Sri Lanka committed to improving access to quality essential health care services during the peak of COVID-19 outbreak. Since the mental health sequela of the outbreak was prominent, the Directorate of Mental Health (DMH) within the Ministry of Health (MoH) of Sri Lanka prioritized the delivery of Mental Health and Psychosocial Support (MHPSS) under the mandate of the Deputy Director-General for Noncommunicable Diseases. The country has successfully maintained a comprehensive MHPSS. With the support of WHO, the DMH took proactive preventive measures combined with an effective public health approach, to strengthen its MHPSS response.

WHO provided seamless support to DMH and MHPSS communities through the provision of strategic support, capacity building, coordination and technical assistance. This helped the population, the frontline health practitioners and the most vulnerable to have continued access to essential mental health services and medications at a time when the Government was focused on effectively controlling the transmission and management of cases. Building on the work in the past biennium, WHO worked in tandem with MoH to reinforce the preventive health system and sustain the delivery of care to communities.

During the outbreak, undue stigmatized behaviour in the general public was soaring. Therefore, the DMH conducted a rapid online survey to define the magnitude and nature of stigma and discrimination and developed an evidence-based communication campaign to combat this situation. WHO supported this initiative by providing information in Sinhala and Tamil languages including sign language to deliver the message. WHO also supported the MHPSS response by developing messages about wellbeing that were shared to the population via electronic media and community based organizations. The wellbeing messages were inserted as ring tones in all mobile phone lines for three weeks during the peak of COVID-19.

Global resources developed by WHO headquarters and Inter Agency Standing Committee reference group for MHPSS were translated and adopted in local languages with the support of WHO. These guidelines reinforced the standard response for continuity of mental health services and built capacity of the frontline workers in providing care to patients. To ensure the continuation of medications for patients with existing mental health conditions and psychiatric disorders, oral medications were sent through postal services to patients for two consecutive months and injectable medicines were administered either at community level or in clinics. Medical Officers of Mental Health (MOMH) teams and the community of Psychiatry Nursing Officers conducted home visits to the most vulnerable patients for the administration of injectable medicines.

Healthcare staff taking care of COVID-19 patients and public health personnel involved in contact tracing and quarantine processes were at the highest risk of stress and burnout. The DMH with the help of the National Technical Committee on Mental Health developed guidelines for health administrators of the curative and preventive health sectors to promote mental wellbeing of frontline health personnel and contain future mental health conditions. Through close collaboration, WHO helped MoH conduct a Mental Health Wellbeing Programme dedicated to frontline health workers and their families, assisting more than 2000 families along the line. All hospitals have since taken initiatives to promote the wellbeing of their employees in accordance with these guidelines.

WHO is currently working with DMH and Sri Lanka Telecom to build capacity and decentralize the helpline service (1926) of the National Institute of Mental Health to district level, as a means to accommodate an escalation in distressed calls.

Furthermore, WHO is providing technical assistance to uplift the capacity of the quarantine centres and reinforce the proficiency of the personnel through capacity building efforts in self-care, mental and psychosocial wellbeing. Consequently, staff members will be better equipped to deal with the wellbeing of COVID-19 patients.

Following the comprehensive MHPSS response, MoH received constructive comments from members of the public. The success of the response was the outcome of a robust partnership and the collective action of MoH, WHO and key partners; a strong political commitment from the Government; solidarity of all stakeholders and the dedication of health care professionals.

In the context of Sri Lanka, early identification of mental health issues and appropriate interventions will be pivotal to further limit the psychological catastrophe of COVID-19. Hence screenings will be mandatory for individuals at risk and those in need of special attention namely health care workers, affected females, the elderly and quarantined individuals. Knowledge of previous disaster management will assist in setting up support networks and assessment mechanisms. The Psychological First Aid (PFA) will play a substantial role in sustaining these networks to preserve the mental wellbeing of Sri Lankans.

Photo caption: The counsellor providing psychological support through 1926 mental health helpline at the National Institute of Mental Health.

Photo credit: National Institute of Mental Health