Abstract

Introduction

Brazil is now the country of the world with the second most COVID-19 cases and deaths (August 2020), and the impacts pose a triple challenge for mental health: (1) to prevent the increase in the impacts on mental health related to the reduction in psychosocial well-being that affects the entire population; (2) to protect persons with mental illnesses from the psychosocial impacts associated with the increase in their vulnerability; and (3) to provide care for health workers and caregivers ¹1. Campion J, Javed A, Sartorius N, Marmot M. Addressing the public mental health challenge of COVID-19. Lancet Psychiatry 2020; 7:657-9..

With the objective of providing rapid responses to health services based on scientific knowledge, a volunteer and collaborative Working Group (GT) on mental health and psychosocial care was assembled in the context of COVID-19 at the Oswaldo Cruz Foundation (Fiocruz). This paper systematizes the experience that resulted from the development of strategies of care in mental health and psychosocial care for the Brazilian Unified National Health System (SUS).

Methodology

The GT was created on March 21, 2020, one day after the official declaration of the state of public calamity due to COVID-19 in Brazil. A permanent group was assembled, consisting of nine researchers in the field of mental health, including psychologists, psychiatrists, and social scientists. The group resulted from partnership between the Center for Research in Disasters (CEPEDES), the Graduate Studies Program in Public Health (Sergio Arouca National School of Public Health - ENSP/Fiocruz), and the Fiocruz Brasília, with institutional support through the provision of human resources and digital platforms from the Open University of the SUS (UNA-SUS).

The first step was to collect current evidence from the scientific literature on the mental health impact in populations affected by COVID-19 and previous public health emergencies. A literature search was performed in four online bases with a wide scope in the health field: PubMed, Virtual Health Library (BVS), Embase, and CAPES Periodicals. The search took place from March 24 to 29, 2020, using the combination of descriptors in two groups: (1) “coronavirus”, “pandemic”, “SARS”, “MERS”, “COVID-19”, and (2) “quarantine”, “psychosocial support”, “mental health”, “psychosocial care”. The descriptors were adjusted according to the thesauruses used in each base, except in the BVS, which has a specific window called “BVS Corona”.

A systematic reading identified 1,563 scientific articles, categorized by themes and characteristics referring to the most frequent mental health and psychosocial care issues involved in public health emergencies. Next, a second survey was conducted on central themes with a total of 117 researchers from 25 Brazilian and international institutions, selected on the basis of their research output and experience with the theme. Third, the themes were organized systematically according to the phases in the response by mental health and psychosocial care in a pandemic ²2. Organização Pan-Americana da Saúde. Proteção da saúde mental em situações de epidemias. https://www.paho.org/hq/dmdocuments/2009/Protecao-da-Saude-Mental-em-Situaciones-de-Epidemias--Portugues.pdf (acessado em 28/Ago/2020).
https://www.paho.org/hq/dmdocuments/2009... . At least one permanent member of the working group was in charge of leading the production of one or more manuals and linking the participation by outside collaborators.

Results and discussion

Rapid response in public health emergencies requires not only the availability of scientific evidence, but the development of knowledge translation strategies capable of producing syntheses, dissemination, exchange, and application of knowledge in minimal time frames based on user-friendly formats, simple language, and direct messages ³3. El-Jardali F, Bou-Karroum L, Fadlallah R. Amplifying the role of knowledge translation platforms in the COVID-19 pandemic response. Health Res Policy Syst 2020; 18:58.^,44. Miranda ÉDS, Figueiró AC, Potvin L. Are public health researchers in Brazil ready and supported to do knowledge translation? Cad Saúde Pública 2020; 36:e00003120..

Considering the pandemic’s speed and magnitude, the efforts were focused on the production of thematic manuals with technical guidelines for health workers and administrators in the SUS. In five weeks of work, from April to May 2020, 18 manuals were produced, listed in Box 1.

The first manuals aimed to orient the administration and organize the health services, with general recommendations for administrators and health workers on the frontline of care (manuals 1 and 2). The next manuals addressed groups of themes that appeared repeatedly in the literature, as well as demands from services that emerged as the pandemic evolved. In this area, manuals were produced with a focus on the services and the healthcare provided by them (manuals 4, 5, 10, 17, and 18); with a focus on age groups (manuals 3, 12, and 14); for the prevention and treatment of collective behavior problems (manuals 7 and 8); or by conditions of social exclusion (manuals 9, 11, 13, and 15); and on the process of illness and dealing with death (manuals 5, 6, and 16). Importantly, the work process in the GT kept pace with the virus’s spread in Brazil and the successive increase in the number of cases and deaths with the passing Epidemiological Weeks (EW). Many of the manuals were published before the critical phases hit the various states, as shown in Figure 1.

The manuals were made available through an online, open-access, free platform. The distribution drew on strategies involving the social communications structure of Fiocruz, in addition to webinars, talks, and press interviews that also enabled broad dissemination of the materials on social media (Instagram and Facebook). They were subsequently recommended as references on the websites of universities, professional boards (Psychology, Pharmacy, Medicine), National Council of State Health Secretaries (CONASS), Office of the Public Prosecutor, and various local governments, besides translation of five manuals into English (manuals 1, 3, 4, 5, and 6).

To meet the growing demand, a 40-hour course was organized, called the National Course on Mental Health and Psychosocial Care in COVID-19, with a self-administered distance-education format. The course was developed by the School of Government of Fiocruz Brasília with 16 modules, each containing a video-class and a synchronous virtual meeting (“live”) broadcast via YouTube through partnership with 3,740 researchers and professors. Launched on May 12, within a month there were 60,780 people registered from all 27 states of Brazil.

Finally, the GT collaborated directly in the organization of the online psychological care service promoted by Fiocruz Brasília through the elaboration of the electronic patient file and the development of monitoring indicators, with three manuals produced to support it (manuals 4, 10, and 18).

As noted by El-Jardali et al. ³3. El-Jardali F, Bou-Karroum L, Fadlallah R. Amplifying the role of knowledge translation platforms in the COVID-19 pandemic response. Health Res Policy Syst 2020; 18:58., mobilizing groups or platforms for rapid response to public health emergencies is both a challenge and a key element for supplying high-quality evidence in a short time. The World Health Organization (WHO) considers mental health part of the public health emergency response for handling COVID-19 ⁵5. World Health Organization. Mental health and psychosocial considerations during COVID-19 outbreak. https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf (acessado em 28/Ago/2020).
https://www.who.int/docs/default-source/... . This has been the GT’s central objective: to provide rapid responses to health services for dealing with the triple challenge and to mitigate the mass psychological harms in confronting the pandemic ¹1. Campion J, Javed A, Sartorius N, Marmot M. Addressing the public mental health challenge of COVID-19. Lancet Psychiatry 2020; 7:657-9.^,66. Inter-Agency Standing Committee. Como lidar com os aspectos psicossociais e de saúde mental referentes ao surto de COVID-19. Versão 1.5, março 2020. https://interagencystandingcommittee.org/system/files/2020-03/IASC%20Interim%20Briefing%20Note%20on%20COVID-19%20Outbreak%20Readiness%20and%20Response%20Operations%20-%20MHPSS%20%28Portuguese%29.pdf (acessado em 28/ago/2020).
https://interagencystandingcommittee.org... .

Based on the experience of the GT on mental health and psychosocial care in the context of COVID-19, we proposed some topics for reflection and as a contribution to future experiences with knowledge translation in pandemics and other public health emergencies.

(1) Combine volunteer and collaborative work with experience - The possibility of convening a group of researchers who had never worked together before, but who were focused on fighting the pandemic with their knowledge and academic expertise, provided the essential energy for assembling the GT. Still, the presence of health professionals who had already worked in mental health and psychosocial care in the organization of services in public health emergencies was crucial for orienting the work and formulating the initial questions and plans.

(2) Institutional support and resources - Beyond the merit of each researcher involved in the GT, it was essential to obtain institutional resources and infrastructure (the graduate studies program, online platforms, social networks, and the Fiocuz social communications infrastructure) to expand the reach of the production and communication to different audiences, thereby overcoming one of the main difficulties in knowledge translation.

(3) Speed, networks, and credibility - Pandemics and other public health emergencies require not only translation strategies, but mainly speed to furnish evidence to the health administrators and workers involved in the responses ³3. El-Jardali F, Bou-Karroum L, Fadlallah R. Amplifying the role of knowledge translation platforms in the COVID-19 pandemic response. Health Res Policy Syst 2020; 18:58.. The production’s speed (13 manuals were launched in April, and the national course was launched in May) was important, but it gained national scale and extended to other countries when combined with a collaborative network of researchers and reference institutions on various themes, expanding the topics addressed and the materials’ credibility.

(4) Respond to needs and shape paths - The production of manuals and the national course aimed not only to organize the response in mental health and psychosocial care according to the pandemic’s different phases ²2. Organização Pan-Americana da Saúde. Proteção da saúde mental em situações de epidemias. https://www.paho.org/hq/dmdocuments/2009/Protecao-da-Saude-Mental-em-Situaciones-de-Epidemias--Portugues.pdf (acessado em 28/Ago/2020).
https://www.paho.org/hq/dmdocuments/2009... , but to ensure that the agenda includes themes related to the different vulnerable groups as well as the perspective of a universal health system in the elaboration of strategies of care through organization of the online mental healthcare service.

Final remarks

Death, illness, social distancing, loss of income and work, accumulated debts, and uncertainties towards the future are known factors with impacts on mental health. These factors are exacerbated in public health emergencies, making the feeling of fear a collectively shared experience ⁷7. Lu S. An epidemic of fear. https://www.apa.org/monitor/2015/03/fear (acessado em 28/Ago/2020).
https://www.apa.org/monitor/2015/03/fear... and posing a triple challenge for mental health1. It is crucial for health professionals to acknowledge the situation’s uniqueness in order to seek accurate and timely knowledge. Likewise, conceiving science and researchers in the urgent quest for actions means placing themselves at the service of society in its pressing demand for answers, in keeping with the pandemic’s severity.

The current intervention’s results illustrate the importance of initiatives involving knowledge translation through working groups and platforms to provide evidence quickly, strengthening the actions and practices by health professionals and administrators, responding to the needs of the SUS in confronting COVID-19, other public health emergencies, and future pandemics.

Acknowledgments

F. Serpeloni has a Post-Doctoral Nota-10 from Rio de Janeiro State Research Foundation (FAPERJ) and M. S. Souza is a 2019 Post-Doctoral Scholarship holder from the Brazilian National Research Council (CNPq).

References

Publication Dates

History