BasicNeeds Pakistan: Supporting mental health in under-resourced communities during COVID-19
Dr Fizza Yasmeen is the Chief Executive Officer BasicNeeds Pakistan, a nonprofit, non-governmental organisation working to improve the lives of people living with mental health conditions and/or epilepsy in Pakistan. In this post, Dr Yasmeen describes challenges in supporting rural and under-resourced communities in Pakistan and adaptations to service delivery in response to the COVID-19 pandemic.
|Shift to remote-mental health interventions as much as possible||Online and phone counselling and consultation|
|Activities for economic empowerment are crucial to mental health in under-resourced communities||Videos on social media using role-play to raise awareness about COVID-19 and its impact on mental health|
|Rural and under-resourced communities need screening, testing and PPE for health care workers to continue much needed support during this time||Creation of a rapid mental health response team “Alone Together” providing psychological support in communities|
Human connection is now more important than ever. With COVID-19 heightening stress, anxiety and isolation, our teams aim to support those struggling with mental health conditions by connecting them to the right support. With 60 Mental Health First Aid (MHFA) instructors, BasicNeeds Pakistan has trained 3610 community members as ‘Mental Health First Aiders’ in the regions of Lahore, Peshawar, Quetta and Karachi. We are joining the national effort to fight COVID-19 by raising awareness about mental health in rural and under-resourced communities.
Infrastructure is fragmented in these communities with limited internet access. Houses are usually congested with potentially ten people living in one to two rooms. Many have lost their jobs and livelihoods and cannot afford medication. We anticipate a spike in mental health problems. Additionally, there are no screening and testing facilities in these communities, and people cannot afford to go to the hospital at their own expense.
Our six vocational training centres for women’s economic empowerment have closed due to lockdown, and this has created great financial loss and overwhelming anxiety among the newly trained entrepreneurs. The centres are now partially open, and some women are sewing protective masks for their communities that are either donated or sold at a low price. To abide by physical distancing guidelines, we have limited the number of people allowed in the centre to five at a time. Upon entering, they have their temperature screened and are given a mask and sanitizing hand gel. There is also an instructor present who provides information about infection prevention and the importance of physical distancing, hand-washing and hygiene.
- “When I first heard about coronavirus and lockdown, I thought I would stop going to the centre but continue taking orders at home. I assumed things wouldn’t be that bad. Then, suddenly everything went to a standstill. I was devastated. My invisible enemy emerged. I started having headaches and wasn’t able to sleep at night. My dreams were shattered. I was feeling helpless and worthless. My earnings were everything to me. It was my pride. I earned respect in my family. Now everything seemed to be sabotaged. My family was in a severe financial crisis. My sewing work stopped, but my connection and link with my fellow women never stopped. When they realized that I was going into depression, they asked me to contact my counsellor who was also my sewing instructor. She supported me a lot.” - Samreen, entrepreneur in Karachi
'Alone Together' Rapid Response team members
BasicNeeds Pakistan has created an Online Mental Health Rapid Response team of psychologists providing remote counselling during the pandemic. While we have moved to online and phone consultations, this is only available to people with access to devices and the internet. We are also raising awareness through social media using role-play videos to share information on the mental health impacts of COVID-19.
Our Mental Health First Aiders have also been essential in responding to concerns in the community, for example, from health care workers experiencing fear and distress about treating COVID-19 patients. The Mental Health First Aid programme prepares participants to interact with a person in crisis. First Aiders do not diagnose or provide counselling, but ask questions and connect people to helpful resources and professional counsellors.
- “When I was assigned to work with coronavirus patients in isolation as a nurse, I was very much distressed. I was thinking about my children if I were to get the virus. I am not very young, and I knew it affected older people more. If I died, what would happen to them? Who would look after them? This train of negative thoughts was running through my mind. After the second day, I called the Mental Health First Aider in Karachi. I was weeping and saying, “This is my last call. I might not talk to you again. I am working with corona patients.” I confessed that I could not express my feelings to anyone else. I am a nurse. My duty is to serve patients. Why am I feeling this way? I shared all my fears. She replied that it is ok to feel this way and that there is nothing to be ashamed of. After talking to her, I felt relieved and was able to do my duty with the same enthusiasm and compassion as I used to before.” - Shazia Khalil, staff nurse at Sheikh Zahid hospital in Quetta
Providing too much information about COVID-19 without providing adequate medical and psychosocial services leads to more psychosocial distress. During this time, government and public and private sector coordination is essential. We need to find ways to make screening and testing facilities accessible to the most vulnerable and hard-to-reach communities. Community health workers need accurate information and personal protective equipment (PPE) so they can continue delivering much needed mental health support during this time of crisis.
This video encourages people to provide basic psychosocial support to the public and family members in a time of crisis using a role-play example.
- Remote Psychological First Aid during the COVID-19 outbreak: Interim Guidance, March 2020 (IFRC) [Link]
- Briefing note: Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak (IASC) [Link]
- Mental health and psychosocial considerations during the COVID-19 outbreak (WHO) [Link]
- Mental Health & Psychosocial Support for Staff, Volunteers and Communities (IFRC) [Link]
- Mental Health and Psychosocial Considerations for Volunteers in COVID-19 (IFRC) [Link]