Asian Journal of Psychiatry 54 (2020) 102443
Available online 13 October 2020
1876-2018/© 2020 Elsevier B.V. All rights reserved.
Letter to the Editor
Challenges and opportunities for early career child mental health professionals during the COVID19 pandemic
There has been a steady stream of literature emerging about the possible psychological impact of COVID19 and the measures to contain it (Rajkumar, 2020 and Tandon, 2020). Children and adolescents are amongst the most vulnerable groups likely to be significantly impacted due to the pandemic. Factors including change of social structure, disruption of daily routine, longer screen time and irregular sleep pat- terns are likely to contribute to this (Dalton et al., 2020).
Early career clinicians (psychiatrists, psychologists, doctoral and postdoctoral students) contribute significantly to delivery of child mental health services & research. They cater to a large proportion of children & adolescents presenting with mental health difficulties in clinics or hospitals and face a variety of challenges in the face of the evolving pandemic. Though different professional bodies have devel- oped and disseminated resources to address some of the pertinent questions in managing children & adolescents presenting with mental health difficulties, the ground reality still continues to be challenging (Cortese et al., 2020).
An increase in psychiatric disorders such as depressive and anxiety disorders, as well as grief-related symptoms has been reported in this population. An increase in a variety of anxiety presentations in children
& adolescents including obsessions, compulsions and health related
anxiety has also been observed globally (Kaufman et al., 2020). In addition, a rise in presentations with self-harm and attempted suicides in this population has been anecdotally reported in some settings. Constant exposure to news channels with frequently exaggerated health threats, the ever rising rumours and the global infodemic on social media regarding COVID19 have significantly impacted the adolescents, in particular (Jiao et al., 2020). All this has resulted in early career pro- fessionals frequently working out of their area of expertise or without appropriate supervision. The pandemic has also highlighted the need for early career clinicians to further appreciate and acknowledge the role of social media in shaping the contours of mental health and resilience, particularly in adolescents (Hamilton et al., 2020).
Difficulty in managing patients with neurodevelopmental disorders including ADHD and ASD has also been a common experience in different settings. Lack of a structured routine due to closure of schools has posed additional challenges to parents of these children. Multiple stressors including fears of infection, frustration, boredom, lack of per- sonal contact with friends & teachers and lack of personal space at home can accentuate the psychological effects of school closure (Fegert et al., 2020). An increase in psychosocial and intra-familial issues including domestic violence and child sexual abuse has been reported from across the globe (Guessoum et al., 2020). Lack of school based interventions and pressure on social services has translated to a need for other improvised models of care by early career clinicians.
For example, telephonic or video consultation models have been
commonly employed for assessment and management in most clinic settings. Though technologically inclined, most early career child mental health professionals have not actually been trained in these models of care previously. In addition, need for a good internet band- width for high quality video calls can be challenging, even in developed countries. This can again pose considerable challenges in achieving good quality clinical care. Also, it is worth noting the significant ‘digital divide’ that exists in low & middle income countries, particularly in Africa which simply negates any online solution for many of these children and families due to non-availability or lack of access to internet (Boada et al., 2016).
Face to face lectures or workshops have been temporarily suspended for early career child mental health professionals, to minimise risk of infection and difficulty in ensuring social distancing. However, online web-based applications have been increasingly used globally to conduct training events and programs. In fact, even a number of international conferences have moved to virtual platforms ensuring much more accessibility and affordability for early career clinicians. The diversity of clinical experiences encountered by trainees appears to be significantly impacted by the pandemic. This has a definite bearing on the quality of training and diversity of skill development as well as clinical experience.
Examinations in different contexts have already been conducted virtually, particularly in developed countries. There is a further move towards online assessment systems globally. The challenges include incorporating elements of checking fraudulent activity during exams when attempting from homes, quality assurance of the exam process and methods to improvise OSCE (objective structured clinical exams) virtually.
The pandemic has significantly impacted the career of young pro- fessionals in child & adolescent mental health research who are often funded by grants and fellowships (usually doctoral and postdoctoral researchers). Recruitment is not possible for many of the studies, excluding those web-based/online studies. Also, a significant chunk of research funds by different grant agencies have been ear marked for COVID19 related research and this could further impede the already under resourced research in child & adolescent mental health for a long period.
On a positive note, a number of early career researchers are utilizing their time to effectively formulate and address priority research ques- tions at the moment including understanding the mental health effects of social distancing, identifying risk & resilience factors and preventive methods for long-term psychological consequences (Vieta et al., 2020).
The early career clinicians (particularly those not technologically in- clined) have felt the need to rapidly upskill themselves to utilize vir- tual/online platforms for research, training, networking and collaborating. This definitely bodes well for the future.
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Asian Journal of Psychiatry
journal homepage: www.elsevier.com/locate/ajp
https://doi.org/10.1016/j.ajp.2020.102443 Received 29 August 2020
Asian Journal of Psychiatry 54 (2020) 102443
2 Early career clinicians in child and adolescent psychiatry face unique challenges in providing clinical services, accessing training opportu- nities and conducting research during the pandemic. However, it has also provided some great opportunities to improvise current models of patient care and training that may leave a lasting impression even after the pandemic recedes. This has significant implications for policy making, teaching and training of early career clinicians and research in child and adolescent mental health globally in the future.
Financial disclosure
No funding source involved.
Declaration of Competing Interest
None of the authors have any conflict of interest to declare, per- taining to content of this manuscript.
Acknowledgement
We thank our patients (children and adolescents) as well as parents/
carers across the globe for providing us further insight into the psy- chological impact of COVID19 pandemic.
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Sundar Gnanavel*
Northumbria Healthcare NHS Foundation Trust, United Kingdom Tanay Maiti All India Institute of Medical Sciences Bhubaneswar, India Pawan Sharma Patan Academy of Health Sciences, Nepal Darpan Kaur Department of Psychiatry, Mahatma Gandhi Missions Medical College and Hospital, Navi Mumbai, India Fransiska Kaligis Department of Psychiatry, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia Jane Pei-Chen Chang Department of Psychiatry, China Medical University Hospital, Taiwan Hidekazu Kato Department of Psychiatriy, Nagoya University Graduate School of Medicine, Japan Asilay Seker Erciyes University Hospital, Turkey Dmytro Martsenkovskyi Bogomolets National Medical University, Ukraine Massimiliano Orri McGill University Health Centre, McGill Group for Suicide Studies, Douglas Mental Health University Institute, Canada Sifat E. Syed Bangabandhu Sheikh Mujib Medical University, Bangladesh Evelyne Baroud American University of Beirut Medical Center, Lebanon Muftau Mohammed Department of Psychiatry, Federal Neuropsychiatric Hospital, Kaduna, Nigeria Julia Dray The University of Newcastle Faculty of Health and Medicine, Australia Aarya K. Rajalakshmi Massachusetts General Hospital, United States Dorottya Ori Vadaskert Child and Adolescent Psychiatric Hospital, Hungary Tze Jui Goh Institute of Mental Health, Singapore Anna Sofie Hansen Aalborg University hopital, Denmark Ana Munjiza Institute of Mental Health, Serbia Alessia Delle Grottaglie Universit`a Degli Studi Di Padova, Italy
*Corresponding author.
Letter to the Editor