Improve Access to Mental Health Services Peer Review

Introduction

The COVID-nineteen pandemic has had a devastating touch on lodge, from the closure of businesses, disrupted services, and a mounting decease toll of millions worldwide. Many individuals, even those who were not directly impacted by this virus, were placed into lockdowns instituted by their corresponding municipalities, states/provinces, and countries. This enforced isolation has resulted in greater rates of depression, feet, psychological distress, insomnia, deprival, and anger around the world (1, 2). As the mandated isolations continue to become more frequent and longer in duration, the rates of low, anxiety, and loneliness are just predicted to increase, particularly amidst children, adolescents and young adults (18- to 24-twelvemonth olds) (3).

Given that prolonged isolation can be quite harmful for individuals when left unaddressed, there needs to be a way to alive with implemented public health measures while mitigating their negative furnishings on one's mental health. One could argue that individuals should be more than proactive in consulting professional mental health services before their mental health declines significantly. Notwithstanding, but 36% of American university students who screened positive for major depression and 52% of students that screened positive for generalized anxiety disorder or panic disorder pursued professional mental wellness services, despite the sample having access to nearly universal health insurance and various free mental health resources (four–half-dozen). Furthermore, in Canada, information technology was found that individuals from ages fifteen to 24 are the least likely historic period group to seek professional person aid for their mental wellness, despite being the almost afflicted by mental illness (seven). Thus, the need for individuals to improve back up one another becomes apparent, much like outset aid grooming amid the general populous. A fashion to achieve this would be through the provision of peer support from one individual to another, and unlike concrete first assistance, this does not require any official certification. Peer support is divers equally the social and emotional back up offered past an individual in equal standing, founded on respect, shared responsibility, and a common understanding of what is helpful (8). Due to information technology existence an informal form of back up that is widely attainable and effective, it led u.s.a. to hypothesize that it would be a valuable tool in aiding the mental wellness of individuals who are negatively affected by the pandemic. This review discusses the mental health implications of the COVID-19 pandemic as found in peer-reviewed literature during October 2020–March 2021, and further, we advise the usefulness of peer support as a course of mental wellness support during these trying times.

Methods

Database Search for Literature Review

Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). The following databases were searched: PubMed/MEDLINE (October 2020–April 2021), Spider web of Scientific discipline (October 2020–Apr 2021) and Worldcat (October 2020–April 2021). We too searched for literature using the Google search engine and the starting time twenty results were reviewed as this search engine displays the results by relevance. Articles that were published and peer reviewed, as well as official documentation by the Mental Health Commission of Canada, were examined in this report. The reference lists of articles selected for full-text review were searched for additional articles. Nosotros also used Google Scholar to place other published scholarly literature past performing a championship and author searches. All publication/report types and languages were included in this search strategy. At that place were no limits placed and no restriction on the year of publication, with databases searched back to their inception. Search terms used in Google/online databases to find the commodity include: "coronavirus," "COVID-xix," "mental health," "feet," "depression," "isolation," "mental wellness resources," "peer back up," "online mental health resources," and "healthcare workers." Example of search query used in PubMed database: [("coronavirus" OR "COVID-19") AND ("mental health" OR "feet" OR "depression" OR "isolation")].

The Prevalence of Poor Mental Wellness During the COVID-xix Pandemic

Worsening mental health has go an increasingly concerning issue in countries instituting measures such equally mandated lockdowns. Contempo survey studies done revealed that large proportions of the sampled population showed a higher prevalence of stress, feet, and depression as a outcome of lockdowns and concrete distancing (ix). For instance, in Italian republic, the period of the get-go lockdown had pregnant detrimental effects on the mental health of its citizens (10). In fact, ane survey administered in Italy revealed that the perceived levels of happiness and mental health decreased as a result of the lockdown, while their feelings of loneliness increased (xi). Other studies accept shown that the negative psychological effects experienced by adults also included confusion, acrimony, and distress (3). There are several stressors experienced during quarantine which tin pb to these negative affective states such every bit the duration of quarantine, fears of infection, frustration, boredom, insufficient supplies, and inadequate information (12). Additionally, the constant fears of the unknown, stigma, and land of 1's finances can proceed to act as stressors post-quarantine (12).

Amidst children 11-years of age or younger, and youth 18- to 24-years of historic period, a significant portion reported experiencing increased loneliness during the pandemic due to lockdowns, social distancing, and school closures, with the latter age group existence affected the most (3, x). The loneliness was associated with depressive symptoms, social isolation, generalized anxiety, suicidal ideation, cocky-harm, and eating disorder behavior (3). One report which analyzed parent-reported levels of mental well-being of their children isolated in the context of various infections revealed increased levels of aligning disorder, astute stress, grief, and post-traumatic stress disorder (PTSD). One reason for this could be the of import role that peer groups and social identity plays in the development of young individuals (thirteen, 14). This is an issue of cracking business as politicians and policymakers in various countries determine the length of instituted lockdowns, schoolhouse closures, and social distancing in the context of COVID-19.

The Impact of the Pandemic on the Mental Wellness of Healthcare Workers

One portion of the population that is severely impacted by this pandemic are the frontline medical workers. In fact, surveys done in Prc, Togo and India during this pandemic accept shown that at that place is a higher prevalence of insomnia, feet, depression, somatization, and obsessive-compulsive symptoms in medical workers compared to non-medical workers (15–17). One study that interviewed hospital staff who were quarantined during the kickoff SARS outbreak constitute that they were more likely to report feeling exhaustion, detachment from others, irritation, poor sleep, poor concentration, and ultimately a decline in their performance in the workplace (eighteen). In fact, survey-based analysis washed on healthcare workers during the initial COVID-xix outbreak in China revealed that 23.2% of them experienced anxiety, 22.8% showed prevalence of low, and 38.9% experienced insomnia (19). Moreover, there were sex-specific differences with female healthcare workers experiencing more of the affective symptoms than their male counterparts (19).

These are extraordinarily difficult times for those working in the inpatient units, consul liaison services, emergency departments, too as those having to widen their scope of practise in the presence of an overloaded healthcare system (20). This underscores the need for an accessible support organisation to aid those that direct provide intendance at the frontlines during the COVID-19 pandemic. To address this decline in healthcare worker mental wellness, it has been suggested that there be increased provisions of mental health back up which will event in greater self-efficacy and confidence (21). Additionally, the apply of technology to evangelize psychosocial supports while preserving social distancing would exist greatly beneficial (21).

The Lack of Accessible and Effective Mental Wellness Resources During the COVID-19 Pandemic

Social distancing and lockdown measures have forced many individuals to stay inside, leaving them unable to access traditional mental health services. Moreover, many back up services are not able to finer transition to an online delivery model in an attainable manner. To address the issue of dwindling mental health, many governments are making the try to annunciate resource such as telephone helplines, videos, and readable material (22, 23). Though they can serve to inform, they are frequently inadequate in meeting the increased need of mental health resource caused past the COVID-19 pandemic (24).

Many digital interventions currently be to address social isolation and loneliness in young people. Computerized cognitive-behavioral therapies such as BRAVE-TA, MoodGym, SPARX, and "Think, Experience, Do" take small, but positive impacts on mental health (25–27). Additionally, self-help interventions such as bibliotherapy and computerized therapy accept shown to accept a somewhat positive outcome on mental health but are agreed to generally exist less constructive than face to face up therapies (28–30). Unfortunately, even though mobile apps are a very accessible and easy-to-use medium of obtaining information and accessing resource, in that location is a lack of testify supporting their effectiveness in improving mental health (25, 31, 32).

Fortunately, for healthcare workers, an evidence-based community forum known as Schwartz Rounds allows medical staff from all backgrounds to discuss their emotions regarding work-related matters (33). Moreover, those who used this online forum reported feeling acknowledged and validated (33). Withal, staff are nevertheless encouraged to use institutional peer back up programs as a single forum-based resources may not exist sufficient (34).

In order to make mental health resources more than accessible, platforms such as WeChat, Weibo, and WhatsApp are existence used in many countries to meliorate connect individuals with psychological counseling services (23, 35). Yet, the take chances of increasing suicide mortality amongst regular citizens and health care workers is of bang-up business organisation given the present economic stress, social isolation, decreased admission to community and religious support, and barriers to mental health treatment and illness (36). Hence, information technology has been suggested that having a telephone back up line that is staffed by nurses and/or counselors would exist beneficial for individuals in quarantine (37).

Community is sought during times of strife and the differences in access to adequate mental health support beyond dissimilar socioeconomic groups makes it challenging to find a reliable resource (20). This suggests the need for an accessible form of support that tin can remove barriers between a struggling individual and a supporter. There is currently evidence for the utility of telepsychiatry in aiding the mental health of growing adults and adolescents (38). However, the limitations of this approach include the need for trained psychiatric counselors, as well as the stigma associated with seeking professional person help (39).

Peer Support equally a Viable Mental Wellness Resource

Peer back up equally a mental health resources has grown exponentially in the last few decades around the world, namely North America and Europe (40). In the U.s. alone, Goldstrom et al. has reported that services run by, and delivered to, people with mental health issues more double traditional, professional person mental wellness organizations (41). This growth is supported by numerous studies that illustrate the safety and efficacy of peer support which include its power to ameliorate empowerment, promise, quality of life, self-esteem, social functioning, and care appointment for those accessing its services (xl, 42–45). Furthermore, two comprehensive systematic reviews have shown that non but are peer supporters able to achieve like outcomes to mental health professionals, but that peer supporters reduced inpatient service use and improved relationships with providers, care engagement, and various recovery-related outcomes in people struggling with severe mental affliction when compared to professionals (46, 47). On the other hand, one of the systematic reviews did identify a study that institute that the presence of a peer increased the number of psychiatric hospitalization days (46). They postulate this could be considering the peer heightened the awareness of the clients' suffering and appropriately advocated for interventions leading to boosted hospitalizations (48). In the other studies with the positive results, however, the recipients may have felt that the peer support provided was sufficient and that further assistance in the form of professional services was not required. Overall, there are many peer support services and organizations that are used to assist the mental health of patients with various mental and physical ailments, but the general consensus toward peer support is that it is either inconclusive or yields positive furnishings (Table ane). Notably, the presence of alien results reiterates the need for further research to ameliorate narrate the affect of peer support.

Table 1. Summary of peer support resource investigated in peer-reviewed literature.

Looking specifically at educational institutions, peer support has been shown to better self-esteem, feet, depression, stress, burnout, loneliness, and overall mental well-existence, although the literature here is express (Tabular array ane) (78–81). Interestingly, one of these studies determined that structured peer support is unlikely to accept a pregnant effect on improving early on and preventative intervention (79). Although they expected peer support to facilitate early intervention for students reluctant to access professional services, they found that many of the students attending peer support groups had already sought professional support and had been experiencing mental health difficulties for over a year. Therefore, they argue that integrating peer support into professional-led services may maximize outcomes every bit opposed to pursuing one intervention over the other (79).

Nevertheless, peer support tin pose a few challenges. Previous studies have demonstrated concerns regarding boundaries and power dynamics merely also the stress, accountability, and risk assessment peer supporters are faced with in their roles, and so it is imperative that they prioritize their own mental health as well (xl, 82–85). One systematic review has plant that in that location was piffling to no evidence that peer support impacted hospitalization or overall symptoms, and that the positive furnishings reported on promise, recovery, and empowerment were nowadays merely inconsistent (86). Altogether, they land that electric current bear witness is promising but does non support the requirement of mental health services to provide peer support programmes (86). 1 reason for this could potentially be considering peer back up is a relatively new phenomenon in the mental health landscape, that is just recently getting traction for being a viable mental health resource. Therefore, boosted research studies and clinical trials are required to ameliorate understand the role of complex interventions such as peer support.

Strategies for Obtaining and Providing Peer Support in the Context of the COVID-nineteen Pandemic

Another strength of peer back up is its flexibility. Peer support can be provided in diverse settings through several different mediums every bit illustrated in Tabular array 1. The first distinction is whether the peer support is provided in a group or an individual setting. Grouping peer support typically functions with a peer support facilitator and then multiple service users who each share and discuss their experiences with the group. Perhaps the best and oldest example of grouping peer support, and peer support in general, is Alcoholics Anonymous (AA) (87). AA is an established and heavily researched peer support delivery method with a recent review indicating social support variables such as shared experiences every bit being a key factor to its effectiveness (87). Grouping peer support methods take at present been successfully deployed in various settings, ranging from mental health focused groups such as the Health Recovery Activeness Programme (WRAP) (88) and Building Recovery of Private Dreams and Goals through Education and Support (BRIDGES) (89) programmes to supporting HIV-infected adolescents (ninety) and improving quality of life in breast cancer patients (91).

Private peer support, on the other manus, is typically a 1-on-one delivery with a single supporter and service user (88–91). These interactions have been shown to provide beneficial applied, emotional, and social supports in a non-treatment based, normalizing relationship but are highly understudied and lack show regarding the necessary duration, frequency, quality, or intensity to maximize its effectiveness (92). For these reasons, peer support has been acknowledged every bit a resource that should complement rather than supervene upon professional mental wellness resources at this time, suggesting the fact that a blended arroyo may piece of work synergistically to maximize mental health outcomes (79). The benefit of professional person mental health services is not to be understated every bit they indeed have been proven to exist very useful for aiding i's mental wellness, notwithstanding, numerous barriers can all the same prevent individuals from obtaining the help they need (93–95). Therefore, culling sources of support demand to be explored, and notably, individual peer back up is becoming an extremely mutual delivery method that continues to grow in popularity (forty, 41).

With the inflow of the COVID-19 pandemic and the swift transition of many services to online platforms, virtual peer support services accept quickly come up to the forefront of novel mental health back up delivery methods. Past removing traditional barriers to peer back up programs such equally accessibility and availability, virtual peer support may be a very promising alternative to in-person peer support via utilization of video conferencing software such as Zoom, Google Meets, and Cisco Webex. A 2019 article by Fortuna et al. summarizes the diverse engineering science modalities that digital peer support tin can be delivered through, which includes "peer-delivered and smartphone-supported interventions, peer-supported asynchronous engineering, artificial peer back up, breezy peer-to-peer support via social media, video games, and virtual worlds" (96). Unfortunately, inquiry on virtual peer support is limited with various systematic reviews identifying an overall lack of high-quality studies in online peer back up, mainly because many of these interventions are used adjunctively and therefore the individual effect of online peer support cannot be conspicuously demonstrated (97–100). Yet, the findings they practice annotation are promising and could exist the next frontier of peer support and mental health intendance in the futurity (97–100).

Collectively, through reviewing peer-reviewed studies, we identified the following steps as being effective ways to provide peer back up during the COVID-19 pandemic:

In person (for the people within your social-distancing bubble):

1. Detect a comfy and welcoming room/space with minimal interruptions.

2. Reassure the person y'all will be confidential, not-judgemental, and non-directional toward anything that they will say.

iii. Actively listen using minimal encouragers and appropriate body linguistic communication. Additionally, validate and normalize the individual's thoughts, feelings, and experiences. Notation: the supporter should try and maintain a balance between listening fourscore% of the time and talking 20% of the time.

• Some example phrases/sentence starters to employ:

○ "From what I am hearing, it sounds similar…"

○ "It is understandable why someone in your position would experience like that."

○ "Thank you for opening upward to me, it takes a lot of backbone to share something and then personal."

○ "Your experience is unique, but anyone in a similar position would feel that way."

4. Paraphrase and summarize the key points of what they are sharing with you. Ask for description and allow them to correct yous as necessary.

5. Ask open-ended question to encourage conversation and keep it flowing organically.

• Some example open-ended questions to enquire:

○ "How did you feel earlier that happened? How did you feel after?"

○ "How has this affected your sleep, eating habits, etc."

○ "What do you like to exercise for self-care?"

○ "How can I offering you back up? Delight tell me what that looks like to you."

6. If the individual is seeking communication or counsel, you lot may brainstorm potential ideas with them non-directionally, but take them lead the discussion.

• This can be washed through redirection:

○ "I do not know your experience as well as yous do. What do yous feel yous should practise? Why?"

○ "Earlier I share whatever of my thoughts, I would dearest to hear a bit more than about what things you have already considered."

Almost (for the people outside of your bubble):

1. Find a comfortable room or space with an appropriate/welcoming background and minimal noise.

• Note: using earphones is highly encouraged if there are other people passing by in that area.

two. Open a video conferencing software such as Google Meets, Zoom, WebEx, etc. on a calculator or mobile device and ship the private the meeting link.

three. Allow them to keep the video on/off depending on what they prefer and assure them that they are free to leave the call at any time.

4. Reassure the person that you volition exist confidential, non-judgemental, and non-directional toward anything that they will say.

five. Actively mind using minimal encouragers and appropriate torso language. Additionally, validate and normalize the individual's thoughts, feelings, and experiences. Notation: the supporter should endeavor and maintain a remainder between listening eighty% of the time and talking 20% of the time.

• Some example phrases/judgement starters to use:

○ "From what I am hearing, information technology sounds like…"

○ "Information technology is understandable why someone in your position would feel similar that."

○ "Thank you for opening up to me, it takes a lot of courage to share something so personal."

○ "Your feel is unique, but anyone in a similar position would feel the same way."

○ "You're not solitary."

half-dozen. Paraphrase and summarize the central points of what they are sharing with y'all. Inquire for clarification and let them to correct you as necessary.

7. Ask open-ended question to encourage conversation and keep it flowing organically.

• Some example open-ended questions to ask:

○ "How did y'all feel before that happened? How did you feel after?"

○ "How has this affected your sleep, eating habits, etc."

○ "What do you like to practice for self-care?"

○ "How can I offer you support? Please tell me what that looks like to yous."

viii. If the individual is seeking advice or counsel, y'all may brainstorm potential ideas with them non-directionally, but take them lead the discussion.

• This can be washed through redirection:

○ "I do non know your feel also as you practice. What exercise you lot feel yous should do? Why?"

○ "Before I share whatever of my thoughts, I would love to hear a bit more nigh what things y'all have already considered."

- Troubleshooting tips for virtual peer support:

• If the video telephone call lags, be honest well-nigh it and ask them to repeat what they had said.

• If the call ends unexpectedly, send them another coming together link and go on from where you left-off.

• If the call is lagging excessively, turning off the video may reduce the lag.

Concluding Remarks

The COVID-19 pandemic has had devastating effects on communities all around the world. Notably, its affect on the mental health of individuals by way of instituted lockdowns and social distancing/isolation measures remains to exist sufficiently addressed. Although professional mental health services accept begun transitioning to online delivery models, this adaptation has non been sufficient to meet the growing need of mental wellness support. That existence said, there still remains viable options for those in need. Peer support, although not a psychiatric or professional service, can be generally beneficial in improving mental wellness. This review identifies numerous studies illustrating the positive impacts of peer support, only the presence of studies demonstrating its lack of utility should not exist ignored. Information technology should exist noted that the vast bulk of the peer back up studies discussed hither have not identified any clear adverse outcomes on recipients' mental health and so, information technology appears that peer support can actually exist a quite condom and benign resource. More research is necessary, but for the time being, utilizing peer support as a complementary resource to professional services may maximize positive outcomes. During the pandemic, nevertheless, peer support stands out as a resources that can be hands provided by members of the community to i another through accessible online mediums, even during times of quarantine and lockdown. Equally this pandemic draws on for extended periods of fourth dimension, mental health can deteriorate. However, members of the customs can help 1 some other through the provision of peer back up to ensure that all members of order are able to suffer these trying times.

Author Contributions

RS: conception of review topic, writing of review, table analyzing peer-reviewed literature on peer support, and editing of manuscript. AA: writing of review and editing of manuscript. ZK: table analyzing peer-reviewed literature on peer support. All authors contributed to the article and canonical the submitted version.

Funding

The costs associated with publishing were kindly funded by McGill'southward Peer Back up Centre and the Students' Society of McGill Academy.

Conflict of Interest

The authors declare that the enquiry was conducted in the absence of any commercial or financial relationships that could exist construed as a potential disharmonize of interest.

Abbreviations

COVID-xix, coronavirus-19; PTSD, mail-traumatic stress disorder; RCT, randomized controlled trial.

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