COVID-19 facility should have provision for psychiatric consultation: Health Ministry
New Delhi: Highlighting that coronavirus pandemic has induced mental health concerns, both pre-existing and new-onset triggered by lifestyle restrictions and uncertain future, the Centre has issued guidelines stating that COVID-19 facilities should have provision for psychiatric consultation.
The Union health ministry on Sunday issued 'Guidelines on Managing Mental Illness in Hospital Settings during COVID-19' stating there are at least three groups affected by mental health concerns during the pandemic.
Research suggests that depression (present in about 30 percent of diagnosed patients) and symptoms of post-traumatic stress disorder (almost everybody diagnosed with COVID-19--96 percent) could be extremely high.
Secondly, pre-existent patients with psychiatric disorders may experience a recurrence or worsening of their symptoms during the pandemic.
Thirdly, a wide variety of psychiatric symptoms, including anxiety (ranging from mild to severe), worries, non-specific psychological distress, depression, stress symptoms, insomnia, hallucinations, paranoid and suicidal ideations, among others, have been noted during the pandemic.
"In addition, worries related to the restriction of lifestyles, issues related to special populations including children and adolescents, job losses and uncertainty about future, increase in domestic violence and child abuse have also been reported.
"Therefore, there is a need for specific guidelines for medical officers and mental health professionals on how to prevent the infection and provide COVID-19 related care in hospital-based settings," the document stated.
The COVID-19 pandemic has put an inordinate strain on health facilities, and posed unique challenges to mental health care delivery, both in the community and institutional and hospital settings, it said.
According to the guidelines, COVID-19 facility should have a facility for consultation with a psychiatrist either in person or by tele-consultation, while admitting a person with mental illness, and at no point should any psychotropic medication be stopped abruptly without a psychiatrist's advice, unless in case of a life-threatening emergency.
Also, the bed allocated for the patient should be preferably close to the nursing station to ensure he or she can be observed round-the-clock while steps must be taken to ensure that the windows are well boarded and there is no access to instruments to harm self/others, they said.
Information about PPE and social distancing can be provided using simple language and visual depictions or videos and contact with caregivers should be maintained via the video-call facility at set times in the day.
Care-givers must be provided daily updates regarding both the physical and mental health conditions of the patient, the guidelines stated.
The challenges faced by mental health service providers include difficulty in isolating/quarantining patients with active symptoms of mania and acute psychosis, as well as people with mental health emergencies.
Also, patients with psychiatric disorders (by virtue of their symptoms) may not cooperate during swabbing and testing and thus may have to be sedated, and some of the procedures and appropriate tests may get delayed.
"Staff has to be in close contact with some of the patients who are at risk of violence or suicidality and to keep a check on them frequently.
"Some patients may be uncooperative or at times hostile (for example, those with delusional disorders, psychotic disorders) to the treating team, creating additional challenges to the health providers. Provisions of the Mental Healthcare Act, 2017 have to be complied with-particularly those related to the assessment of capacity, supported admission, etc," the document highlighted.
Besides, homeless persons with mental illnesses are usually brought (including those with intellectual disabilities) to Mental Health Establishments (MHEs). Such patients often fail to provide proper history and no reliable informants would be available in most cases.
Also, the lack of identity proof and valid phone number for the COVID testing (prerequisite as per the ICMR guidelines) are commonly seen in this population, adding to the challenges faced by the mental health service providers, it said.
"Patients and caregivers need to be encouraged not to visit OPDs of MHEs unless any emergency arises. In case of difficulty in procuring medications locally, they can contact the local/state/national helpline number services for further assistance.
"Services like home visits for patients who are unable to visit the OPDs, but require clinical consultation need to be initiated," the guidelines said.
The guidelines also stated that MHEs need to constitute a Hospital Infection Committee which ensures the implementation of the newer norms recommended by the health ministry during the pandemic at their establishments, so as to safely practice mental health services.
As far as outpatient facilities are concerned, only appointment-based OPD consultations to prevent crowding should be encouraged.
In addition, provision for telemedicine/tele-psychiatry services shall be utilized for reducing the footfalls further.
The document mentions guidelines for the management of COVID-19 in special populations -- elderly with mental illness, perinatal women with mental illness, children and adolescents with mental illness, substance use disorder (Alcohol), and substance use disorder (Tobacco).
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AI reshaping music, filmmaking in Kannada cinema
Bengaluru: Artificial Intelligence is slowly changing the way music and creativity are produced in the Kannada film industry, raising concerns among musicians, singers and technicians, The New Indian Express reported on Sunday.
Music composer, actor and director V Manohar reportedly said, AI is being used to write lyrics, especially in low-budget movies. Once lyrics are generated, AI can suggest thousands of tunes. It even asks whether the voice should be male or female. With one click, a complete song is ready.
“If this continues, singers and musicians will have less or no work in the coming days. But it may not succeed either. A few years ago, dubbing was allowed and people could watch movies in any language they preferred. But not many took to it as they wanted to watch a movie in the original,” TNIE quoted him as saying.
According to the report, Filmmaker Avinash U Shetty, a National Award winner, said resistance to new technology is not new. Those who resisted shifting from analogue to digital films years ago have now embraced it. The industry is now using only 10% of the AI potential. If it is scaled up, it can do unimaginable things. What we consider bad now, may not be after five years.
Highlighting the cost advantage, Sangamesh, an independent creator reportedly said, he made a three-minute video using AI for just Rs 4,500. Earlier, the same work would have cost nearly Rs 15 lakh. I finished the entire project in three days. The only expense was the AI software subscription, he said.
These days, it has become difficult to differentiate between the real and AI. AI is creating artistes. Scenes like war, big fights and dance can be shot with a lesser number of artistes. Then with the aid of visual effects and AI, you can achieve what you have in mind, he said.
Actor-director D P Raghuram felt that while AI has made an impact on music, it lacks emotional depth. Cinema earlier involved hard work and strong emotional connections. AI can help improve our work, but creativity should remain human, he reportedly said.
As per the report, earlier, Kannada cinema employed hundreds of junior artistes, who not only earned wages but also shared meals on sets and formed lasting bonds with stars like Dr Rajkumar, Vishnuvardhan and Ambareesh. Today, filmmakers fear that increasing dependence on AI could reduce such human connections, turning creativity into just another automated process.
