Notice on the Issuance of Guiding Principles for Emergency Psychological Crisis Intervention in the Novel Coronavirus Epidemic

Notice on the Issuance of Guiding Principles for Emergency Psychological Crisis Intervention in the Novel Coronavirus Epidemic

Issue Date： 2020-01-27

Source: Center for Disease Control

肺炎机制发〔2020〕8号

To each province, autonomous region, or directly-governed municipality's joint prevention and control mechanism (leading group, command department) for responding to the novel coronavirus pneumonia epidemic:

In order to guide all regions to carry out in a scientific and standardized way psychological crisis intervention work related to the novel coronavirus pneumonia epidemic, we hereby issue to you the Notice on the Issuance of Guiding Principles for Emergency Psychological Crisis Intervention in the Novel Coronavirus Epidemic. Please refer to and implement it. Please promptly give feedback to the National Health Commission Bureau of Epidemic Control on issues discovered during implementation.

Contact Person: National Health Commission Bureau of Epidemic Control; Zhang Shubin

Contact Number: 010－68792352

Working Mechanism for the Joint Prevention and Control of the Novel Coronavirus Pneumonia Epidemic

January 26, 2020

(Information disclosure type: Proactive Disclosure)

Guiding Principles for Emergency Psychological Crisis Intervention in the Pneumonia Epidemic from the Novel Coronavirus Infection

These Guiding Principles shall be implemented under the direction of trained mental health professionals.

I. Organization and Leadership

Each province, autonomous region, or directly governed municipality's joint prevention and control mechanism (leading group, command group) for response to the novel coronavirus pneumonia epidemic is to uniformly lead efforts for psychological crisis intervention, and provide necessary organization and financial safeguards.

The National Association for Mental Health and mental health-related associations and societies are to mobilize experts with experience in post-disaster psychological crisis intervention, and organize a psychological aid experts group to provide technical guidance; to carry out emergency psychological crisis intervention and psychological counseling in an orderly manner under the unified coordination of the health administration departments.

II. Basic Principles

(1) Include psychological crisis intervention in the overall deployments for prevention and control of the epidemic, with reducing the psychological damage caused by the epidemic and promoting social stability as the premise, timely adjust the focus of psychological crisis intervention work according to the progress of the epidemic prevention and control work.

(2) Implement differentiated categories of intervention for different groups of people, and strictly protect the personal privacy of those receiving aid. Those giving and receiving aid shall all pay attention to avoid further trauma.

III. Drafting Intervention Plans

(1) Purpose.

1. to provide the affected population with mental health services;

2. to provide the population in need with psychological crisis intervention;

3. to proactively prevent, reduce, or control the psychosocial impact of the epidemic as far as possible;

4. to continue to do the work of managing and treating severe mental disorders.

(2) Work Content.

1. Understand the mental health situation of all types of groups impacted by the epidemic, and based on information learned, promptly identify high-risk groups, avoid the occurrence of extreme incidents such as suicide and impulsive actions. Promptly report emerging signs of mass psychological crisis to the joint mechanism (leading group, command department) for the prevention and control of the epidemic, and provide a recommended plan for resolving them.

2. Comprehensively use all types of techniques for psychological crisis intervention, and combine it with publicity and education, and with provision of mental health services.

3. Train and support social organizations in carrying out psychological health services.

4. Do a good job of management. treatment, and community care of persons with severe disabilities living at home,

(3) Determine the number of people in the target group. Groups impacted by the novel coronavirus pneumonia epidemic are divided into 4 groups. The focus of intervention shall begin the first level and gradually expand. Ordinary publicity and education should cover groups at all 4 levels.

Group Level 1: Novel coronavirus pneumonia patients (serious cases receiving in-patient care or higher), frontline epidemic prevention and control medical care personnel, disease control personnel, and management personnel.

Group Level 2: Light patients in home quarantine (persons in close contact, suspected cases), patients with fevers arriving at hospitals for care.

Group Level 3: Persons related to those in groups 1 and 2 such as relatives, co-workers, and friends; and those participating in background aid work in the epidemic response, such as on-site commanders, organizational and management personnel, and volunteers.

Group Level 4: Persons in infected areas impacted by epidemic prevention and control measures, susceptible populations, and the general public.

(4) Assessment of the target groups and drafting of categorized intervention plans. Assess the psychological state of the target groups, promptly distinguish between a high-risk group and an ordinary group; carry out psychological crisis intervention for the high-risk group and mental health education for the ordinary group.

(5) Draft a work timetable. Arrange work and draft work timetables based on the scope and numbers of the target groups, as well as the number of psychological crisis intervention personnel.

IV. Team Building

(1) Psychological assistance teams. May be independent teams or mixed in comprehensive medical teams. Personnel are primarily to be from psychiatric departments, but clinical psychologists and psychiatric nurses may participate. Those with experience in psychological crisis intervention are to be given priority in selection. When forming independent teams, a team leader is to be appointed and one liaison appointed to be responsible for ensuring logistics and contact with other parties.

(2) Psychological assistance hotline teams. Will draw for the most part on mental health workers who have received psychological hotline training, and volunteers with experience in public emergency psychological crisis intervention. Before taking up their posts they should receive training on psychological assistance in response to the novel coronavirus pneumonia epidemic, and experts should be organised to offer supervision to hotline staff.

V. Work Methods

(1) Psychiatric and mental health specialists shall promptly study and judge the situation considering both the development of the epidemic and the psychological state of the groups in question, provide joint epidemic prevention and control mechanisms (leading groups, command groups) with recommendations and advice on decision making, provide psychological crisis intervention personnel with training and supervision, and provide the public with mental health publicity and education.

(2) Fully make use of the role of the Healthy China Strategy, the Ministry of Health’s 12320 public hotline, provincial-level health platforms, existing psychological crisis intervention hotlines, and different types of online communication methods, make coordinated arrangements for mental health workers to work in shifts to provide 24/7 hotline services, promptly provide real-time psychological support for people in Group Level 3 and Group Level 4, and provide additional psychological assistance for people in Group Level 1 and Group Level 2.

(3) Widely mobilize social forces, providing social support on the basis of the needs and challenges of all groups impacted by the epidemic.

Attachment: Key Points for Psychological Crisis Intervention for Different Groups

Attachments:

Key Points for Psychological Crisis Intervention for Different Groups

1. Diagnosed Patients

(1) Initial Isolated Treatment

Mental State:numbness, denial, anger, fear, anxiety, depression, disappointment, complaint, insomnia, or aggression, etc.

Intervention Measures:

1. Understand that patients' emotional reactions are a normal stress response to stress, and be prepared in advance; don't be angered by the patient's attacks and sorrow so as to lose a doctors' perspective, such as by quarreling or becoming overly entangled with patients.

2. While understanding the patient, in addition to pharmaceutical treatment, psychological crisis intervention shall be given, such as assessing the risk of suicide, self-harm, or attacks; giving direct psychological support, and not having direct conflicts with patients. When necessary, seek psychiatric consultation. Explain the importance and necessity of isolation and treatment, and encourage patients to have confidence in a positive recovery.

3. Emphasize that isolation is not only for better observation and treatment of patients but is also a method for protecting loved ones and public safety. Explain the key points in current treatment and the efficacy of intervention.

Principles:Mainly support and comfort. Tolerance towards patients, steadying patients' emotions, early assessment of the risk of suicide, self-injury, or attack.

(2) Period of isolated treatment.

Mental State:in addition to the possible mental states described above, loneliness, refusal to cooperate with or abandon treatment due to fear of the disease, or overoptimism and unduly high expectations for treatment may also occur.

Intervention Measures:

1. To the extent that patients can accept it, objectively and truthfully explain the sickness and the outside epidemic conditions, to give patients a clear understanding;

2. Assist in communications with relatives outside the area, and the transfer of information;

3. Actively encourage all behaviors that assist in the patients' treatment;

4. Make the environment as suitable for treatment as possible;

5. When necessary, seek psychiatric consultation.

Principles:actively communicate information, seek psychiatric consultation when necessary.

(3) Patients experiencing respiratory distress, extreme agitation, or difficulty expressing themselves.

Mental State:feeling of impending death, panic, despair, etc.

Intervention Measures:Calm and soothe while concurrently strengthening treatment of the primary illness and alleviating symptoms.

Principles:Comfort, calm, pay attention to emotional communication, enhance confidence in treatment.

(4) Patients with light symptoms quarantined at home and patients with fevers seeking care at hospitals.

Mental State:panic, agitation, loneliness, helplessness, repression, depression, pessimism, anger, nervousness; or stress, grievance, or shame from being alienated or shunned by others; or indifference to the disease.

Intervention Measures:

1. Aid recipients of services in understanding true and reliable information and knowledge; accept authoritative scientific and medical materials.

2. Encourage active cooperation in treatment and isolation measures, healthy diet and rest, read and listen to music more, and use modern communication methods to keep in touch and for other routine activities.

3. Accepting isolation, understanding one's own reactions, and looking for positive meaning in adversity;

4. Seek societal support in responding to stress: use of modern means of communication to contact friends and family, colleagues and so on, share feeling and experiences, maintain communication with the community to get support and encouragement;

5. Encourage use of the psychological assistance hotline or online psychological intervention, etc.

Principles:Health education, encouraging cooperation and adaptation to change.

II. Suspected Cases

Mental State:Feelings of invulnerability, avoiding treatment, and fear of discrimination, or anxiety, excessively seeking treatment, frequently going to different hospitals, etc.

Intervention Measures:

1. Policy education, close observation, seek treatment as soon as possible;

2. Adopt necessary protective measures for oneself and others.

3. Make arrangements in service of the big picture and report one's own circumstances as provided.

4. Use conduct that reduces stress and reduce pressure.

Principles:Timely education, correct protections, serve overall situation, reduce stress.

III. Medical Care and Related Personnel

Mental State:Excessive fatigue and tension, even exhaustion, anxiety, insomnia, depression, sadness, feeling of injustice, helplessness, distress, or frustration and self-blaming over the death of a patient. Worried about infection, worried about family, and afraid that family is worried about them. Over-excitement, refusal to take reasonable rest, unable to properly ensure their own health, etc.

Intervention Measures:

1. Conduct psychological crisis intervention training prior to participation in aid, understand stress reactions, study methods to respond to stress and control emotions. Conduct preventive interviews, public discussion of feelings and experiences; support and comfort; resource mobilization; help the parties to be prepared psychologically to respond to stress.

2. Eliminate front-line medical workers' worries, arrange dedicated personnel for logistical support, try to rotate staff in quarantine areas once a month to the extent possible.

3. Make reasonable schedules, arrange appropriate relaxation and rest, guarantee adequate sleep and diet. To the degree possible, arrange accommodations near the hospital for frontline personnel at key hospitals.

4. Where it is possible, maintain contact and communication with families and the outside world as much as possible.

5. When insomnia, despair, or anxiety occur, professional psychological crisis intervention or mental health services may be sought through the psychological assistance hotline or online psychological services, and areas with the capacity may carry out in-person psychological crisis intervention. Where it continues for two weeks and impacts workers, the psychiatry department needs to conduct an assessment and consultation.

6. If symptoms of stress have already occurred, work positions shall be promptly adjusted and professional help sought.

Principles:Regular rotations, adjusting oneself, seek help if there are problems.

IV. Those having close contact with patients (family, co-workers, friends, etc.)

Mental State:Hiding, restlessness, and other anxiety in the waiting period; or blind courage, refusing protection and home observation.

Intervention Measures:

1. Education on policies, encourage facing the truth, cooperate in observation of residents;

2. Transmit and communicate correct information, release feelings of anxiety.

Principles:Educate, comfort, encourage communicating online.

V. People unwilling to seek medical care publicly.

Mental State:Fear of misdiagnosis and isolation, lack of understanding, avoidance, neglect, anxiety and so on.

Intervention Measures:

1. Factual education, eliminating fear.

2. Early treatment, helping others;

3. Discard feelings of shame, and protect scientiffically.

Principles:Explain and persuade, do not criticize, support seeking care.

VI. Susceptible Groups and General Population

Mental State:Panic, afraid to go out, blindly disinfecting, disappointment, fear, irritability, aggressive behavior, excessive optimism, or giving up.

Intervention Measures:

1. Provide accurate information and information on further services.

2. Communication and guidance on adapting behaviors.

3. Do not discriminate against patients and suspected patients;

4. Give reminders on unhealthy coping methods (such as drinking, smoking, etc.)

5. Self-recognition of symptoms.

Principles:Health education, guiding active responses, eliminating panic, scientific response.