The tipping point

  • Using psychosocial intervention and approaches in pandemic emergency response to prevent burnout of systems

As Sri Lanka grapples with the Covid-19 pandemic, almost every aspect of our lives have been altered. With panic and uncertainty gripping our hearts, the constantly fluctuating numbers of patients, increasing inflation and unemployment, and the emergence of cases of domestic violence, for instance, have been putting our existing systems on the brink of crippling.

Psychologist and MHPSS technical personnel Thiviya Kandiah

However, the implementation of psychosocial interventions and approaches in emergency responses have been assisting our frontline workers to meet the challenges of the pandemic. To understand the role of these methods better, Brunch spoke to psychologist and MHPSS (mental health and psychosocial support) technical personnel Thiviya Kandiah about the implementation of these and how it reinforces the systems in place.

Following are excerpts of the interview.

What is psychosocial intervention or support, and how does it come into play during an emergency response, such as the Covid-19 pandemic?

Psychosocial support is providing support to the presented needs of an individual or community, keeping in mind their mental wellbeing. During an emergency, the needs of an individual get divided into immediate needs, the needs that come soon after immediate needs, and long-term needs. This is important because some needs of individuals may surface after a few years of them experiencing the crisis.

The psychosocial approach deals with the immediate needs and the needs that follow. For example, the Covid-19 pandemic in Sri Lanka caused other crises like exacerbated poverty, unemployment, inflation, violence against women/children, school closure, and more. All of these have an immediate effect on people and need to be addressed then and there, such as by offering intervention to somebody who has just lost their only income, a healthcare worker who is experiencing complete burnout, or a victim of domestic violence. These outcomes of the pandemic also have a long-term impact on the population, which then needs to be addressed.

A person’s mental health is not just biology. Social factors play a role as well, which is why psychosocial intervention is crucial. Hence, an intervention that takes into account the social and health (mental and physical) needs a population would have, as a result of emergencies, can prevent burnout of the system.

How badly would you say systems have been affected by the pandemic, and why is implementing psychosocial approaches or interventions important in Sri Lanka?

We are a collectivist nation, meaning we draw our sense of wellbeing from social factors. For instance, an individual in our communities can say that he/she feels good because of a supportive family, understanding friends, and a sustainable socioeconomic status, which allows the person to access services and resources to meet basic needs. We become dysfunctional when our social support is disrupted, because our collective identity provides us with a sense of self which can be through social class, cultural identity, our friends’ circle, and so on.

The social isolation protocol at present has disrupted the lives of Sri Lankans, as we have been restricted in accessing our basic needs with an overnight change in our social functioning. Most people in Sri Lanka struggle to meet basic needs. Our existing systems that were primarily designed to meet the needs of people in a socially active crisis have been challenged into making changes immediately, to meet the needs of people in a remote manner. This shift has widened the gap between rising needs and existing systems.

Intervention pyramid for mental health and psychosocial support  PHOTO © RESEARCHGATE

Are psychosocial interventions and approaches limited to talk therapy or do they include providing individuals with resources such as employment opportunities, nutrition, etc.?

Psychological or mental health interventions include therapeutic forms that address the mental health needs of the person, whereas the psychosocial approach includes meeting the need of the person during the crisis in a dignified manner, which is not just limited to therapeutic remedies. For instance, apparel factory workers were required to report to work despite the breaking out of multiple clusters in factories. The psychosocial approach entails ensuring that such workers are made to feel safe and cared for in the event they must report to work, through providing them with compensation perhaps or proper attention and medical help if they were to fall ill, and other such resources. These will help the individual function optimally, through promoting their wellbeing.

We speak about inclusivity during these challenging times. Is inclusivity a part of psychosocial intervention, and why is it important?

Inclusivity allows people who are generally marginalised to cope with the distress that results due to a crisis by being recognised and acknowledged. When we have services that are inclusive, we are providing a wider response in the frontlines, which will allow people to better cope with the crisis. This, as a result, can definitely prevent tipping the system and overburdening it.

In Sri Lanka, we have already identified vulnerable groups and minorities, be it those who have a disability, come from a specific ethnic background, are from low socioeconomic backgrounds, are from the queer community, or are children and women – two populations that are most at risk under any circumstance.

Is it correct to assume that direct psychosocial intervention, or implementing psychosocial approaches, is what constitutes emergency responses?

With the pandemic in Sri Lanka, the demand for help is beginning to overwhelm the systems, leading to a tipping point where there is burnout of services. Therefore, part of the emergency response is to also build capacity among others who are not specialised professionals, but can still offer immediate care during an emergency, as long as one is aware of the needs of the people as well as the risks attached to it. They become gatekeepers that support the system, by reducing the pressure on it, allowing people to help themselves without having to be dependent on service providers completely.

For example, if there is a domestic abuse situation, the emergency responder first assesses the case, offers immediate and “soon after” care, and then, based on the evaluation, directs them to specialised care, if they require it.

How successful has this mobilisation of gatekeepers been? Are people experiencing a crisis responding to them well?

A key intervention here is the launching of the online self-learning tool “Basic Psychosocial Skills”, which is available in Sinhala, Tamil, and English. This short course helps Covid-19 frontline support workers to take care of themselves and the people they assist. The tool is an adaptation of “Basic Psychosocial Skills: A Guide for Covid-19 Responders” published by the Inter-Agency Standing Committee (IASC) in 2020. This course consists of five modules: your wellbeing, supportive communication in everyday interactions, offering practical support, supporting people who are experiencing stress, and helping vulnerable people in specific situations.

While this course is primarily designed to support Covid-19 frontline support workers, these skills can be adapted by frontline support workers to other crisis situations. Since its launch, it has been widely accessed by professionals and non-professionals to be aware of the needs of people during the pandemic and how to support them. Some of the groups who have been utilising this tool are community-based psychosocial workers, youth groups, community volunteers, healthcare workers, teachers, and administrative officers.

What are the challenges prevalent when providing psychosocial interventions or implementing approaches? Have these changed after Covid?

As a practitioner personally, and generally in the field, one of the primary challenges is that psychosocial interventions require an “all-hands-on-deck” approach. A single psychologist or counsellor cannot support an individual. When we assess an individual, we find many contributing factors that need addressing. Therefore, while we educate the client, we also need to refer them to other professionals. This is a challenge in the country because we do not have an established, professional body that identifies intervention. Therefore, creating a collaborative space is tedious, as people do not want to commit to something that is ambiguous. When there is no legal authorised body, who is taking accountability for psychosocial intervention? Is it the group advocating for it? This has been a challenge pre-Covid, during Covid, and quite possibly post-Covid.

What can we as people of this country do to prevent tipping over our systems that are already stretched thin?

We can come together in understanding the needs of our communities by being there for each other in our social capacities. We can also educate ourselves, become more attuned to what our communities are experiencing, and encourage inclusivity. These actions of ours can prevent overburdening the system, whilst giving us the agency to make systematic changes within our communities.