Letter to the editor: Mental health work in the context of the COVID-19 pandemic: What progress have we made so far and what is the next step?

Since the first confirmed COVID-19 case reported in China in December 2019, the number of confirmed COVID-19 cases has been increasing rapidly in most countries of the world, and the COVID-19 outbreak was characterized as a “pandemic” by the World Health Organization (WHO) in early March 2020. In addition to economic impacts and social disruptions, COVID-19 has also brought a massive impact on public mental health. Up to now, a number of studies concerning the mental health work during the COVID-19 pandemic have been reported from different countries around the globe. We have continuously explored potential approaches to carry out public mental health work more effectively during the COVID-19 pandemic in the past three months, and much progress has been made. It is time for us to review previous research results and look to future work directions, with a view to improving the ongoing mental health work.

1. What progress have we made so far?

Targeting people who are vulnerable to COVID-19-related psychological and mental problems is the focus of current research which is a valuable aid in guiding governments and relevant institutions to further optimize allocation of medical resources, reduce mental health burden, and prevent unnecessary medical resource loss. Currently, We have identified vulnerable populations at high risk for getting affected by the COVID-19 pandemic, which include 1) the infected and ill patients, their families and colleagues; 2) individuals with preexisting mental/physical conditions; 3) healthcare and aid professionals (especially nurses and physicians working directly with ill and quarantined persons) (Shigemura et al., 2020), 4) older adults (especially those with psychiatric conditions), 5) international migrant workers (Lima et al., 2020), 6) college students (Cao et al., 2020), and 7) children confined to their homes (Wang et al., 2020). In addition to the targeted vulnerable populations mentioned above, there is also a need to identify potential high-risk populations, such as relatives who have suffered from grief-related emotions because of their family's death caused by SARS-CoV-2 infection, pregnant women and front-line police, etc.

Due to the impact of mass quarantine, most conventional approaches of psychological interventions can no longer be properly carried out. In response to this, several studies have reported potential intervention approaches which could be effectively applied in the current mental health work. To conclude, there are two main types of psychological intervention strategies proposed in previous studies. The first type is to carry out conventional procedure of psychological consultation and the diagnosis and treatment of mental health problems via a remote doctor-patient interaction platform. And the second is to develop a novel psychological intervention approach that has not been used before. The former mainly includes online mental health services and telehealth (through video conferences, e-mail, telephone, or smartphone apps) (Yang et al., 2020; Zhou et al., 2020). The latter is represented by the recently proposed “structured letter therapy,” which increases the accessibility of psychological intervention by breaking the conventional treatment mode, but research on its efficacy is lacking (Xiao, 2020).

2. What is our next step?

As noted, we have targeted vulnerable populations and developed available psychological intervention approaches in order to combat the psychological impact of the COVID-19 pandemic. However, these studies have many limitations, most of them showed their concerns on the inappropriate ignorance of the mental health work while failed to put forward constructive suggestions, the others reemphasized the necessity of proper attention on the current mental health work, but focused more on description of the current mental health condition instead of dealing with a specific problem. To make up for these limitations, in this letter, we make several proposals as follows:

• 1)Although the virus is spreading rapidly, there is still time for experience transmission and knowledge dissemination between infected countries and those at high risk for infection. In order to truly realize the timely sharing of mental health work experience among countries, it is necessary to establish a global mental health collaborative. Establishing and improving a global mental health collaborative to jointly maintain public mental health during the pandemic is an efficient measure to reduce the burden of COVID-19-related psychological and mental problems and avoid undesirable disability and mortality caused by the imbalanced tilt of devoting more resources to COVID-19 physical treatment.
• 2)Most hospitals have been overcrowded since a large number of confirmed COVID-19 cases have occurred in Wuhan, China. In view of this, there is a need to provide more concerted and comprehensive mental health services by integrating and combining hospital and community resources so as to ease the pressure of hospitals (Ho et al., 2020). Additionally, Well-formed first-line mental health resources could effectively offer timely intervention to each individual in need.
• 3)Increase research efforts on developing and assessing psychological intervention approaches for COVID-19-related psychological and mental problems during the pandemic and promote valuable research results to be used into clinical practice in a timely manner. This will further avoid negative social phenomena that are not conducive to the prevention and control work of the pandemic.
• 4)Particular effort should be direct to the timely diagnosis/treatment of patients with potential/preexisting mental conditions. The neglect of this point may lead to the rapid aggravation of the disease condition and the occurrence of adverse outcomes. It is noteworthy that some patients with certain mental disorders (e.g. patients with schizophrenia) are more likely to leave home which could result in a higher risk of getting infected, while the risk could be reduced by ensuring prompt and timely hospital admission.
• 5)Use standardized patient self-help manuals to further increase the public popularity of mental health knowledge by making full use of e-mail, telephone, network, etc., to build a remote doctor-patient interaction platform. The contents of a standardized patient self-help manual should include: introduction to the COVID-19-related psychological and mental problems and the way how to protect yourself, description on self-help interventions to address some common psychological and mental problems, and contact information of local mental health centers, etc.
• 6)Suicide may be preceded by suicidal ideation, threat, and gestures, nonsuicidal self-injuries, and suicide attempts with various degrees of lethality, which is considered preventable. During the COVID-19 pandemic, those populations with various psychological distress, such as infected patients, persons who lost their families, would be more prone to suicide-related mental health issues. Accordingly, A special suicide prevention programme should be developed to deal with this challenge.

Declaration of competing interest

The authors have declared that no competing interests exist.

Appendix A. Supplementary data

The following is the Supplementary data to this article: