Challenges to peer support in low- and middle-income countries during COVID-19

Abstract

Background A recent editorial urged those working in global mental health to “change the conversation” on coronavirus disease (Covid-19) by putting more focus on the needs of people with severe mental health conditions. UPSIDES (Using Peer Support In Developing Empowering mental health Services) is a six-country consortium carrying out implementation research on peer support for people with severe mental health conditions in high- (Germany, Israel), lower middle- (India) and low-income (Tanzania, Uganda) settings. This commentary briefly outlines some of the key challenges faced by UPSIDES sites in low- and middle-income countries as a result of Covid-19, sharing early lessons that may also apply to other services seeking to address the needs of people with severe mental health conditions in similar contexts. Challenges and lessons learned The key take-away from experiences in India, Tanzania and Uganda is that inequalities in terms of access to mobile technologies, as well as to secure employment and benefits, put peer support workers in particularly vulnerable situations precisely when they and their peers are also at their most isolated. Establishing more resilient peer support services requires attention to the already precarious situation of people with severe mental health conditions in low-resource settings, even before a crisis like Covid-19 occurs. While it is essential to maintain contact with peer support workers and peers to whatever extent is possible remotely, alternatives to face-to-face delivery of psychosocial interventions are not always straightforward to implement and can make it more difficult to observe individuals’ reactions, talk about emotional issues and offer appropriate support. Conclusions In environments where mental health care was already heavily medicalized and mostly limited to medications issued by psychiatric institutions, Covid-19 threatens burgeoning efforts to pursue a more holistic and person-centered model of care for people with severe mental health conditions. As countries emerge from lockdown, those working in global mental health will need to redouble their efforts not only to make up for lost time and help individuals cope with the added stressors of Covid-19 in their communities, but also to regain lost ground in mental health care reform and in broader conversations about mental health in low-resource settings.

Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation

“…PSW training has evolved in response to organizational needs and more recently the COVID-19 global pandemic. In a recent commentary, barriers to implementing web-based peer support in low- and middle-income countries in the context of COVID-19 were identified [ 59 ]. The low-to-moderate consensus about web-based delivery of training found in our study indicates that further work is needed to explore the relative costs and benefits of web-based versus face-to-face training.…”

Hospital workforce mental reaction to the pandemic in a low COVID-19 burden setting: a cross-sectional clinical study

“…This advantage of advancing age might be useful in implementing and fostering (one-to-one) peer support interventions, which are on the increase worldwide [44][45][46], to enhance efficacy of hospital workforces in coping with the COVID-19 crisis, although even such interventions are not immune to the detrimental effects of the pandemic crisis and the difficulties related to its management (e.g. social distancing, reliance on communication via internet) [47].…”

“…shortened shifts, staff involvement in organisational decisions), effective (online) listening and communication [54], easily accessible professional support (e.g. web-or telephone based hotlines, hospital-based teams providing counselling on handling stress) [39] and models such as the structured forum Schwartz rounds [55] and (one-to-one) peer support [44][45][46][47] may contribute to the alleviation of the distress of hospital workforces due to the COVID-19 crisis.…”

COVID-19-pandemian aiheuttaman poikkeustilanteen merkitys kokemusasiantuntijatoiminnalle mielenterveystyössä

“…Lisäksi on tuotu esiin, että pandemian kaltaisissa kriisitilanteissa on muistettava myös vertaistoimijoiden merkitys ammattilaisten työn rinnalla ja heidän tarvitsemansa tuki (43). Siirtymisen puhelimitse tarjottuun vertaistukeen on kuvattu voivan olla hankalaa esimerkiksi tilanteissa, joissa vertaistukea on aiemmin tarjottu sairaalaympäristössä eivätkä vertaistoimijat koe saavuttaneensa riittävän läheisiä suhteita tuettaviensa kanssa voidakseen jatkaa yhteydenpitoa vastaavalla tavalla puhelimitse (44).…”