On being diagnosed with the novel coronavirus disease (COVID-19), Wang Lan felt despondent. While receiving treatment at a hospital in Wuhan, central China, the 70-year-old thought she might not recover. She had undergone a bypass surgery in the past and was deeply worried that her treatment could become a burden for her family. She began to refuse to talk to them, going to the extent of turning off her mobile phone and hiding it under the quilt. Unable to get in touch with her, her family was distressed and worried.

Her doctor described her problem to Yin Ping, a psychiatrist from the Guangdong Provincial People's Hospital in south China offering psychological counseling to patients in Wuhan. Yin went to Wang's ward to speak with her.

He persuaded her to restart her phone and helped her to video chat with her husband, who tried to encourage her but it didn't work. Then Yin learned that Wang's son lived in Canada with his two sons. So he persuaded her to have a video chat with them and finally, on seeing her son and grandchildren, Wang smiled.

For patients like Wang, it's pointless to say things like "You'll be fine. Cheer up," Yin told ThePaper.cn, an online media. "We need to tackle their problem from a special angle. For Wang, her son and grandchildren can give her the courage to fight for her life."

COVID-19 has had considerable impact on people's mental health as well, making psychological counseling an important defense line against the virus. Since January, emergency psychological counseling has been provided extensively across the country for patients, suspected patients and medical workers.

Surviving trauma

"Why do I still have a fever?" "I want to stop my treatment." These are some of the remarks that Chen Jun, a psychiatrist from the Shanghai Mental Health Center, often hears in the wards for COVID-19 patients where he is providing psychological treatment.

"Some patients fear they will never wake up again once they fall asleep. Some tear off their oxygen mask when they are anxious. Some have depression and slow response," Chen told Xinhua News Agency. "All these conditions are normal reactions to the disease and they will improve noticeably after medical treatment and psychological counseling."

Many can develop post-traumatic stress disorder (PTSD), a mental health condition after a person has experienced or witnessed a traumatic event in which serious physical harm occurred or was threatened. For those who lost their family members and couldn't hold a formal funeral to say goodbye to their loved ones, the recovery will be a long process.

Mei Junhua, a neurologist from the Wuhan No.1 Hospital, has been working as a psychiatrist since February 12, when his hospital was designated to treat COVID-19 patients. "Some patients are depressed and keep worrying even when their conditions have improved. Some think they have passed on the virus to their families and don't want to communicate or cooperate with doctors," Mei told China Youth Daily.

He found a patient in his ward, a woman in her 50s, was sleeping only for one to two hours every day. He learned her mother had died of COVID-19 and her father and husband were also in hospital with the disease. He began to talk to her to make her realize that her husband's infection was mild and he would recover soon. He tried to calm her down, and eventually her anxiety lessened. She started taking medicine for depression and began to sleep longer. Soon she had come out of her shell and was willing to talk to other patients and doctors.

Mei said those who have lost a family member or who have themselves recovered from the disease often find it hard to put their traumatic experiences behind them.

Recovered patients may also face stigmatization for some people harbor unfounded suspicions that they are still infectious.

Zhou Jing, a COVID-19 patient from Wuhan, told ThePaper.cn about the reaction of a family friend upon learning that she had contracted the disease and was cured after 12 days. He said if he got infected, he would hold her responsible for passing on the disease to him. Zhou described how hurt she felt. She stopped going out or posting her experiences on the social media for fear of more adverse reactions.

Medical workers also need psychological help. The Shanghai Mental Health Center found that medical workers suffer from mental exhaustion due to excessive work, pressure and helplessness in face of the large inflow of patients and fear that they themselves and their families might get infected.

Psychological help for medical workers is available in many places. For instance, the health commission of Zhejiang Province in east China has organized a psychological consulting team for medical workers. "Care and support from society is very important for medical workers. For instance, some people sent milk tea and fruits for medical workers, which cheered them up," Chen told Xinhua.

Guo Lei, an associate professor at the department of psychology, Southwest University in southwest China, conducted a psychological survey involving 14,000 people across the country in February. The survey found among the respondents, medical workers suffered the highest level of depression, anxiety, fear and regret. Around 8.7 percent of them showed symptoms of PTSD and 10.87 percent had sleep problems.

Guo told China Youth Daily the survey shows both the medical workers on the frontline of the epidemic control and patients need psychological help. They urgently need to release their pent-up feelings but dare not tell them to anyone around them. Guo's team received over 300 phone calls seeking psychological help, many of which were from Wuhan. "Some say nothing on the phone but only cry, sometimes for several minutes," he said.

On January 27, the National Health Commission issued a guideline for emergency psychological crisis intervention. It categorizes those affected by COVID-19 into four groups. The first group, which needs intervention the most, includes confirmed patients, frontline medical workers and disease control staff.

Post-epidemic intervention

Guo said after the epidemic, patients and medical workers are likely to develop PTSD, especially those who lose one or more family members. Psychological intervention for the key groups should be stepped up in the later phase of the epidemic and in the post-epidemic period. There is a need for regular face-to-face counseling by professional psychiatrists.

Yin agreed that patients' psychological problems may be more serious after they are discharged from hospital. "When they are in hospital, they have a clear goal: Recover and leave. To do that they suppress a lot of emotions. But once they are discharged, psychological problems will surface," Yin told ThePaper.cn. While most patients can recover from psychological problems by themselves, some who have been seriously traumatized may need to be monitored and treated for years.

Since the start of the epidemic, over 100 psychological institutions have been offering online counseling or have opened hotlines to provide counseling. Several nonprofit organizations in Beijing and professional volunteers across China have come together to form the Beijing-Hubei iWill volunteer team to provide psychological help online and on telephone for residents in Hubei, the province where Wuhan is located. As of March 8, over 1,800 volunteers had served nearly 20,000 people under the project.

Zhu He, head of a counseling center in Beijing, is one of the initiators of the project. He provided similar services during the devastating earthquake that hit Wenchuan in southwest China in 2008 and other natural disasters. Zhu told China Youth Daily he wishes to go to Wuhan with other volunteers to provide face-to-face counseling. Psychological recovery, he said, will be a sustained battle for the residents of the city that has borne the brunt of the losses.

Some mental health experts suggest that the government should procure services from nongovernmental organizations with expertise in psychological counseling so that people can get more professional help.

Copyedited by Sudeshna Sarkar

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