-8","volume":"395","author":[{"family":"Brooks","given":"Samantha K"},{"family":"Webster","given":"Rebecca K"},{"family":"Smith","given":"Louise E"},{"family":"Woodland","given":"Lisa"},{"family":"Wessely","given":"Simon"},{"family":"Greenberg","given":"Neil"},{"family":"Rubin","given":"Gideon James"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2020",3,14]]}}}],"schema":""} (Brooks et al., 2020). Consequences of untreated mental illness include lack of help-seeking behaviour, social exclusion ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aovmsbfK","properties":{"formattedCitation":"(Evans-Lacko et al., 2012; Rusch et al., 2005)","plainCitation":"(Evans-Lacko et al., 2012; Rusch et al., 2005)","noteIndex":0},"citationItems":[{"id":124,"uris":[""],"uri":[""],"itemData":{"id":124,"type":"article-journal","container-title":"Psychological Medicine","DOI":"10.1017/S0033291711002558","page":"1741–1752","title":"Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries","volume":"42","author":[{"family":"Evans-Lacko","given":"Sara"},{"family":"Brohan","given":"E"},{"family":"Mojtabai","given":"R"},{"family":"Thornicroft","given":"Graham"}],"issued":{"date-parts":[["2012"]]}}},{"id":125,"uris":[""],"uri":[""],"itemData":{"id":125,"type":"article-journal","container-title":"Psychiatrische Praxis","page":"221–232","title":"The stigma of mental illness : concepts, forms, and consequences","volume":"32","author":[{"family":"Rusch","given":"N"},{"family":"Angermeyer","given":"M. C."},{"family":"Corrigan","given":"P. W."}],"issued":{"date-parts":[["2005"]]}}}],"schema":""} (Evans-Lacko et al., 2012; Rusch et al., 2005), stigma, decreased self-efficacy ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PfoBatyB","properties":{"formattedCitation":"(Evans-Lacko et al., 2012; Link et al., n.d.)","plainCitation":"(Evans-Lacko et al., 2012; Link et al., n.d.)","noteIndex":0},"citationItems":[{"id":124,"uris":[""],"uri":[""],"itemData":{"id":124,"type":"article-journal","container-title":"Psychological Medicine","DOI":"10.1017/S0033291711002558","page":"1741–1752","title":"Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries","volume":"42","author":[{"family":"Evans-Lacko","given":"Sara"},{"family":"Brohan","given":"E"},{"family":"Mojtabai","given":"R"},{"family":"Thornicroft","given":"Graham"}],"issued":{"date-parts":[["2012"]]}}},{"id":126,"uris":[""],"uri":[""],"itemData":{"id":126,"type":"article-journal","container-title":"Psychiatric Services","page":"1621–1626","title":"Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses","volume":"52","author":[{"family":"Link","given":"B. G."},{"family":"Struening","given":"E. L."},{"family":"Neese-Todd","given":"S."},{"family":"Asmussen","given":"S"},{"family":"Phelan","given":"J. C."}]}}],"schema":""} (Evans-Lacko et al., 2012; Link et al., n.d.), increased morbidity, premature mortality, delay in receiving treatment ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Xa8gVKje","properties":{"formattedCitation":"(Thornicroft et al., 2016)","plainCitation":"(Thornicroft et al., 2016)","noteIndex":0},"citationItems":[{"id":109,"uris":[""],"uri":[""],"itemData":{"id":109,"type":"article-journal","container-title":"The Lancet","issue":"10023","page":"1123-1132","title":"Evidence for effective interventions to reduce mental-health-related stigma and discrimination","URL":"(15)00298-6","volume":"387","author":[{"family":"Thornicroft","given":"Graham"},{"family":"Mehta","given":"Nisha"},{"family":"Clement","given":"Sarah"},{"family":"Evans-Lacko","given":"Sara"},{"family":"Doherty","given":"Mary"},{"family":"Rose","given":"Diana"},{"family":"Koschorke","given":"Mirja"},{"family":"Shidhaye","given":"Rahul"},{"family":"O’Reilly","given":"Claire"},{"family":"Henderson","given":"Claire"}],"issued":{"date-parts":[["2016"]]}}}],"schema":""} (Thornicroft et al., 2016), loss of productivity, unemployment, lower income ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"9MuSOjTA","properties":{"formattedCitation":"(Evans-Lacko et al., 2012; Sharac et al., 2010)","plainCitation":"(Evans-Lacko et al., 2012; Sharac et al., 2010)","noteIndex":0},"citationItems":[{"id":124,"uris":[""],"uri":[""],"itemData":{"id":124,"type":"article-journal","container-title":"Psychological Medicine","DOI":"10.1017/S0033291711002558","page":"1741–1752","title":"Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries","volume":"42","author":[{"family":"Evans-Lacko","given":"Sara"},{"family":"Brohan","given":"E"},{"family":"Mojtabai","given":"R"},{"family":"Thornicroft","given":"Graham"}],"issued":{"date-parts":[["2012"]]}}},{"id":127,"uris":[""],"uri":[""],"itemData":{"id":127,"type":"article-journal","container-title":"Epidemiologia e Psichiatria Sociale","page":"223–232","title":"The economic impact of mental health stigma and discrimination: A systematic review","volume":"19","author":[{"family":"Sharac","given":"J"},{"family":"McCrone","given":"P"},{"family":"Clement","given":"S."},{"family":"Thornicroft","given":"Graham"}],"issued":{"date-parts":[["2010"]]}}}],"schema":""} (Evans-Lacko et al., 2012; Sharac et al., 2010), and poor physical health ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Sjq4EKTF","properties":{"formattedCitation":"(Galea, 2020)","plainCitation":"(Galea, 2020)","noteIndex":0},"citationItems":[{"id":123,"uris":[""],"uri":[""],"itemData":{"id":123,"type":"speech","genre":"Transcript","title":"The Science of Social Distancing, Part 2","URL":"","author":[{"family":"Galea","given":"Sandro"}],"issued":{"date-parts":[["2020",4,1]]}}}],"schema":""} (Galea, 2020), among many others. The Nurses' Health Study II conducted in the United States found that having post-traumatic stress disorder increases the risk of type 2 diabetes mellitus and high body mass index for women ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"3ChtgUPf","properties":{"formattedCitation":"(Roberts et al., 2015)","plainCitation":"(Roberts et al., 2015)","noteIndex":0},"citationItems":[{"id":133,"uris":[""],"uri":[""],"itemData":{"id":133,"type":"article-journal","abstract":"Posttraumatic stress disorder (PTSD) is a common, debilitating mental disorder that has been associated with type 2 diabetes mellitus (T2D) and its risk factors, including obesity, in cross-sectional studies. If PTSD increases risk of incident T2D, enhanced surveillance in high-risk populations may be warranted.To conduct one of the first longitudinal studies of PTSD and incidence of T2D in a civilian sample of women.The Nurses’ Health Study II, a US longitudinal cohort of women (N?=?49?739). We examined the association between PTSD symptoms and T2D incidence over a 22-year follow-up period.Type 2 diabetes, self-reported and confirmed with self-report of diagnostic test results, symptoms, and medications, a method previously validated by physician medical record review. Posttraumatic stress disorder was assessed by the Short Screening Scale for DSM-IV PTSD. We examined longitudinal assessments of body mass index, smoking, alcohol intake, diet quality, physical activity, and antidepressant use as mediators of possible increased risk of T2D for women with PTSD. The study hypothesis was formulated prior to PTSD ascertainment.Symptoms of PTSD were associated in a dose-response fashion with T2D incidence (1-3 symptoms: hazard ratio, 1.4 [95% CI, 1.2-1.6]; 4 or 5 symptoms; hazard ratio, 1.5 [95% CI, 1.3-1.7]; 6 or 7 symptoms: hazard ratio, 1.8 [95% CI, 1.5-2.1]). Antidepressant use and a higher body mass index associated with PTSD accounted for nearly half of the increased risk of T2D for women with PTSD. Smoking, diet quality, alcohol intake, and physical activity did not further account for increased risk of T2D for women with PTSD.Women with the highest number of PTSD symptoms had a nearly 2-fold increased risk of T2D over follow-up than women with no trauma exposure. Health professionals treating women with PTSD should be aware that these patients are at risk of increased body mass index and T2D. Comprehensive PTSD treatment should be expanded to address the health behaviors that contribute to obesity and chronic disease in affected populations.","container-title":"JAMA Psychiatry","DOI":"10.1001/jamapsychiatry.2014.2632","ISSN":"2168-622X","issue":"3","journalAbbreviation":"JAMA Psychiatry","page":"203-210","title":"Posttraumatic Stress Disorder and Incidence of Type 2 Diabetes Mellitus in a Sample of Women: A 22-Year Longitudinal Study","URL":"","volume":"72","author":[{"family":"Roberts","given":"Andrea L."},{"family":"Agnew-Blais","given":"Jessica C."},{"family":"Spiegelman","given":"Donna"},{"family":"Kubzansky","given":"Laura D."},{"family":"Mason","given":"Susan M."},{"family":"Galea","given":"Sandro"},{"family":"Hu","given":"Frank B."},{"family":"Rich-Edwards","given":"Janet W."},{"family":"Koenen","given":"Karestan C."}],"accessed":{"date-parts":[["2020",6,5]]},"issued":{"date-parts":[["2015",3,1]]}}}],"schema":""} (Roberts et al., 2015). Policies must adequately support care workers, not only to prevent them from the harmful effects of poor mental health, but to protect public health at large.Learnings from prior large-scale traumaA traumatic event is defined as, “an experience that causes physical, emotional, psychological distress, or harm … is perceived and experienced as a threat to one’s safety or to the stability of one’s world” ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XO1YdG62","properties":{"formattedCitation":"(Galea, 2020, p. 6)","plainCitation":"(Galea, 2020, p. 6)","noteIndex":0},"citationItems":[{"id":123,"uris":[""],"uri":[""],"itemData":{"id":123,"type":"speech","genre":"Transcript","title":"The Science of Social Distancing, Part 2","URL":"","author":[{"family":"Galea","given":"Sandro"}],"issued":{"date-parts":[["2020",4,1]]}},"locator":"6"}],"schema":""} (Galea, 2020, p. 6). By this definition, COVID-19 is a traumatic event. The world has never experienced a coronavirus pandemic like this before ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"GwwB1xfl","properties":{"formattedCitation":"(Adhanom Ghebreyesus, 2020)","plainCitation":"(Adhanom Ghebreyesus, 2020)","noteIndex":0},"citationItems":[{"id":171,"uris":[""],"uri":[""],"itemData":{"id":171,"type":"article","title":"WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020","URL":"","author":[{"family":"Adhanom Ghebreyesus","given":"Tedros"}],"issued":{"date-parts":[["2020",3,11]]}}}],"schema":""} (Adhanom Ghebreyesus, 2020). Therefore, we look to large-scale national and multi-national traumatic events, such as epidemics and war, for evidence of long-term effects on population mental health.During the 2014 Ebola epidemic, health care workers were stigmatised in West Africa. Due to a lack of health literacy regarding the pathogen, health care workers were blamed for the disease spread. As a result, sick patients elected not to enter health care facilities and some died at home. Patients left facilities against medical advice, thereby spreading the disease even more. Health care workers were victims of violence due to this misunderstanding ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"APc088mw","properties":{"formattedCitation":"(Shultz et al., 2015)","plainCitation":"(Shultz et al., 2015)","noteIndex":0},"citationItems":[{"id":122,"uris":[""],"uri":[""],"itemData":{"id":122,"type":"article-journal","abstract":"The World Health Organization (WHO) Ebola Response Roadmap declared that the affected West African countries of Guinea, Liberia, and Sierra Leone are “struggling to control the escalating outbreak” because of limited health system capacity and “rampant fear.” The WHO director-general subsequently described how fear behaviors have propelled Ebola virus transmission, citing symptomatic patients escaping from treatment units, families concealing sick relatives at home, preferential use of traditional healers, and physical contact with infectious corpses. Nevertheless, the Roadmap includes few recommendations to alleviate fear behaviors and address mental health needs in Ebola-affected communities.","container-title":"JAMA","DOI":"10.1001/jama.2014.17934","ISSN":"0098-7484","issue":"6","journalAbbreviation":"JAMA","page":"567-568","title":"The 2014 Ebola Outbreak and Mental Health: Current Status and Recommended Response","URL":"","volume":"313","author":[{"family":"Shultz","given":"James M."},{"family":"Baingana","given":"Florence"},{"family":"Neria","given":"Yuval"}],"accessed":{"date-parts":[["2020",6,5]]},"issued":{"date-parts":[["2015",2,10]]}}}],"schema":""} (Shultz et al., 2015). While violence specifically targeted at health care workers has not yet been witnessed during the COVID-19 pandemic, there may be potential for stigma as restrictions begin to lift and the public start to interact with each other. Banerjee argues that health care workers may be victims of mass hysteria, xenophobia, or stigma ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"HeQes8jn","properties":{"formattedCitation":"(Banerjee, 2020)","plainCitation":"(Banerjee, 2020)","noteIndex":0},"citationItems":[{"id":84,"uris":[""],"uri":[""],"itemData":{"id":84,"type":"article-journal","container-title":"Asian Journal of Psychiatry","DOI":"10.1016/j.ajp.2020.102014","ISSN":"1876-2018","journalAbbreviation":"Asian Journal of Psychiatry","page":"102014","title":"The COVID-19 outbreak: Crucial role the psychiatrists can play","URL":"","volume":"50","author":[{"family":"Banerjee","given":"Debanjan"}],"issued":{"date-parts":[["2020",4,1]]}}}],"schema":""} (Banerjee, 2020).Twenty-five years after civil war in Liberia, post-traumatic stress disorder remains markedly increased in areas that experienced violence. Dr. Sandro Galea argues that similar long-term effects may be witnessed following the COVID-19 pandemic stating, “It's not just the initial trauma, but the initial trauma compounded by the stressors and compounded by the social and economic upheaval, which is exactly what we are seeing now with COVID” ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"0iLuZYpW","properties":{"formattedCitation":"(Galea, 2020, p. 9)","plainCitation":"(Galea, 2020, p. 9)","noteIndex":0},"citationItems":[{"id":123,"uris":[""],"uri":[""],"itemData":{"id":123,"type":"speech","genre":"Transcript","title":"The Science of Social Distancing, Part 2","URL":"","author":[{"family":"Galea","given":"Sandro"}],"issued":{"date-parts":[["2020",4,1]]}},"locator":"9"}],"schema":""} (Galea, 2020, p. 9). Country examples for mental health policy response to COVID-19ChinaThe first known COVID-19 cases in the world were reported in China on 31 December 2019 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"UY88ayst","properties":{"formattedCitation":"(World Health Organization, 2020)","plainCitation":"(World Health Organization, 2020)","noteIndex":0},"citationItems":[{"id":78,"uris":[""],"uri":[""],"itemData":{"id":78,"type":"article","title":"WHO Timeline - COVID-19","URL":"","author":[{"literal":"World Health Organization"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020",4,27]]}}}],"schema":""} (World Health Organization, 2020). On 7 May 2020, there were 83,968 confirmed cases and 4,637 deaths ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qnAS5Gt7","properties":{"formattedCitation":"(Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020a)","plainCitation":"(Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020a)","noteIndex":0},"citationItems":[{"id":660,"uris":[""],"uri":[""],"itemData":{"id":660,"type":"webpage","title":"COVID-19 dashboard [7 May 2020]","URL":"","author":[{"family":"Center for Systems Science and Engineering, Johns Hopkins University of Medicine","given":""}],"issued":{"date-parts":[["2020",5,7]]}}}],"schema":""} (Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020a). As of 6 June 2020, those figures increased to 84,177 and 4,638, respectively ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"wjWcGZF4","properties":{"formattedCitation":"(Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020b)","plainCitation":"(Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020b)","noteIndex":0},"citationItems":[{"id":178,"uris":[""],"uri":[""],"itemData":{"id":178,"type":"webpage","title":"COVID-19 dashboard [6 June 2020]","URL":"","author":[{"family":"Center for Systems Science and Engineering, Johns Hopkins University of Medicine","given":""}],"issued":{"date-parts":[["2020",6,6]]}}}],"schema":""} (Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020b). China was relatively well prepared to support the mental health of its care workers, having previously created national guidelines for large-scale mental health emergency response. These guidelines were created in 2004 following the severe acute respiratory syndrome (SARS) epidemic ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Aiclk1zv","properties":{"formattedCitation":"(Duan & Zhu, 2020)","plainCitation":"(Duan & Zhu, 2020)","noteIndex":0},"citationItems":[{"id":86,"uris":[""],"uri":[""],"itemData":{"id":86,"type":"article-journal","container-title":"The Lancet Psychiatry","DOI":"10.1016/S2215-0366(20)30073-0","ISSN":"2215-0366","issue":"4","note":"publisher: Elsevier","page":"300-302","title":"Psychological interventions for people affected by the COVID-19 epidemic","URL":"(20)30073-0","volume":"7","author":[{"family":"Duan","given":"Li"},{"family":"Zhu","given":"Gang"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020",4,1]]}}}],"schema":""} (Duan & Zhu, 2020). The strategy outlined the need to strengthen mental health literacy among medical providers, and specified necessity to deliver mental health support to health care workers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"sHyLg72V","properties":{"formattedCitation":"(The State Council of the People\\uc0\\u8217{}s Republic of China, 2004)","plainCitation":"(The State Council of the People’s Republic of China, 2004)","noteIndex":0},"citationItems":[{"id":89,"uris":[""],"uri":[""],"itemData":{"id":89,"type":"webpage","container-title":"Guobanfa [State Council Bulletin]","title":"The General Office of the State Council forwards the Ministry of Health and other departments: Notice on guiding opinions on further strengthening mental health work","URL":"","author":[{"literal":"The State Council of the People's Republic of China"}],"issued":{"date-parts":[["2004",9,20]]}}}],"schema":""} (The State Council of the People’s Republic of China, 2004). Having pre-existing guidelines enabled China to move quickly. In January 2020 the Chinese National Health Commission published guidance for mental health response to COVID-19. This includes a 24-hour crisis support hotline and therapeutic services for all people affected by COVID-19 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"3nfGIUWf","properties":{"formattedCitation":"(Duan & Zhu, 2020; National Health Commission of the People\\uc0\\u8217{}s Republic of China, 2020)","plainCitation":"(Duan & Zhu, 2020; National Health Commission of the People’s Republic of China, 2020)","noteIndex":0},"citationItems":[{"id":86,"uris":[""],"uri":[""],"itemData":{"id":86,"type":"article-journal","container-title":"The Lancet Psychiatry","DOI":"10.1016/S2215-0366(20)30073-0","ISSN":"2215-0366","issue":"4","note":"publisher: Elsevier","page":"300-302","title":"Psychological interventions for people affected by the COVID-19 epidemic","URL":"(20)30073-0","volume":"7","author":[{"family":"Duan","given":"Li"},{"family":"Zhu","given":"Gang"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020",4,1]]}}},{"id":85,"uris":[""],"uri":[""],"itemData":{"id":85,"type":"webpage","title":"Notice on the Guiding Principles of Emergency Psychological Crisis Intervention for Pneumonia with New Coronavirus Infection","URL":"","author":[{"literal":"National Health Commission of the People's Republic of China"}],"issued":{"date-parts":[["2020",1,27]]}}}],"schema":""} (Duan & Zhu, 2020; National Health Commission of the People’s Republic of China, 2020). There is a stipulation for mental health workers to support frontline medical staff, but no mention is made regarding social care workers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"IOUpnB1z","properties":{"formattedCitation":"(National Health Commission of the People\\uc0\\u8217{}s Republic of China, 2020)","plainCitation":"(National Health Commission of the People’s Republic of China, 2020)","noteIndex":0},"citationItems":[{"id":85,"uris":[""],"uri":[""],"itemData":{"id":85,"type":"webpage","title":"Notice on the Guiding Principles of Emergency Psychological Crisis Intervention for Pneumonia with New Coronavirus Infection","URL":"","author":[{"literal":"National Health Commission of the People's Republic of China"}],"issued":{"date-parts":[["2020",1,27]]}}}],"schema":""} (National Health Commission of the People’s Republic of China, 2020). Duan and Zhu report that implementation has been inadequate with a lack of coordination between medical and mental health services. COVID-19 patients are kept in isolation and appropriately-trained psychological staff are unable to reach them. This results in undue burden on health care workers because they must provide psychological support to patients without sufficient preparation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"OmXXffZe","properties":{"formattedCitation":"(Duan & Zhu, 2020)","plainCitation":"(Duan & Zhu, 2020)","noteIndex":0},"citationItems":[{"id":86,"uris":[""],"uri":[""],"itemData":{"id":86,"type":"article-journal","container-title":"The Lancet Psychiatry","DOI":"10.1016/S2215-0366(20)30073-0","ISSN":"2215-0366","issue":"4","note":"publisher: Elsevier","page":"300-302","title":"Psychological interventions for people affected by the COVID-19 epidemic","URL":"(20)30073-0","volume":"7","author":[{"family":"Duan","given":"Li"},{"family":"Zhu","given":"Gang"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020",4,1]]}}}],"schema":""} (Duan & Zhu, 2020). Xiang et al. find that most health care workers in China do not receive mental health training. No studies nor policies were found specifying the mental health needs of social care workers in China. This is likely due to the fact that China does not have a formal social care structure, as most caregiving is provided by family members within the home ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"itu3Vm8L","properties":{"formattedCitation":"(Wang et al., 2014)","plainCitation":"(Wang et al., 2014)","noteIndex":0},"citationItems":[{"id":97,"uris":[""],"uri":[""],"itemData":{"id":97,"type":"article-journal","container-title":"Aging & Mental Health","DOI":"10.1080/13607863.2014.899976","ISSN":"1360-7863","issue":"8","journalAbbreviation":"Aging & Mental Health","note":"publisher: Routledge","page":"986-996","title":"Factors contributing to caregiver burden in dementia in a country without formal caregiver support","URL":"","volume":"18","author":[{"family":"Wang","given":"Jing"},{"family":"Xiao","given":"Lily Dongxia"},{"family":"He","given":"Guo-Ping"},{"family":"Ullah","given":"Shahid"},{"family":"De Bellis","given":"Anita"}],"issued":{"date-parts":[["2014",11,17]]}}}],"schema":""} (Wang et al., 2014).AustraliaThe first case of COVID-19 in Australia was detected on 12 March 2020. As of 7 May 2020, there were 6,894 confirmed cases, with 97 deaths ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"KVzcyFKb","properties":{"formattedCitation":"(Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020a)","plainCitation":"(Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020a)","noteIndex":0},"citationItems":[{"id":660,"uris":[""],"uri":[""],"itemData":{"id":660,"type":"webpage","title":"COVID-19 dashboard [7 May 2020]","URL":"","author":[{"family":"Center for Systems Science and Engineering, Johns Hopkins University of Medicine","given":""}],"issued":{"date-parts":[["2020",5,7]]}}}],"schema":""} (Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020a). By 6 June 2020, those figures had increased to 7,255 confirmed cases, with 102 deaths ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"X1lT3bTf","properties":{"formattedCitation":"(Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020b)","plainCitation":"(Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020b)","noteIndex":0},"citationItems":[{"id":178,"uris":[""],"uri":[""],"itemData":{"id":178,"type":"webpage","title":"COVID-19 dashboard [6 June 2020]","URL":"","author":[{"family":"Center for Systems Science and Engineering, Johns Hopkins University of Medicine","given":""}],"issued":{"date-parts":[["2020",6,6]]}}}],"schema":""} (Center for Systems Science and Engineering, Johns Hopkins University of Medicine, 2020b). Australia was also relatively well-prepared for the mental health impacts, as they already had a successful nation-wide mental health awareness programme ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"yeFGc1Zy","properties":{"formattedCitation":"(Highet et al., 2006)","plainCitation":"(Highet et al., 2006)","noteIndex":0},"citationItems":[{"id":209,"uris":[""],"uri":[""],"itemData":{"id":209,"type":"article-journal","abstract":"Objective: This report records the level of exposure to depression-related information across the Australian community and explores associations with recognition of depression and relevant sociodemographic factors.Method: A cross-sectional telephone survey was conducted with a representative community sample. Participants consisted of 3200 respondents (400 respondents across each Australian State/Territory).Results: Sixty-five point four per cent (n=2089/3193) of respondents indicated that they or someone close to them had experienced depression, of whom 18.7% (n=391/2089) reported a personal experience of this illness. Various measures of recent exposure to depression-related information were high with 69.0% (n=2207/3200) reporting that they had seen, read or heard something in the media in the last 12 months. Recognition of beyondblue: the national depression initiativewas also surprisingly high (61.9%, 1982/3200). Those with greater understanding that depression is common and debilitating were more likely to recall recent media stories, spontaneously recall relevant organizations such as beyondblue, to have had direct or family experiences, to be younger and to have achieved higher levels of education. Depression, however, is rarely mentioned (1.3%, 47/3720) as a major general health as distinct from a mental health problem.Conclusion: The active promotion of depression-related material to the community appears to have contributed to recognition of the commonality and impacts of this illness. Although depression is commonly recognized as a mental health problem, it is not yet considered a major general health problem. Further, like many public health campaigns, those initially reached appear more likely to be female, younger, better educated and residing in metropolitan areas.","container-title":"Australian & New Zealand Journal of Psychiatry","DOI":"10.1080/j.1440-1614.2006.01742.x","ISSN":"0004-8674","issue":"1","journalAbbreviation":"Aust N Z J Psychiatry","note":"publisher: SAGE Publications Ltd","page":"55-58","title":"Positive Relationships Between Public Awareness Activity and Recognition of the Impacts of Depression in Australia","URL":"","volume":"40","author":[{"family":"Highet","given":"Nicole J."},{"family":"Luscombe","given":"Georgina M."},{"family":"Davenport","given":"Tracey A."},{"family":"Burns","given":"Jane M."},{"family":"Hickie","given":"Ian B."}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2006",1,1]]}}}],"schema":""} (Highet et al., 2006). BeyondBlue is an exemplary government-sponsored campaign to reduce stigma related to mental illness ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"S0ms0J9s","properties":{"formattedCitation":"(BeyondBlue, 2019)","plainCitation":"(BeyondBlue, 2019)","noteIndex":0},"citationItems":[{"id":186,"uris":[""],"uri":[""],"itemData":{"id":186,"type":"article-journal","title":"Annual highlights 18/19: Annual financial statements 18/19","URL":"","author":[{"literal":"BeyondBlue"}],"issued":{"date-parts":[["2019"]]}}}],"schema":""} (BeyondBlue, 2019). In 2018, BeyondBlue published guidelines to support mental health in health care settings ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"LSKL4XRg","properties":{"formattedCitation":"(BeyondBlue, 2018)","plainCitation":"(BeyondBlue, 2018)","noteIndex":0},"citationItems":[{"id":193,"uris":[""],"uri":[""],"itemData":{"id":193,"type":"article","title":"Developing a workplace mental health strategy: A how-to guide for health services [PDF]","URL":"","author":[{"literal":"BeyondBlue"}],"issued":{"date-parts":[["2018",6]]}}}],"schema":""} (BeyondBlue, 2018). In response to COVID-19, BeyondBlue launched a website devoted to mental health for care workers. The site normalises stress that will be felt by care workers and provides advice for self-care and colleague support. Tips include taking breaks, acknowledging distress, exercising, eating well, maintaining personal contacts via phone or video, using support networks, and connecting with mental health supports in the workplace. They helpfully advise, “for those already managing mental health issues, continue with your treatment plan and monitor for any new symptoms” ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"xDY3ergj","properties":{"formattedCitation":"(BeyondBlue, 2020c)","plainCitation":"(BeyondBlue, 2020c)","noteIndex":0},"citationItems":[{"id":187,"uris":[""],"uri":[""],"itemData":{"id":187,"type":"webpage","title":"Protecting your mental health and wellbeing as a healthcare worker","URL":"","author":[{"literal":"BeyondBlue"}],"issued":{"date-parts":[["2020"]]}}}],"schema":""} (BeyondBlue, 2020c). BeyondBlue specifies the importance of managers creating a healthy working environment. They also link to pre-existing support services, including a mental health support line for doctors, and a separate service line for nurses and midwives. In addition, BeyondBlue links doctors to an independent, free, and confidential doctor-to-doctor advice line ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8AXpO2en","properties":{"formattedCitation":"(BeyondBlue, 2020c)","plainCitation":"(BeyondBlue, 2020c)","noteIndex":0},"citationItems":[{"id":187,"uris":[""],"uri":[""],"itemData":{"id":187,"type":"webpage","title":"Protecting your mental health and wellbeing as a healthcare worker","URL":"","author":[{"literal":"BeyondBlue"}],"issued":{"date-parts":[["2020"]]}}}],"schema":""} (BeyondBlue, 2020c). Though the Australian Code of Professional Conduct for Nurses emphasises supporting the health of colleagues, Joyce et al. found that most nurses lack sufficient mental health literacy to effectively support a colleague with a mental health condition ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jbpOipi6","properties":{"formattedCitation":"(Joyce et al., 2012)","plainCitation":"(Joyce et al., 2012)","noteIndex":0},"citationItems":[{"id":142,"uris":[""],"uri":[""],"itemData":{"id":142,"type":"article-journal","abstract":"A 3-stage qualitative study conducted in 2008 aimed to explore the issues to inform a mental health education program to deliver to nurses. This article presents the findings of Stage 1. Data were collected from semistructured interviews conducted with 14 Australian nurses. The interviews explored nurses' knowledge and understanding of mental health problems and their workplace experiences of working with nurses with mental health problems. The interviews were audiotaped, transcribed, and analyzed for the main themes: textbook knowledge, day-to-day support, and workplace considerations. These nurses' narratives guided the implementation of a mental health education workshop targeting nurses (Stage 2).","container-title":"Archives of Psychiatric Nursing","DOI":"10.1016/j.apnu.2011.12.003","ISSN":"0883-9417","issue":"4","journalAbbreviation":"Archives of Psychiatric Nursing","page":"324-332","title":"The Experiences of Nurses With Mental Health Problems: Colleagues' Perspectives","URL":"","volume":"26","author":[{"family":"Joyce","given":"Terry"},{"family":"Higgins","given":"Isabel"},{"family":"Magin","given":"Parker"},{"family":"Goode","given":"Susan"},{"family":"Pond","given":"Dimity"},{"family":"Stone","given":"Teresa"},{"family":"Elsom","given":"Stephen"},{"family":"O'Neill","given":"Kerry"}],"issued":{"date-parts":[["2012",8,1]]}}}],"schema":""} (Joyce et al., 2012). For the general public, BeyondBlue has created the Coronavirus Mental Wellbeing Support Service, which has a 24-hour telephone and chat line, an online community forum, and population-specific guidance such as ‘managing difficult conversations with employees’, and ‘supporting older people during the coronavirus pandemic’ ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2eLZuyax","properties":{"formattedCitation":"(BeyondBlue, 2020a)","plainCitation":"(BeyondBlue, 2020a)","noteIndex":0},"citationItems":[{"id":194,"uris":[""],"uri":[""],"itemData":{"id":194,"type":"webpage","title":"Coronavirus Mental Wellbeing Support Service","URL":"","author":[{"literal":"BeyondBlue"}],"issued":{"date-parts":[["2020"]]}}}],"schema":""} (BeyondBlue, 2020a). As soon as the pandemic was declared on 11 March, the Australian government announced additional training and funding for social care workers. Disease specialists were sent to do on-site consultations in long-term care facilities. Funding was allocated for quarterly COVID-19 retention bonus to be paid to social care workers. COVID-19 infection control training has been provided online for social care workers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"u3Ym9iDW","properties":{"formattedCitation":"(Low, 2020)","plainCitation":"(Low, 2020)","noteIndex":0},"citationItems":[{"id":196,"uris":[""],"uri":[""],"itemData":{"id":196,"type":"webpage","container-title":"Country report in , International Long-Term Care Policy Network, CPEC-LSE","title":"Australia: COVID-19 impact on long-term care and mitigation measures","URL":"","author":[{"family":"Low","given":"Lee-Fay"}],"issued":{"date-parts":[["2020",4,3]]}}}],"schema":""} (Low, 2020). Guidance released to residential care facilities regarding prevention of COVID-19 outbreaks outlined that staff may be reduced by up to 1/3 of the norm due to quarantine restrictions. In anticipation of being short-staffed, work restrictions for international students were temporarily lifted to allow them to fill social care vacancies. There was no mention of employee mental health ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"5pakVDK3","properties":{"formattedCitation":"(Low, 2020)","plainCitation":"(Low, 2020)","noteIndex":0},"citationItems":[{"id":196,"uris":[""],"uri":[""],"itemData":{"id":196,"type":"webpage","container-title":"Country report in , International Long-Term Care Policy Network, CPEC-LSE","title":"Australia: COVID-19 impact on long-term care and mitigation measures","URL":"","author":[{"family":"Low","given":"Lee-Fay"}],"issued":{"date-parts":[["2020",4,3]]}}}],"schema":""} (Low, 2020).Mental health policy recommendations during and beyond COVID-19Mental health policies cannot stand alone. In fact, it has been argued that there is no such thing as a ‘mental health policy’, but rather mental health must be considered for all policymaking. This applies to policy as it relates to health, housing, employment, law, education, immigration, environment, etc. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ieFwmIlq","properties":{"formattedCitation":"(Knapp, 2020a)","plainCitation":"(Knapp, 2020a)","noteIndex":0},"citationItems":[{"id":102,"uris":[""],"uri":[""],"itemData":{"id":102,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 1: What is mental illness? What are the impacts?","URL":"","author":[{"family":"Knapp","given":"Martin"}],"issued":{"date-parts":[["2020",1,20]]}}}],"schema":""} (Knapp, 2020a). The WHO defines mental health policy to be “an organized set of values, principles and objectives for improving mental health and reducing the burden of mental disorders in a population” ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"eSlLZXUi","properties":{"formattedCitation":"(World Health Organization, 2004, p. 12)","plainCitation":"(World Health Organization, 2004, p. 12)","noteIndex":0},"citationItems":[{"id":167,"uris":[""],"uri":[""],"itemData":{"id":167,"type":"article","title":"Mental health policy and service guidance package: Mental health policy, plans and programmes","URL":"","author":[{"literal":"World Health Organization"}],"issued":{"date-parts":[["2004"]]}},"locator":"12"}],"schema":""} (World Health Organization, 2004, p. 12) Incorporating mental health considerations into policies is a statement that the government prioritises mental health ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jUWxQltD","properties":{"formattedCitation":"(World Health Organization, 2004)","plainCitation":"(World Health Organization, 2004)","noteIndex":0},"citationItems":[{"id":167,"uris":[""],"uri":[""],"itemData":{"id":167,"type":"article","title":"Mental health policy and service guidance package: Mental health policy, plans and programmes","URL":"","author":[{"literal":"World Health Organization"}],"issued":{"date-parts":[["2004"]]}}}],"schema":""} (World Health Organization, 2004). It is imperative that policy-makers and supervisors facilitate a supportive working environment for frontline care workers, which includes adequate services for mental health prevention and promotion. Employers should ensure that staff are offered opportunities to practice self-care, including sufficient breaks and rest ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"mZH9yULX","properties":{"formattedCitation":"(Xu et al., 2020)","plainCitation":"(Xu et al., 2020)","noteIndex":0},"citationItems":[{"id":131,"uris":[""],"uri":[""],"itemData":{"id":131,"type":"article-journal","abstract":"The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which appeared in early December 2019, had an atypical viral pneumonia outbreak in Wuhan, Hubei, China. And there is a high risk of global proliferation and impact. The sudden increase in confirmed cases has brought tremendous stress and anxiety to frontline surgical staff. The results showed that the anxiety and depression of surgical staff during the outbreak period were significantly higher and mental health problems appeared, so psychological interventions are essential.","container-title":"Psychiatry Research","DOI":"10.1016/j.psychres.2020.112955","ISSN":"0165-1781","journalAbbreviation":"Psychiatry Research","page":"112955","title":"Psychological status of surgical staff during the COVID-19 outbreak","URL":"","volume":"288","author":[{"family":"Xu","given":"Jian"},{"family":"Xu","given":"Qian-hui"},{"family":"Wang","given":"Chang-ming"},{"family":"Wang","given":"Jun"}],"issued":{"date-parts":[["2020",6,1]]}}}],"schema":""} (Xu et al., 2020). Casual interactions with colleagues should be encouraged, as this is a known protective factors against job-related stress among health care workers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"girkKwus","properties":{"formattedCitation":"(Reid et al., 1999)","plainCitation":"(Reid et al., 1999)","noteIndex":0},"citationItems":[{"id":130,"uris":[""],"uri":[""],"itemData":{"id":130,"type":"article-journal","abstract":"Background: High levels of both burnout and job satisfaction have been found in recent studies of mental health professionals. A qualitative methodology was used in a related study to explore reasons for these findings and to investigate staff's accounts of their strategies for coping with their work, and their views of support provided for them and how their jobs might be made less stressful and still more satisfying. Methods: A semi-structured schedule was used to interview a purposive sample of 30 mental health staff drawn from three South London geographical sectors, selected to include junior and senior members of each profession in both hospital and community settings. Interviews were transcribed and analysed using QSR NUD.IST software. Results: Informal contacts with colleagues were the most frequently mentioned way of coping with the difficult and demanding aspects of work in both hospital and community settings, closely followed by time management techniques. The main formal sources of support described by staff were individual supervision and staff support groups. Accounts of the former were generally positive, but there was great variation in opinions about whether support groups are useful. Almost all the interviewees believed that their jobs could be improved by further training. For community mental health staff the main training gaps were the development of skills in various forms of clinical intervention, whilst ward staff identified the need for further skills in diffusing potentially confrontational and aggressive situations.","container-title":"Social Psychiatry and Psychiatric Epidemiology","DOI":"10.1007/s001270050149","ISSN":"1433-9285","issue":"6","journalAbbreviation":"Social Psychiatry and Psychiatric Epidemiology","page":"309-315","title":"Improving support for mental health staff: a qualitative study","URL":"","volume":"34","author":[{"family":"Reid","given":"Y."},{"family":"Johnson","given":"S."},{"family":"Morant","given":"N."},{"family":"Kuipers","given":"E."},{"family":"Szmukler","given":"G."},{"family":"Bebbington","given":"P."},{"family":"Thornicroft","given":"G."},{"family":"Prosser","given":"D."}],"issued":{"date-parts":[["1999",6,1]]}}}],"schema":""} (Reid et al., 1999). Adverse events should be debriefed and safety protocol made clear ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"zrIwZBJa","properties":{"formattedCitation":"(Shultz et al., 2015)","plainCitation":"(Shultz et al., 2015)","noteIndex":0},"citationItems":[{"id":122,"uris":[""],"uri":[""],"itemData":{"id":122,"type":"article-journal","abstract":"The World Health Organization (WHO) Ebola Response Roadmap declared that the affected West African countries of Guinea, Liberia, and Sierra Leone are “struggling to control the escalating outbreak” because of limited health system capacity and “rampant fear.” The WHO director-general subsequently described how fear behaviors have propelled Ebola virus transmission, citing symptomatic patients escaping from treatment units, families concealing sick relatives at home, preferential use of traditional healers, and physical contact with infectious corpses. Nevertheless, the Roadmap includes few recommendations to alleviate fear behaviors and address mental health needs in Ebola-affected communities.","container-title":"JAMA","DOI":"10.1001/jama.2014.17934","ISSN":"0098-7484","issue":"6","journalAbbreviation":"JAMA","page":"567-568","title":"The 2014 Ebola Outbreak and Mental Health: Current Status and Recommended Response","URL":"","volume":"313","author":[{"family":"Shultz","given":"James M."},{"family":"Baingana","given":"Florence"},{"family":"Neria","given":"Yuval"}],"accessed":{"date-parts":[["2020",6,5]]},"issued":{"date-parts":[["2015",2,10]]}}}],"schema":""} (Shultz et al., 2015).Mental health counselling should be offered to all care workers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"FuLNGtoR","properties":{"formattedCitation":"(Banerjee, 2020; Shultz et al., 2015; Xu et al., 2020)","plainCitation":"(Banerjee, 2020; Shultz et al., 2015; Xu et al., 2020)","noteIndex":0},"citationItems":[{"id":84,"uris":[""],"uri":[""],"itemData":{"id":84,"type":"article-journal","container-title":"Asian Journal of Psychiatry","DOI":"10.1016/j.ajp.2020.102014","ISSN":"1876-2018","journalAbbreviation":"Asian Journal of Psychiatry","page":"102014","title":"The COVID-19 outbreak: Crucial role the psychiatrists can play","URL":"","volume":"50","author":[{"family":"Banerjee","given":"Debanjan"}],"issued":{"date-parts":[["2020",4,1]]}}},{"id":122,"uris":[""],"uri":[""],"itemData":{"id":122,"type":"article-journal","abstract":"The World Health Organization (WHO) Ebola Response Roadmap declared that the affected West African countries of Guinea, Liberia, and Sierra Leone are “struggling to control the escalating outbreak” because of limited health system capacity and “rampant fear.” The WHO director-general subsequently described how fear behaviors have propelled Ebola virus transmission, citing symptomatic patients escaping from treatment units, families concealing sick relatives at home, preferential use of traditional healers, and physical contact with infectious corpses. Nevertheless, the Roadmap includes few recommendations to alleviate fear behaviors and address mental health needs in Ebola-affected communities.","container-title":"JAMA","DOI":"10.1001/jama.2014.17934","ISSN":"0098-7484","issue":"6","journalAbbreviation":"JAMA","page":"567-568","title":"The 2014 Ebola Outbreak and Mental Health: Current Status and Recommended Response","URL":"","volume":"313","author":[{"family":"Shultz","given":"James M."},{"family":"Baingana","given":"Florence"},{"family":"Neria","given":"Yuval"}],"accessed":{"date-parts":[["2020",6,5]]},"issued":{"date-parts":[["2015",2,10]]}}},{"id":131,"uris":[""],"uri":[""],"itemData":{"id":131,"type":"article-journal","abstract":"The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which appeared in early December 2019, had an atypical viral pneumonia outbreak in Wuhan, Hubei, China. And there is a high risk of global proliferation and impact. The sudden increase in confirmed cases has brought tremendous stress and anxiety to frontline surgical staff. The results showed that the anxiety and depression of surgical staff during the outbreak period were significantly higher and mental health problems appeared, so psychological interventions are essential.","container-title":"Psychiatry Research","DOI":"10.1016/j.psychres.2020.112955","ISSN":"0165-1781","journalAbbreviation":"Psychiatry Research","page":"112955","title":"Psychological status of surgical staff during the COVID-19 outbreak","URL":"","volume":"288","author":[{"family":"Xu","given":"Jian"},{"family":"Xu","given":"Qian-hui"},{"family":"Wang","given":"Chang-ming"},{"family":"Wang","given":"Jun"}],"issued":{"date-parts":[["2020",6,1]]}}}],"schema":""} (Banerjee, 2020; Shultz et al., 2015; Xu et al., 2020). Early identification and intervention for care worker distress will be the best way to prevent harm ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"YcNKJSbe","properties":{"formattedCitation":"(Banerjee, 2020; Xu et al., 2020)","plainCitation":"(Banerjee, 2020; Xu et al., 2020)","noteIndex":0},"citationItems":[{"id":84,"uris":[""],"uri":[""],"itemData":{"id":84,"type":"article-journal","container-title":"Asian Journal of Psychiatry","DOI":"10.1016/j.ajp.2020.102014","ISSN":"1876-2018","journalAbbreviation":"Asian Journal of Psychiatry","page":"102014","title":"The COVID-19 outbreak: Crucial role the psychiatrists can play","URL":"","volume":"50","author":[{"family":"Banerjee","given":"Debanjan"}],"issued":{"date-parts":[["2020",4,1]]}}},{"id":131,"uris":[""],"uri":[""],"itemData":{"id":131,"type":"article-journal","abstract":"The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which appeared in early December 2019, had an atypical viral pneumonia outbreak in Wuhan, Hubei, China. And there is a high risk of global proliferation and impact. The sudden increase in confirmed cases has brought tremendous stress and anxiety to frontline surgical staff. The results showed that the anxiety and depression of surgical staff during the outbreak period were significantly higher and mental health problems appeared, so psychological interventions are essential.","container-title":"Psychiatry Research","DOI":"10.1016/j.psychres.2020.112955","ISSN":"0165-1781","journalAbbreviation":"Psychiatry Research","page":"112955","title":"Psychological status of surgical staff during the COVID-19 outbreak","URL":"","volume":"288","author":[{"family":"Xu","given":"Jian"},{"family":"Xu","given":"Qian-hui"},{"family":"Wang","given":"Chang-ming"},{"family":"Wang","given":"Jun"}],"issued":{"date-parts":[["2020",6,1]]}}}],"schema":""} (Banerjee, 2020; Xu et al., 2020), as connecting people to mental health services as soon as possible lowers their risk of serious long-term consequences ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"dyWjZ698","properties":{"formattedCitation":"(Fletcher-Brown, 2015)","plainCitation":"(Fletcher-Brown, 2015)","noteIndex":0},"citationItems":[{"id":138,"uris":[""],"uri":[""],"itemData":{"id":138,"type":"article-journal","container-title":"Perspectives in Public Health","DOI":"10.1177/1757913914561673","ISSN":"1757-9139","issue":"1","journalAbbreviation":"Perspect Public Health","note":"publisher: SAGE Publications Ltd","page":"18-20","title":"‘Mind Your Own Business’ – how can we best support employers to improve the mental health of their employees?","URL":"","volume":"135","author":[{"family":"Fletcher-Brown","given":"Ruth"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2015",1,1]]}}}],"schema":""} (Fletcher-Brown, 2015). Mental health first aid training should be provided to all care workers. Campaigns may need to be conducted to improve the mental health literacy of health care workers and administrators so that they may recognise signs of mental health issues. Educating peers to identify symptoms will increase the likelihood of early recognition of mental health problems, and empower peers to conduct mental health first aid, as necessary ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ijNJ2M0d","properties":{"formattedCitation":"(Joyce et al., 2012)","plainCitation":"(Joyce et al., 2012)","noteIndex":0},"citationItems":[{"id":142,"uris":[""],"uri":[""],"itemData":{"id":142,"type":"article-journal","abstract":"A 3-stage qualitative study conducted in 2008 aimed to explore the issues to inform a mental health education program to deliver to nurses. This article presents the findings of Stage 1. Data were collected from semistructured interviews conducted with 14 Australian nurses. The interviews explored nurses' knowledge and understanding of mental health problems and their workplace experiences of working with nurses with mental health problems. The interviews were audiotaped, transcribed, and analyzed for the main themes: textbook knowledge, day-to-day support, and workplace considerations. These nurses' narratives guided the implementation of a mental health education workshop targeting nurses (Stage 2).","container-title":"Archives of Psychiatric Nursing","DOI":"10.1016/j.apnu.2011.12.003","ISSN":"0883-9417","issue":"4","journalAbbreviation":"Archives of Psychiatric Nursing","page":"324-332","title":"The Experiences of Nurses With Mental Health Problems: Colleagues' Perspectives","URL":"","volume":"26","author":[{"family":"Joyce","given":"Terry"},{"family":"Higgins","given":"Isabel"},{"family":"Magin","given":"Parker"},{"family":"Goode","given":"Susan"},{"family":"Pond","given":"Dimity"},{"family":"Stone","given":"Teresa"},{"family":"Elsom","given":"Stephen"},{"family":"O'Neill","given":"Kerry"}],"issued":{"date-parts":[["2012",8,1]]}}}],"schema":""} (Joyce et al., 2012). Quarantine was deemed necessary by most countries during COVID-19 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PVPtqT2J","properties":{"formattedCitation":"(Hale et al., 2020)","plainCitation":"(Hale et al., 2020)","noteIndex":0},"citationItems":[{"id":81,"uris":[""],"uri":[""],"itemData":{"id":81,"type":"article","publisher":"Blavatnik School of Government. Data use policy: Creative Commons Attribution CC BY standard.","title":"Oxford COVID-19 Government Response Tracker","author":[{"family":"Hale","given":"Thomas"},{"family":"Webster","given":"Sam"},{"family":"Petherick","given":"Anna"},{"family":"Phillips","given":"Toby"},{"family":"Kira","given":"Beatriz"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020"]]}}}],"schema":""} (Hale et al., 2020). In order to limit harmful effects of quarantine, Brooks et al. advise the public should have access to adequate supplies, accurate public health information, and be informed about the importance of and protocol for quarantine. The authors suggest limiting quarantine to the minimum duration necessary for public safety ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cPgbXAUk","properties":{"formattedCitation":"(Brooks et al., 2020)","plainCitation":"(Brooks et al., 2020)","noteIndex":0},"citationItems":[{"id":128,"uris":[""],"uri":[""],"itemData":{"id":128,"type":"article-journal","container-title":"The Lancet","DOI":"10.1016/S0140-6736(20)30460-8","ISSN":"0140-6736","issue":"10227","note":"publisher: Elsevier","page":"912-920","title":"The psychological impact of quarantine and how to reduce it: rapid review of the evidence","URL":"(20)30460-8","volume":"395","author":[{"family":"Brooks","given":"Samantha K"},{"family":"Webster","given":"Rebecca K"},{"family":"Smith","given":"Louise E"},{"family":"Woodland","given":"Lisa"},{"family":"Wessely","given":"Simon"},{"family":"Greenberg","given":"Neil"},{"family":"Rubin","given":"Gideon James"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2020",3,14]]}}}],"schema":""} (Brooks et al., 2020). While not necessarily a direct effect of isolation, it may also be harmful if loneliness occurs. For example, older people who feel lonely have an increased risk of depression, stroke, heart disease, and premature death ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1CnNQEzw","properties":{"formattedCitation":"(Courtin & Knapp, 2017)","plainCitation":"(Courtin & Knapp, 2017)","noteIndex":0},"citationItems":[{"id":164,"uris":[""],"uri":[""],"itemData":{"id":164,"type":"article-journal","abstract":"Abstract The health and well-being consequences of social isolation and loneliness in old age are increasingly being recognised. The purpose of this scoping review was to take stock of the available evidence and to highlight gaps and areas for future research. We searched nine databases for empirical papers investigating the impact of social isolation and/or loneliness on a range of health outcomes in old age. Our search, conducted between July and September 2013 yielded 11,736 articles, of which 128 items from 15 countries were included in the scoping review. Papers were reviewed, with a focus on the definitions and measurements of the two concepts, associations and causal mechanisms, differences across population groups and interventions. The evidence is largely US-focused, and loneliness is more researched than social isolation. A recent trend is the investigation of the comparative effects of social isolation and loneliness. Depression and cardiovascular health are the most often researched outcomes, followed by well-being. Almost all (but two) studies found a detrimental effect of isolation or loneliness on health. However, causal links and mechanisms are difficult to demonstrate, and further investigation is warranted. We found a paucity of research focusing on at-risk sub-groups and in the area of interventions. Future research should aim to better link the evidence on the risk factors for loneliness and social isolation and the evidence on their impact on health.","container-title":"Health & Social Care in the Community","DOI":"10.1111/hsc.12311","ISSN":"0966-0410","issue":"3","journalAbbreviation":"Health & Social Care in the Community","note":"publisher: John Wiley & Sons, Ltd","page":"799-812","title":"Social isolation, loneliness and health in old age: a scoping review","URL":"","volume":"25","author":[{"family":"Courtin","given":"Emilie"},{"family":"Knapp","given":"Martin"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2017",5,1]]}}}],"schema":""} (Courtin & Knapp, 2017). Efforts should be made to encourage care workers to maintain social connections during quarantine. Smartphone technologies may be used to decrease social isolation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Px4pupeK","properties":{"formattedCitation":"(Xiang et al., 2020)","plainCitation":"(Xiang et al., 2020)","noteIndex":0},"citationItems":[{"id":90,"uris":[""],"uri":[""],"itemData":{"id":90,"type":"article-journal","container-title":"The Lancet Psychiatry","DOI":"10.1016/S2215-0366(20)30046-8","ISSN":"2215-0366","issue":"3","note":"publisher: Elsevier","page":"228-229","title":"Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed","URL":"(20)30046-8","volume":"7","author":[{"family":"Xiang","given":"Yu-Tao"},{"family":"Yang","given":"Yuan"},{"family":"Li","given":"Wen"},{"family":"Zhang","given":"Ling"},{"family":"Zhang","given":"Qinge"},{"family":"Cheung","given":"Teris"},{"family":"Ng","given":"Chee H"}],"accessed":{"date-parts":[["2020",5,5]]},"issued":{"date-parts":[["2020",3,1]]}}}],"schema":""} (Xiang et al., 2020).Policy-makers must accommodate for mental illness in all areas including social services, health care, housing, etc. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vEHLOGpz","properties":{"formattedCitation":"(Knapp & Iemmi, 2016)","plainCitation":"(Knapp & Iemmi, 2016)","noteIndex":0},"citationItems":[{"id":166,"uris":[""],"uri":[""],"itemData":{"id":166,"type":"chapter","container-title":"In R. M. Scheffler (Ed.), World scientific handbook of global health economics and public policy","page":"1-41","publisher":"World Scientific Press","title":"Mental health","volume":"2","author":[{"family":"Knapp","given":"Martin"},{"family":"Iemmi","given":"Valentina"}],"issued":{"date-parts":[["2016"]]}}}],"schema":""} (Knapp & Iemmi, 2016). Many mental health advocates support a recovery approach to mental illness, acknowledging that “recovery is a process, a way of life, an attitude, and a way of approaching the day’s challenges” ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hh0kWvSj","properties":{"formattedCitation":"(Deegan, 1988; Knapp, 2020a)","plainCitation":"(Deegan, 1988; Knapp, 2020a)","noteIndex":0},"citationItems":[{"id":149,"uris":[""],"uri":[""],"itemData":{"id":149,"type":"article-journal","container-title":"Psychiatric Rehabilitation Journal","page":"11-19","title":"Recovery: The lived experience of rehabilitation","volume":"11","author":[{"family":"Deegan","given":"Pat E."}],"issued":{"date-parts":[["1988"]]}}},{"id":102,"uris":[""],"uri":[""],"itemData":{"id":102,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 1: What is mental illness? What are the impacts?","URL":"","author":[{"family":"Knapp","given":"Martin"}],"issued":{"date-parts":[["2020",1,20]]}}}],"schema":""} (Deegan, 1988; Knapp, 2020a). According to the recovery approach, mental wellness includes having a sense of purpose and identity, hope, connection with others, empowerment, and the ability to advocate for oneself ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XDtR9xxC","properties":{"formattedCitation":"(Faulkner, 2020; Shepherd et al., 2008)","plainCitation":"(Faulkner, 2020; Shepherd et al., 2008)","noteIndex":0},"citationItems":[{"id":150,"uris":[""],"uri":[""],"itemData":{"id":150,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 6: Knowing our own minds","URL":"","author":[{"family":"Faulkner","given":"Alison"}],"issued":{"date-parts":[["2020",3,2]]}}},{"id":151,"uris":[""],"uri":[""],"itemData":{"id":151,"type":"article","publisher":"Sainsbury Centre for Mental Health","title":"Making recovery a reality: Policy paper","URL":"","author":[{"family":"Shepherd","given":"Geoff"},{"family":"Boardman","given":"Jed"},{"family":"Slade","given":"Mike"}],"issued":{"date-parts":[["2008"]]}}}],"schema":""} (Faulkner, 2020; Shepherd et al., 2008). Factors that support mental health recovery include (but are not limited to) a healthy living environment, positive relationships, work satisfaction, and the ability to pause responsibilities during a time of personal crisis ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"uA9FyX6k","properties":{"formattedCitation":"(Knapp, 2020b; Mental Health Foundation, 2018)","plainCitation":"(Knapp, 2020b; Mental Health Foundation, 2018)","noteIndex":0},"citationItems":[{"id":148,"uris":[""],"uri":[""],"itemData":{"id":148,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 2: Policy responses to mental illness","URL":"","author":[{"family":"Knapp","given":"Martin"}],"issued":{"date-parts":[["2020",1,27]]}}},{"id":176,"uris":[""],"uri":[""],"itemData":{"id":176,"type":"webpage","title":"Recovery","URL":"","author":[{"literal":"Mental Health Foundation"}],"issued":{"date-parts":[["2018",12,12]]}}}],"schema":""} (Knapp, 2020b; Mental Health Foundation, 2018). Using this perspective, care workers may be able to ‘recover’ from mental health challenges encountered during and after COVID-19, and continue to have fulfilling lives and successful careers. While it may not be possible for care workers to resign work responsibilities at the moment, it is possible for others to step in to relieve them of their other burdens and stressors. For example, New York city is offering child care to health care workers during the pandemic ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"tcyPcAtg","properties":{"formattedCitation":"(Castellucci, 2020)","plainCitation":"(Castellucci, 2020)","noteIndex":0},"citationItems":[{"id":152,"uris":[""],"uri":[""],"itemData":{"id":152,"type":"article-journal","abstract":"The AMA, along with the American Hospital Association and American Nurses Association, lobbied heavily to get billions of dollars in funding added to the most recent economic relief package.\n\nNew York is offering child care to the city's healthcare workers, so the human resources department is helping staff take advantage of the option.\n\nSTRATEGIES Provide adequate supply of personal protective equipment Offer child care and lodging resources Transition mental health services to virtual offerings","archive":"Business Premium Collection","archive_location":"2385403079","container-title":"Modern Healthcare","ISSN":"01607480","issue":"13","language":"English","note":"publisher-place: Chicago\npublisher: Crain Communications, Incorporated","page":"30","title":"Industry addresses well-being as COVID-19 overwhelms healthcare workforce","URL":"","volume":"50","author":[{"family":"Castellucci","given":"Maria"}],"issued":{"date-parts":[["2020",3,30]]}}}],"schema":""} (Castellucci, 2020).Digital technologies have been used successfully for mental health interventions ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"VlXEcOv3","properties":{"formattedCitation":"(Kavoor et al., 2020; Patel et al., 2018; Thornicroft et al., 2016)","plainCitation":"(Kavoor et al., 2020; Patel et al., 2018; Thornicroft et al., 2016)","noteIndex":0},"citationItems":[{"id":107,"uris":[""],"uri":[""],"itemData":{"id":107,"type":"article-journal","abstract":"In the wake of the recent pandemic of Corona Virus Disease 2019 (COVID-19), with confirmed cases having crossed 750,000, health systems across the world are getting overwhelmed; making it strenuous to maintain essential health services. Several changes were implemented in our acute mental health care service using a collaborative approach to maintain a balance between preventive measures to ‘flatten the curve’ and to provide care to those who were in need. Mode of service delivery was changed predominantly to tele-medicine, amongst others. It was found to be a workable model, albeit further follow up will be required to better understand its viability and feasibility to withstand the COVID-19 cataclysm.","container-title":"Asian Journal of Psychiatry","DOI":"10.1016/j.ajp.2020.102074","ISSN":"1876-2018","journalAbbreviation":"Asian Journal of Psychiatry","page":"102074","title":"Remote consultations in the era of COVID-19 pandemic: Preliminary experience in a regional Australian public acute mental health care setting","URL":"","volume":"51","author":[{"family":"Kavoor","given":"Anjana Rao"},{"family":"Chakravarthy","given":"Kripa"},{"family":"John","given":"Thomas"}],"issued":{"date-parts":[["2020",6,1]]}}},{"id":159,"uris":[""],"uri":[""],"itemData":{"id":159,"type":"article-journal","container-title":"The Lancet","DOI":"10.1016/S0140-6736(18)31612-X","ISSN":"0140-6736","issue":"10157","note":"publisher: Elsevier","page":"1553-1598","title":"The Lancet Commission on global mental health and sustainable development","URL":"(18)31612-X","volume":"392","author":[{"family":"Patel","given":"Vikram"},{"family":"Saxena","given":"Shekhar"},{"family":"Lund","given":"Crick"},{"family":"Thornicroft","given":"Graham"},{"family":"Baingana","given":"Florence"},{"family":"Bolton","given":"Paul"},{"family":"Chisholm","given":"Dan"},{"family":"Collins","given":"Pamela Y"},{"family":"Cooper","given":"Janice L"},{"family":"Eaton","given":"Julian"},{"family":"Herrman","given":"Helen"},{"family":"Herzallah","given":"Mohammad M"},{"family":"Huang","given":"Yueqin"},{"family":"Jordans","given":"Mark J D"},{"family":"Kleinman","given":"Arthur"},{"family":"Medina-Mora","given":"Maria Elena"},{"family":"Morgan","given":"Ellen"},{"family":"Niaz","given":"Unaiza"},{"family":"Omigbodun","given":"Olayinka"},{"family":"Prince","given":"Martin"},{"family":"Rahman","given":"Atif"},{"family":"Saraceno","given":"Benedetto"},{"family":"Sarkar","given":"Bidyut K"},{"family":"De Silva","given":"Mary"},{"family":"Singh","given":"Ilina"},{"family":"Stein","given":"Dan J"},{"family":"Sunkel","given":"Charlene"},{"family":"Un?tzer","given":"J?rgen"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2018",10,27]]}}},{"id":109,"uris":[""],"uri":[""],"itemData":{"id":109,"type":"article-journal","container-title":"The Lancet","issue":"10023","page":"1123-1132","title":"Evidence for effective interventions to reduce mental-health-related stigma and discrimination","URL":"(15)00298-6","volume":"387","author":[{"family":"Thornicroft","given":"Graham"},{"family":"Mehta","given":"Nisha"},{"family":"Clement","given":"Sarah"},{"family":"Evans-Lacko","given":"Sara"},{"family":"Doherty","given":"Mary"},{"family":"Rose","given":"Diana"},{"family":"Koschorke","given":"Mirja"},{"family":"Shidhaye","given":"Rahul"},{"family":"O’Reilly","given":"Claire"},{"family":"Henderson","given":"Claire"}],"issued":{"date-parts":[["2016"]]}}}],"schema":""} (Kavoor et al., 2020; Patel et al., 2018; Thornicroft et al., 2016), and should be used to provide support to care workers. Patel et al. propose that mental health specialists use digital technology to train and mentor health care workers as they respond to the mental health needs of patients. This would lessen the emotional burden on frontline medical staff and prevent burnout ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"VWXIqFeg","properties":{"formattedCitation":"(Patel et al., 2018)","plainCitation":"(Patel et al., 2018)","noteIndex":0},"citationItems":[{"id":159,"uris":[""],"uri":[""],"itemData":{"id":159,"type":"article-journal","container-title":"The Lancet","DOI":"10.1016/S0140-6736(18)31612-X","ISSN":"0140-6736","issue":"10157","note":"publisher: Elsevier","page":"1553-1598","title":"The Lancet Commission on global mental health and sustainable development","URL":"(18)31612-X","volume":"392","author":[{"family":"Patel","given":"Vikram"},{"family":"Saxena","given":"Shekhar"},{"family":"Lund","given":"Crick"},{"family":"Thornicroft","given":"Graham"},{"family":"Baingana","given":"Florence"},{"family":"Bolton","given":"Paul"},{"family":"Chisholm","given":"Dan"},{"family":"Collins","given":"Pamela Y"},{"family":"Cooper","given":"Janice L"},{"family":"Eaton","given":"Julian"},{"family":"Herrman","given":"Helen"},{"family":"Herzallah","given":"Mohammad M"},{"family":"Huang","given":"Yueqin"},{"family":"Jordans","given":"Mark J D"},{"family":"Kleinman","given":"Arthur"},{"family":"Medina-Mora","given":"Maria Elena"},{"family":"Morgan","given":"Ellen"},{"family":"Niaz","given":"Unaiza"},{"family":"Omigbodun","given":"Olayinka"},{"family":"Prince","given":"Martin"},{"family":"Rahman","given":"Atif"},{"family":"Saraceno","given":"Benedetto"},{"family":"Sarkar","given":"Bidyut K"},{"family":"De Silva","given":"Mary"},{"family":"Singh","given":"Ilina"},{"family":"Stein","given":"Dan J"},{"family":"Sunkel","given":"Charlene"},{"family":"Un?tzer","given":"J?rgen"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2018",10,27]]}}}],"schema":""} (Patel et al., 2018). Teletherapy should be explored to provide counselling to care workers. McKinsey & Company found that 74% of people who attend a telehealth appointment report high satisfaction with their appointment ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"X9sUBdtm","properties":{"formattedCitation":"(McKinsey & Company, 2020)","plainCitation":"(McKinsey & Company, 2020)","noteIndex":0},"citationItems":[{"id":179,"uris":[""],"uri":[""],"itemData":{"id":179,"type":"webpage","title":"McKinsey consumer health insights: Preventative behaviors regarding COVID-19","URL":"","author":[{"literal":"McKinsey & Company"}],"issued":{"date-parts":[["2020",4,13]]}}}],"schema":""} (McKinsey & Company, 2020). Orbit Health launched a free telepsychiatry service for health care workers in the United States, citing social distancing recommendations as the reason for providing this service ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"k0c4nY2d","properties":{"formattedCitation":"(\\uc0\\u8216{}Orbit Health Launches Telepsychiatry Initiative to Reduce Impact of COVID-19 (Coronavirus)\\uc0\\u8217{}, 2020)","plainCitation":"(‘Orbit Health Launches Telepsychiatry Initiative to Reduce Impact of COVID-19 (Coronavirus)’, 2020)","noteIndex":0},"citationItems":[{"id":181,"uris":[""],"uri":[""],"itemData":{"id":181,"type":"article-newspaper","archive":"Business Premium Collection","archive_location":"2377301101","container-title":"PR Newswire","event-place":"New York","language":"English","publisher-place":"New York","title":"Orbit Health Launches Telepsychiatry Initiative to Reduce impact of COVID-19 (Coronavirus)","URL":"","issued":{"date-parts":[["2020",3,16]]}}}],"schema":""} (‘Orbit Health Launches Telepsychiatry Initiative to Reduce Impact of COVID-19 (Coronavirus)’, 2020). A mental health clinic in Australia switched to telemedicine with success, limiting in-person care to only those that are unable to access the telemedicine feature ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"kWf7SQBP","properties":{"formattedCitation":"(Kavoor et al., 2020)","plainCitation":"(Kavoor et al., 2020)","noteIndex":0},"citationItems":[{"id":107,"uris":[""],"uri":[""],"itemData":{"id":107,"type":"article-journal","abstract":"In the wake of the recent pandemic of Corona Virus Disease 2019 (COVID-19), with confirmed cases having crossed 750,000, health systems across the world are getting overwhelmed; making it strenuous to maintain essential health services. Several changes were implemented in our acute mental health care service using a collaborative approach to maintain a balance between preventive measures to ‘flatten the curve’ and to provide care to those who were in need. Mode of service delivery was changed predominantly to tele-medicine, amongst others. It was found to be a workable model, albeit further follow up will be required to better understand its viability and feasibility to withstand the COVID-19 cataclysm.","container-title":"Asian Journal of Psychiatry","DOI":"10.1016/j.ajp.2020.102074","ISSN":"1876-2018","journalAbbreviation":"Asian Journal of Psychiatry","page":"102074","title":"Remote consultations in the era of COVID-19 pandemic: Preliminary experience in a regional Australian public acute mental health care setting","URL":"","volume":"51","author":[{"family":"Kavoor","given":"Anjana Rao"},{"family":"Chakravarthy","given":"Kripa"},{"family":"John","given":"Thomas"}],"issued":{"date-parts":[["2020",6,1]]}}}],"schema":""} (Kavoor et al., 2020). Overall, the adoption of digital technologies in mental health has historically been happening much less frequently than in other professions.The WHO Mental Health Action Plan calls for governments and leaders to provide comprehensive mental health care via prevention, promotion, social care services, research, and policies ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"SA5iohSo","properties":{"formattedCitation":"(Knapp, 2020b; World Health Organization, 2013)","plainCitation":"(Knapp, 2020b; World Health Organization, 2013)","noteIndex":0},"citationItems":[{"id":148,"uris":[""],"uri":[""],"itemData":{"id":148,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 2: Policy responses to mental illness","URL":"","author":[{"family":"Knapp","given":"Martin"}],"issued":{"date-parts":[["2020",1,27]]}}},{"id":158,"uris":[""],"uri":[""],"itemData":{"id":158,"type":"article","publisher":"WHO Press","title":"Mental health action plan 2013-2020","URL":"","author":[{"literal":"World Health Organization"}],"issued":{"date-parts":[["2013"]]}}}],"schema":""} (Knapp, 2020b; World Health Organization, 2013). As soon as possible, each country should endeavour to create such a plan, including a mental health crisis response plan. Protective policies should be introduced to retain health care workers.Implementation challengesDue to the integrated nature of mental health, there is no single department that is fully responsible for mental health policy response. This lack of accountability, and designated budget, often results in an unproductive standstill. Even when mental health initiatives are proven to be cost-effective, finding the resources to implement can be a challenge ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rpVY4rN5","properties":{"formattedCitation":"(Knapp, 2020c)","plainCitation":"(Knapp, 2020c)","noteIndex":0},"citationItems":[{"id":83,"uris":[""],"uri":[""],"itemData":{"id":83,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 10: Enduring challenges: Translating evidence & experience into policy","URL":"","author":[{"family":"Knapp","given":"Martin"}],"issued":{"date-parts":[["2020",3,30]]}}}],"schema":""} (Knapp, 2020c). In addition, there is the phenomenon that Knapp and Wong refer to as ‘silo mismatch’. This occurs when the cost of the mental health intervention occurs within one budget, while the benefit is felt in a different department/area ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"NK587KjC","properties":{"formattedCitation":"(Knapp, 2020c; Knapp & Wong, 2020)","plainCitation":"(Knapp, 2020c; Knapp & Wong, 2020)","noteIndex":0},"citationItems":[{"id":83,"uris":[""],"uri":[""],"itemData":{"id":83,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 10: Enduring challenges: Translating evidence & experience into policy","URL":"","author":[{"family":"Knapp","given":"Martin"}],"issued":{"date-parts":[["2020",3,30]]}}},{"id":168,"uris":[""],"uri":[""],"itemData":{"id":168,"type":"article-journal","abstract":"Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and?to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.","container-title":"World Psychiatry","DOI":"10.1002/wps.20692","ISSN":"1723-8617","issue":"1","journalAbbreviation":"World Psychiatry","note":"publisher: John Wiley & Sons, Ltd","page":"3-14","title":"Economics and mental health: the current scenario","URL":"","volume":"19","author":[{"family":"Knapp","given":"Martin"},{"family":"Wong","given":"Gloria"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2020",2,1]]}}}],"schema":""} (Knapp, 2020c; Knapp & Wong, 2020). Using the New York example, the decision to pay for the childcare of health care workers may come from the city’s budget, while the financial beneficiaries are employers and employees.‘Delayed pay-off’ and ‘transmitted pay-off’ make it difficult to measure the impact of a mental health policy. ‘Delayed pay-off’ occurs when an investment today will not bring benefit for many years ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"o89oskce","properties":{"formattedCitation":"(Knapp & Wong, 2020)","plainCitation":"(Knapp & Wong, 2020)","noteIndex":0},"citationItems":[{"id":168,"uris":[""],"uri":[""],"itemData":{"id":168,"type":"article-journal","abstract":"Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and?to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.","container-title":"World Psychiatry","DOI":"10.1002/wps.20692","ISSN":"1723-8617","issue":"1","journalAbbreviation":"World Psychiatry","note":"publisher: John Wiley & Sons, Ltd","page":"3-14","title":"Economics and mental health: the current scenario","URL":"","volume":"19","author":[{"family":"Knapp","given":"Martin"},{"family":"Wong","given":"Gloria"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2020",2,1]]}}}],"schema":""} (Knapp & Wong, 2020). In this case, we know that investing in the mental health of care workers will result in the immediate pay off of having more resilient staff, while the long-term benefits will be a healthier person that uses fewer resources later in life. ‘Transmitted pay-off’ is when the policy directly impacts Person A, but the benefits are mostly seen in Person B ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"4CVS4ORQ","properties":{"formattedCitation":"(Knapp & Wong, 2020)","plainCitation":"(Knapp & Wong, 2020)","noteIndex":0},"citationItems":[{"id":168,"uris":[""],"uri":[""],"itemData":{"id":168,"type":"article-journal","abstract":"Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and?to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.","container-title":"World Psychiatry","DOI":"10.1002/wps.20692","ISSN":"1723-8617","issue":"1","journalAbbreviation":"World Psychiatry","note":"publisher: John Wiley & Sons, Ltd","page":"3-14","title":"Economics and mental health: the current scenario","URL":"","volume":"19","author":[{"family":"Knapp","given":"Martin"},{"family":"Wong","given":"Gloria"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2020",2,1]]}}}],"schema":""} (Knapp & Wong, 2020). For example, investing in the mental health of care workers today will help to prevent illness not only for the care worker, but also for the care worker’s children. This is because adverse childhood events are associated with mental illness as an adult ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qZ4YWqyH","properties":{"formattedCitation":"(Patel et al., 2018)","plainCitation":"(Patel et al., 2018)","noteIndex":0},"citationItems":[{"id":159,"uris":[""],"uri":[""],"itemData":{"id":159,"type":"article-journal","container-title":"The Lancet","DOI":"10.1016/S0140-6736(18)31612-X","ISSN":"0140-6736","issue":"10157","note":"publisher: Elsevier","page":"1553-1598","title":"The Lancet Commission on global mental health and sustainable development","URL":"(18)31612-X","volume":"392","author":[{"family":"Patel","given":"Vikram"},{"family":"Saxena","given":"Shekhar"},{"family":"Lund","given":"Crick"},{"family":"Thornicroft","given":"Graham"},{"family":"Baingana","given":"Florence"},{"family":"Bolton","given":"Paul"},{"family":"Chisholm","given":"Dan"},{"family":"Collins","given":"Pamela Y"},{"family":"Cooper","given":"Janice L"},{"family":"Eaton","given":"Julian"},{"family":"Herrman","given":"Helen"},{"family":"Herzallah","given":"Mohammad M"},{"family":"Huang","given":"Yueqin"},{"family":"Jordans","given":"Mark J D"},{"family":"Kleinman","given":"Arthur"},{"family":"Medina-Mora","given":"Maria Elena"},{"family":"Morgan","given":"Ellen"},{"family":"Niaz","given":"Unaiza"},{"family":"Omigbodun","given":"Olayinka"},{"family":"Prince","given":"Martin"},{"family":"Rahman","given":"Atif"},{"family":"Saraceno","given":"Benedetto"},{"family":"Sarkar","given":"Bidyut K"},{"family":"De Silva","given":"Mary"},{"family":"Singh","given":"Ilina"},{"family":"Stein","given":"Dan J"},{"family":"Sunkel","given":"Charlene"},{"family":"Un?tzer","given":"J?rgen"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2018",10,27]]}}}],"schema":""} (Patel et al., 2018). Together ‘delayed pay-off’, ‘transmitted pay-off’, and ‘silo mismatch’ require creative diagnol accounting because the cost happens today in one sector, but the benefits may be felt several years later in another sector ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"wRjltSQ6","properties":{"formattedCitation":"(Knapp & Wong, 2020)","plainCitation":"(Knapp & Wong, 2020)","noteIndex":0},"citationItems":[{"id":168,"uris":[""],"uri":[""],"itemData":{"id":168,"type":"article-journal","abstract":"Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and?to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.","container-title":"World Psychiatry","DOI":"10.1002/wps.20692","ISSN":"1723-8617","issue":"1","journalAbbreviation":"World Psychiatry","note":"publisher: John Wiley & Sons, Ltd","page":"3-14","title":"Economics and mental health: the current scenario","URL":"","volume":"19","author":[{"family":"Knapp","given":"Martin"},{"family":"Wong","given":"Gloria"}],"accessed":{"date-parts":[["2020",5,6]]},"issued":{"date-parts":[["2020",2,1]]}}}],"schema":""} (Knapp & Wong, 2020). Mental health policy cannot be easily transferred from one country to another without adaptation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"4eF7xZrn","properties":{"formattedCitation":"(Knapp, 2020c)","plainCitation":"(Knapp, 2020c)","noteIndex":0},"citationItems":[{"id":83,"uris":[""],"uri":[""],"itemData":{"id":83,"type":"speech","event":"Mental Health Policy, London School of Economics and Political Science, London, UK","genre":"Lecture notes","title":"Lecture 10: Enduring challenges: Translating evidence & experience into policy","URL":"","author":[{"family":"Knapp","given":"Martin"}],"issued":{"date-parts":[["2020",3,30]]}}}],"schema":""} (Knapp, 2020c). This is because local context plays an important role in the acceptance and success of a policy. Therefore, mental health advocacy groups should be consulted when adapting and creating mental health policies to ensure that the needs of the population are being addressed. For example, in Australia, the advocacy group blueVoices helped to identify discriminatory employment policies that needed to be improved ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"AlDztlQl","properties":{"formattedCitation":"(Hickie, 2004)","plainCitation":"(Hickie, 2004)","noteIndex":0},"citationItems":[{"id":170,"uris":[""],"uri":[""],"itemData":{"id":170,"type":"article-journal","container-title":"Australasian Psychiatry","DOI":"10.1111/j.1039-8562.2004.02097.x","issue":"Supplement","page":"S38-46","title":"Can we reduce the burden of depression? The Australian experience with beyondblue: the national depression initiative.","volume":"12","author":[{"family":"Hickie","given":"I"}],"issued":{"date-parts":[["2004"]]}}}],"schema":""} (Hickie, 2004). Mental health initiatives must be tailored to fit the specific needs of each country’s care workers, and the care workers themselves should provide the expertise for what they need. Prior to designing a mental health policy, care workers should be asked about common threats to policy success, such as self-stigma, public opinion, etc. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"dhjUvYMt","properties":{"formattedCitation":"(World Health Organization, 2004)","plainCitation":"(World Health Organization, 2004)","noteIndex":0},"citationItems":[{"id":167,"uris":[""],"uri":[""],"itemData":{"id":167,"type":"article","title":"Mental health policy and service guidance package: Mental health policy, plans and programmes","URL":"","author":[{"literal":"World Health Organization"}],"issued":{"date-parts":[["2004"]]}}}],"schema":""} (World Health Organization, 2004). Due to variance in populations and settings, policies should be flexible enough to allow for tailored interventions within small geographic region, such as by county/state/province.ConclusionIn conclusion, there is evidence from previous large-scale traumatic events to build upon to support the mental health of care workers. China and Australia provide examples for how care worker mental health may be supported on a national scale. Care workers that suffer from mental health problems during this crisis must be connected to services as soon as possible. Digital technologies should be used to provide mental health support to care workers. When possible, care workers should be enabled to continue employment, or return to work using the recovery approach. The world is slowly opening its eyes to the necessity of mental health policy. 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