Emotional wellbeing during COVID-19

Problem: COVID-19 not only poses a threat to the physical wellbeing of individuals but has also impacted their mental health. Fear and isolation have triggered feelings of depression, anxiety and insomnia that can lead undermine people's capabilities to manage and regulate their emotions and increase of risky behaviors as substance abuse, violence, and suicidal thoughts.  

Solution:  www.QueNoCundaElPanico.co is an online platform created to provide reliable information on the coronavirus. Through our site’s interactive chat and call center, we provide medical attention to those presenting respiratory symptoms and offer support to people dealing with emotional distress though a three-session intervention —at no cost.  

Scalability: Since our services are delivered remotely, we have a great outreach potential across Latin America and spanish speaking communities in Europe and the US. Barriers on access to mental health care are eliminated, and scaling can be done with agility and at a low cost. 

COVID-19 has not only affected people's physical wellbeing but also their mental health. The fear of contagion, alongside with the prolonged isolation and financial hardships, have triggered feelings of depression, anxiety, insomnia and irritability in the general population. These emotions may also increase risky behaviors -such as substance abuse- and increase the risk of aggression or suicide. In the short-term, emotional regulation and adherence to treatment are threatened and might result in prolonging the course of illnesses. 

In Colombia, reports on gender-based violence have almost tripled. Research has shown a decrease on levels of life satisfaction and happiness, and an increasement on depression and worry. Mental health services to address these emotional affectations are limited and expensive, and usually only available for those living in urban areas.   

The urgent need to combat the disease is evident. However, it is important to consider that the psychological effects of the pandemic may linger long after the physical threat is controlled. Thus, the detection, prevention and management of both, physical and mental health problems, should be addressed as soon as possible in order to mitigate their long-term impacts and strengthen the resilience of the population as the pandemic is still ongoing. 

QueNoCundaElPanico.co (loosely translated to www.dontpanic.co) is an online platform that provides evidence-based answers on matters related to COVID-19. As we received more visits, we have identified the need to include not only information related to physical health, but also tu adres issues regarding emotional wellbeing.

Thus, we started offering a free customized attention service in which our healthcare team connects with users, provides them with recommendations, and identify whether COVID-19 protocol and/or mental health support is needed. Users are then connected with the needed health service.  

On the mental health side, a free three-session program is offered to anyone expressing emotional difficulties, starting and ending with the screening of some mental health conditions. Sessions are conducted by volunteer psychologists and delivered via chat or calls. Participants learn how to use self-regulation strategies (based on the principles of CBT) to alleviate their emotional distress. Follow-ups are done after the sessions, and protocols are available if specialized attention is required.  

We aim at quickly detecting and addressing mental health problems, in order to mitigate their consequences in the short and long-term. It also aims to benefit those who do not have access to mental health care or cannot pay for it.  

To date, we have identified three main population groups we seek to inform and offer personalized care: the general population (including people with pre-existing mental health conditions), COVID-19 patients and their families (who may be struggling with emotional difficulties due to the disease), and healthcare workers, who are currently facing a highly distressing situation due to the increased workload and concern for their own health.  

We are constantly reviewing our site's traffic to better understand our users’ characteristics and interests so that we may create content based on their needs. We operate through a demand-driven model, through which we receive queries from our users, answer them and add them to our content data base. This is complemented by the information we receive through the chat and call center, which gives us feedback on the information our public is needing and the best ways to address their concerns. The sessions’ content is also based on the users' needs, and weekly meetings are carried out to review their feedback and adapt the protocols, if necessary.  

Preventing, detecting and responding quickly to physical and emotional problems not only encourage safe behaviors that slow down the spread of the disease, but can also ease the burden on health systems so that efforts in the short-term can be focused on the COVID-19. Identifying and evaluating short and effective mental health interventions in the context of a pandemic will prepare health systems for future events of similar nature. Furthermore, it will give policy-makers evidenced-based information on the most prevalent emotional responses, the most cost-effective ways to address them, and how to include vulnerable population in these solutions. 

What makes our platform innovative is the fact that it seeks to offer a continuum of care. Our first objective was to offer reliable information to avoid disinformation and fake news, however as the situation has evolved and strategies such as isolation have been implemented, we have seen the need to expand our service offer, with the aim of ensuring at home medical care. For this reason, we now have a proposal in which users can solve their doubts in real time through a chat that is answered by health professionals. In case of identifying any specific need, the person is transferred to telemedicine with the required specialty team, ensuring that they receive adequate care to solve the problem that afflicts them, whether physical or emotional.

In the case of mental health, our purpose is to guarantee that anyone with internet access can receive an adequate intervention, based on the best scientific evidence, built to be brief and friendly, that is also free. This way we seek to eliminate some of the most common access barriers, bringing mental health closer to all people.

Finally, we seek to offer additional tools for people, redirecting them to other digital strategies that specialize in sexual and reproductive health, substance use, and mental health issues. This way, the person will have different tools they can reach without the need of a health care professional, that can have a positive impact on their quality of life and emotional well-being.

The platform uses information and communication technologies (ICTs) to bring health services closer to our users, seeking to ensure that people receive the care and attention they need without having to leave home. In this way, we have managed to offer telemedicine services based on the definition offered by the WHO, in which, through these technological channels, it’s possible for anyone to access health services thought and offered by multidisciplinary teams, regardless of their geographical location or socio-economical status.

In this way, it’s possible to democratize information and health care, granting that a greater percentage of the population will have access to diagnosis, treatment and prevention services aimed at different diseases (including, but not limited to, the Covid-19).

Thus, we take advantage of a technology that already exists, and we use it as a tool to overcome some barriers that are often encountered by people seeking access to health care. Specifically, with regard to mental health, it has been found that in Colombia a high number of people who require this type of care never reach for it due to the low availability from their healthcare providers, the costs of private services, as well as a lack of qualified professionals in some regions. This phenomenon also occurs in other countries in the region and for this reason it is increasingly important to take the tools that technology offers us in order to have a stronger health system and a better coverage.

According to the guidelines for the implementation of telemedicine presented in 2016 by PAHO, telemedicine has proven to be effective in achieving more equitable access to different health services. In addition, it reduces waiting times for specialized medical care, which facilitates the early evaluation and identification of medical conditions on time, avoiding complications in the long term and promoting primary health care, which avoids the congestion of the health care centers, as well as of greater complexity hospitals.

This type of care facilitates the construction of health care models that guarantee the continuity of care, in addition to making a special emphasis on education and health promotion, which, together with the aforementioned, can be much more costly effective for health systems, as well as more beneficial for people who will enjoy better care, greater well-being and better quality of life.

Specifically, with regard to mental health, so far the evidence indicates that telemedicine is a cost-effective tool that allows adequate care to be provided to consultants. In addition, it facilitates the process both for therapists, by having online monitoring tools, as well as for consultants who do not have to travel to access these services. In addition, it allows greater flexibility and interconnection between professionals.

Since the pandemic began, we have identified the importance of giving accurate information in order to help people cope with the situation that has arisen from the disease and its spread; We have noticed that, in the midst of uncertainty, people look for information that allows them to take care of themselves and others. Due to this, our solution seeks to generate a change in the health and well-being of people, bringing them closer to quality health services, meeting their needs related to COVID-19, but also ensuring that people can receive care for any health related issue.

For this, the first thing we must do is to ensure that our users receive reliable, evidence-based information. In this way, we prevent the spread of false information, but at the same time we begin to generate a change in people's attitudes towards medical and mental health care through virtual means, motivating them to seek care through these types of strategies. In the medium term we seek to influence the way in which people seek information regarding health, going to safe sources, but also the way they approach health services, making more users look for virtual attention as a valid.

In the long term, this can initiate a major change in the health system, finding an alternative that allows health care not to be limited by geographic access barriers, allowing people in remote areas to access this type of services. Additionally, it can help strengthen primary health care, helping to decongest complex hospital services and, ideally, we would be helping to improve the physical and emotional health of the population through the early identification of diseases, preventing conditions from worsening and increase its costs of care, giving economic relief to the health system.

Finally, in terms of mental health, these types of services could help the population to recognize its importance. This could increase attention rates and make it an increasingly relevant issue on the country's political agenda, making the government support more projects that seek to strengthen mental health related services and research.

To date, we have reached a total of 33,308 users, who have visited 92,000 pages within our platform. What is very important to mention is the fact that our web page has been working for about two months. We expect this number to keep growing, taking into account that our goal is to be a companion por people throughout this whole process. Now that people know the basic regarding Covid, we want to give out useful information for how to carry on with our lives under the current circumstances, this is why in one year we hope to have reached 180,000 people and over a million five years from now.

Our goal during this first year is to turn quenocundaelpanico.co into a refference site on any covid-related topic, not only in Colombia but also in other Latin American countries, as well as in spanish speaking comunities in the United States. Adiotionally, by relying on telemedicine, we hope to offer good quality health care services throughout the continent, reaching people beyond geographical fronteers. Furthermore, we want to expand our content and use this tool to help communicate information regarding other deseases and how they should be treated. We consider that this tool has the potential  to reach people in different settings in order to inform and educate them about differente health probles that might be affecting their physical and emotional wellbeing under regular or special conditions, such as this pandemic or any other emergency state

Our main barrier is financial. In order to keep expanding our reach, we will need a larger team of professionals from different specialties with the objective of generating more health-related content, as well as being able to offer enough medical appointments through telemedicine. We will also require improvements on our webpage in order to offer a better user experience, and other technological upgrades that will make for a better service. All of this implies costs for which we will need financial strength.

As a team, our effort is divided into two main branches. In first place, we focus on generating new content that answer our users’ needs, as well as in guarantying that whoever approaches us looking for health care will receive an adequate attention. On the other hand, we are also constantly looking for grants and alliances that allow us to continue strengthening our solution. We seek support and cooperation from public and private entities at the local level, but also outside Colombia, with the aim of receiving support in financial, human and technological resources that allow us to continue providing quality information and care.