NIGERIAN PSYCHOLOGICAL ASSOCIATION
NATIONAL RESPONSE PROTOCOL TO COVID-19
The Nigerian Psychological Association provides a protocol for psychological response to the Covid-19 pandemic. This document is aimed at giving a general framework and providing guidelines towards halting the transmission of the virus, effective management and evidence-based behavioural response. The document should be used to guide professional practice on the psychological and mental health management of the pandemic, and to serve as working document for engagement with government and relevant stakeholders for collaboration and policy formulation that is suitable and effective for Nigeria.
- Section I: Introduction
- Section II: Role of Psychologists
- Section III: Psychological Response protocol
- Section IV: How to engage the government
- Section V: NPA Fact sheet on Covid-19
- 1 Introduction
The new corona virus disease (COVID-19) pandemic has become a global health problem that requires collective efforts towards mitigating the spread and effect of the disease. The disease is a respiratory tract infection (with a respiratory transmission) that has led to a global health crisis, disrupting every aspect of human live in almost all countries in the world within few months of discovery. The pandemic has, so far, been known to have far reaching implications including heath, social, economic, religious among others.
This is a difficult time in the world, including Nigeria, and the Nigerian Psychological Association must assist our country in our best possible capacity. As a result, the Association provides a guide for professional practice and recommends measures that will reduce panic behaviours and enhance psychological wellbeing during this globally challenging period.
2 About COVID-19
The Corona virus disease 2019 is short named COVID-19. It is a respiratory tract infection that has an incubation period of 1 to 14 days. An individual can be infected with the virus and still shows no symptoms for days. It is known to be a heavy virus that travels about a meter in the air before it falls down, and can be wiped or washed away from surfaces using detergents, bleach or alcohol-based hand sanitizer. It is an airborne disease and not a waterborne disease. The disease is not a spiritual problem, as such, it can be prevented. At the moment, it is believed that there is no known or definite cure although symptomatic management seems helpful.
The virus is known to spread in two ways: directly and indirectly. The direct spread occurs by breathing in droplets from an infected person’s mouth or nose when they sneeze, cough, speak, laugh, exhale, or yawn. While the indirect spread is through contaminations on the hands (virus can be passed by touching oneself or others with contaminated hands), surfaces (virus can be picked up from contaminated surfaces like rails and door handles), contacts (virus can be gotten when one makes contacts with contaminated things, places or persons)
The COVID-19 is deadly especially to people who have weakened immune system (those already suffering from some chronic conditions such as asthmatic patients), individuals aged 70years and above, alcohol and drug users, pregnant women, children among others. And the symptoms of the COVID-19 include: coughing, sneezing, persistent fever, sore throat, difficulty breathing, shortness of breath, chills, headaches, and dizziness. As already noted, COVID-19 has no known cure or vaccine at present; however, symptoms can be treated, and patients recover. It has also been reported that many persons can be infected and remain asymptomatic though they can infect others. The treatment and management measures by government through Healthcare Providers involve testing, medication (these measures require face-to-face contact, thereby endangering healthcare providers and their patients, and psychological Interventions. And some of the precautionary measures issued by government may include physical distancing, self-isolation, quarantine, curfew (where applicable), lockdowns (No Work), stay at home (avoid unnecessary travels).
The World Health Organisation (WHO) is currently gathering data on the pandemic while advising countries on latest scientific information on the pandemic. At the time of preparing this report, ( 14th Apr1, 2020) 1,999,628 persons have been infected with Covid-19 globally, with 500,996 recovered and 128,011 deaths across the world; with United States, Italy, Spain, China being the worst hit. Africa, for now has a low infection figure, although it is still rising following increased testing. The recorded figure of Nigerian infections as provided by the National Centre for Disease Control (NCDC) stands at over 373 cases with 99 recovered cases and 11 deaths.
- 3 Psychological impact of the pandemic on Nigerians
Globally, and in Nigeria in particular, there is a lot of anxiety characterized by apprehension and panic, and many people tend to develop phobia about the dreaded disease. Whereas, many people may exaggerate and over present the situation by spreading information that may be false or misleading which further exacerbates the unwarranted fear, many others may, on the contrary, tend to downplay the issue by not taking or acting appropriately. The information circulated about the Covid-19 virus is varied, thus creating mixed reactions depending on individuals, age, level of education and exposure. It is observed that there is ignorance, misinformation and superstition about the issue, thereby leading to widespread psychological and social problems with accompanying implications.
Corona virus disease is a pandemic and like other human problems, it has social and economic consequences that have negative psychological impacts on people (WHO, 2010). Preparations for an epidemic have traditionally emphasized aspects such as the implementation of national plans, epidemiological surveillance, vaccine and drug requirements, improved vaccination coverage among high-risk groups, as well as the economic impact and burden. The emotional impact of COVID 19 pandemic can be so intense on the patient and relations that they often people do not speak about what they have experienced. Some adults may assume that the child has forgotten, but this is not the case (Pan American Health Organisation/WHO, 2006).
According to Nidal and Asim (2020), pandemics are not just a medical phenomenon; they affect individuals and society on many levels, causing disruptions. Stigma and xenophobia are two aspects of the societal impact of pandemic infectious outbreaks. Common but very troubling psychological impacts that could interfere with prevention and treatment outcomes are:
- Fear – Fear of death, how to survive alone (for those in isolation) or due to social distancing, and the probability of falling ill or getting contaminated especially by those with pre-morbid obsessive-compulsive dispositions.
- Anxiety – Increasing fear of the unknown, what will happen next, which leads to the voracious search for COVID-19 information and this in turn heightens anxiety- because most of the information available and accessible are false and scary. Again, anxiety could arise from hunger especially among the urban poor and other disadvantaged populations, economic regression, financial setbacks, disappointments due to unforeseen cancellation of events (like weddings), loss of job and other sources of income, and inability to cope with the presence of others in the house.
- Depression – Most of the precautionary measures will ordinarily potentiate depression (social distancing, self-isolation and quarantine).The human society is sufficed with intimacy which becomes contraindicated in this pandemic thus forcing new behaviour patterns on the people with the risk of feeling alienated. Ordinarily, this should be a time for social bonding, instead people are advised to separate, spend huge time alone all resulting in interrupted social behaviour, sadness, heightened worry, boredom, lack of motivation, discouragement, sleeplessness, and hopelessness. In cities where total lockdown has been imposed, daily income workers have become frustrated with far reaching psychosocial and economic implications for them and their families.
- Frustration and resentment- Quarantine, self-isolation, lockdown, no work and consequent reduced income or no income for daily wage earners is likely to leave many Nigerians feeling rebellious, mistreated, abandoned, guilty, hopeless, fearful, unsure and or desperate.
- Boredom - Being alone and lonely could leave people short of ideas of how to fill up their days with meaningful activities, feeling useless, worthless and helpless. Poor communication or fear to communicate would also lead negative emotions which may in turn trigger mental health breakdown.
- Stress – Experiences surrounding the spread of COVID-19 might task people more than they have the capacity to cope. Staying at home with shortage of money and inadequate food are major stressors many would face. Workers have been sent home without pay in some States in Nigeria thereby exposing them to economic stressors. Overcrowding, encroachment of personal space, inadequate essential facilities (like light, water, toilets, bathrooms, kitchens, etc.) would be sources of both community and social stress especially among those who live in slums and public yards. These scenarios might increase cases of abuse and domestic violence.
- Stigmatization- Those who test positive and those who fear they might test positive may stay away from treatment facilities because of the fear of being labeled carriers. This becomes more serious since bodies of persons that die from COVID 19 are not released to families in Nigeria but buried by government. This may have some implications given that Nigerians attach some respect to bodies of their relations and will always want family members to bury same in line with cultural and religious realities of the people.
- Anger and Irritability- Resulting from staying at home with no immediate hope of continued income, inactivity, and seeming loss of freedom of movement, financial strain and food shortage, affected persons may become angry and irritable.
- Guilt – Those diagnosed after they may have infected family, friends, relatives, neighbors, colleagues, etc. could be battling with extreme feelings of guilt for contributing to the spread.
- Post-traumatic stress disorder – Those who have pre-existing traumatic events related to infection, isolation, quarantine and related experiences many become activated by the current stressful situation of the pandemic.
- 4 Objectives of Psychological Protocol
i. To ensure that much attention is paid to practical and evidence-based implementation of interventions designed by this noble profession.
ii. To ensure a synergy between the community health care providers and mental health care institutions in the various states of the Federation
iii. As professionals, there should be an urgent need for establishment of psychological intervention team in the states of the federation. The teams will consist of the various subfields of Psychology; Clinical, Counseling, Health, Social, and developmental Psychologists.
iv. To guide national and regional response on the prevention and management of the pandemic and the associated consequences.
- 5 Why Psychologists should be involved
It is important that Psychologists continue to provide professional psychological services to our teaming population, some of whom may be ignorant about the virus. The Nigerian Psychological Association is providing this response guide to the pandemic on the grounds that:
- Psychologists are experts on how people think, feel and act in variety of situations.
- Psychologists recognize the COVID-19 pandemic in Nigeria as a crisis and we create and provide suitable crises interventions.
- Psychologists are aware that this disease has become the bases to escalate other diseases, economic challenges, social difficulties, bereavements, adjustment problems, mental health breakdown and all these call for psychological services.
- Psychologists understand better the need to instill hope and sense of control in the government, corporate leaders, journalists and the masses in the present crisis.
- Psychologists know the importance of disseminating and directing people to accurate information and in a less threatening but persuasive and supportive manner.
- Psychologists can offer telehealth services that will ensure that people cope better with minimal reactions such as panic.
- Psychologists realize the importance of developing an indigenous response to COVID-19 in Nigeria because of our peculiar circumstances.
- 1 ROLE OF PSYCHOLOGISTS
There is a need for a lot of sensitization and awareness creation on the global pandemic and how to curb the infections and to curtail the spread of the deadly virus. The Nigerian Psychological Association in a bid to promote attitudinal change among Nigerians towards the prevention and spread of the virus as key to tackling the pandemic has taken the following stance.
Psychologists would provide psychosocial support for affected individuals, the medical personnel providing care and to the larger communities. We can actively engaged in psychoeducation towards positive attitudinal change as a psychosocial aspect of this health emergency.
Some of the major roles include:
- Psychoeducation (to clarify misconception and prevent superstition)
- Assessment and diagnosis
- Care plan
- Case assignment
- Treatment planning
- Counseling and Psychotherapy
- Provide guidance on negative attitudes that result from the lockdown in the economy and other services.
- Give direction for effective prevention of the spread of the infection, such as people’s attitude towards physical distancing
2. 2 Services to be rendered
The following psychological service using the traditional face-2-face therapy, e-therapy, online psychological services would be offered by psychologists across the nation:
a) Brief online assessment and intervention.
b) Psychological first aid.
c) Mental health diagnostic interview.
d) Individual and family psychotherapy.
e) Adherence therapy.
f) Crisis intervention psychotherapy.
g) Health behavior assessment and intervention services to individuals or groups.
h) Psychoeducation on effective coping strategies.
i) Brief grief (bereavement) counseling.
j) Brief communication and interactive session for appropriate COVID-19 information.
k) Psychological support and advice to front-line medical staff, as well as to other clients, and to the public.
l) Other advisory professional services such as policy review, media messages review, impact assessment of media content and research activities.
- 3 RESPONSE GUIDELINES FOR PRACTITIONERS
This document provides the processes that psychologists should follow in providing services to individuals during and after the pandemic. We expect the government at all levels, leaders and management of industries, educational institutions, hospitals and other health facilities to consult with the association regarding the psychological impact of COVID-19 to the specific circumstance. This document provides the processes that psychologists should follow in providing services to individuals during the pandemic.
2.3.1 Community prevention response protocol
1. Proper dissemination of COVID-19 related information: Information whether good, bad or ugly should be given without falsehood and in a non-threatening manner. The message should change from sickness and death and focus on pre-existing coping abilities, hope and survival. This will help to lessen panic reactions from the populace.
Information no matter how bad must maintain a positive attitude and thereby encourage people to be resilient.
Information dissemination must be through reliable sources like government websites, our association website, federal and state-owned media houses, and distinguished private media houses; people must be directed to find information and updates. At the same time, they are to reduce their appetite for information as increased focus on COVID-19 related information which is mostly scary, ugly and painful could fuel anxiety and depression. Therefore, basic and necessary information is enough to go by.
2 Provide COVID-19 online Psychological ASSESSMENT SCHEDULE FOR NIGERIANS: Offer a COVID-19 assessment schedule for Nigerians who suspect that they might have contracted the virus, who have been directly or indirectly exposed to the virus, who are asymptomatic, who fear that their health might be compromised, who require more information or clarification, who are experiencing COVID-19 related psychological challenges, who feel they cannot cope anymore and who do not know what to do next. The NPA COVID-19 assessment schedule for Nigeria (ASN) should be a structured interview with dimensions which would be offered online. The two goals of ASN is to help psychologists identify individuals who need to be tested and refer them to the testing centers close to them; and to ascertain the kind of psychological intervention (i.e., counseling, psychoeducation, brief therapy, etc.) a client, group or family would need.
3 Provide psychoeducation on how to reduce the risk of traumatization.
4 Help manage patient and community anxiety related to the pandemic.
5 Providing services to families; parents and children services - Helping children cope with changes resulting from COVID-19.
6 Provide psychological services for all ages, from infancy to old age. For example, there is separation anxiety in infancy, undesired behaviors for children who have to stay at home, and isolation for the elderly. Therefore, services should be adjusted for age and need.
7 Provide measures that employees will be protected from infection in the workplace.
8 Behavioral change interventions to improve adherence and compliance with preventive regulations and guidance.
9 Provide psychosocial support services to families who have lost their loved ones to COVID-19 pandemic.
10 Provide services to reduce stigmatization of infected persons, families and communities.
2.3.2 Treatment response protocol
- Practitioners should provide client/patient with teletherapeutic services. The NPA should enlist the government in a bid to mobilize competent psychologists across the nation to offer psychological health services. Treatment to include assessment of clients, treatment planning and execution as well as follow up and termination.
- Psychological Services providers should be competent in conducting online assessment and intervention.
- Develop a patient communication plan, particularly during the pandemic.
- Offer psychological support and advice to front-line medical staff, as well as to other clients, families, media officers, security personnel and other special populations.
- Practitioners should maintain ethical guideline in their practice in line with the ethical code of Nigerian Psychological Association and best practices.
- Practitioners are to promote hygiene in their practice.
- Practitioners must make self-care a priority in providing services during the pandemic.
- All remote professional service should be strictly private and confidential and our clients must be well protected.
- Psychologists should ensure that they are in the best frame of mind to provide services to clients and take necessary measures to protect themselves while at work.
- 1 PSYCHOLOGICAL RESPONSE MEASURES TO MITIGATE IMPACT AND PREVENT THE SPREAD OF COVID-19
Psychologists working with other health workers should be aware, understand and adhere to the standard behavioural health protocol put in place for managing medical patients in isolation.
In addition, there are precautionary psychological measures that individuals can take during the pandemic to safeguard themselves and promote optimal mental health, at least for the mean time.
3. 1. 1 Prevention measures
✔ Psychological hygiene.
✔ Physical and social distance, bearing in mind our cultural practices.
✔ Stay at home except in official capacity.
✔ Avoid crowded places.
✔ Quarantine measures, where necessary.
✔ Do not use non prescribed medication for prevention and/or treatment – e.g. chloroquine and others.
3. 1. 2 During quarantine or lockdown
✔ Try new things at home.
✔ Watch your mood.
✔ Move towards things that are within your control.
✔ Engage in brain and physical exercises.
✔ Setting goals for yourself, whether for the time being or for the future when things get normal.
✔ Ensure you have adequate sleep.
4.3 HOW TO ENGAGE THE GOVERNMENT
- The Federal Government of Nigeria should integrate psychologists in the Presidential Task force on Covid-19 for effective prevention and management of the pandemic using their professional knowledge and skills on human behavior.
- The government should make funds available to the NPA National response team to effectively participate in the fight against the disease with its associated effects.
- The government should formulate policies that will encompass the physical and psychological health components of the Covid-19.
- The government should immediately provide for dedicated COVID-19 Medicare telehealth and telephone items that will allow psychologists to communicate; talk and videoconference with clients who will require psychological care/services in the crisis.
- The Government should make provision for facilities where psychologists can provide services and/or training as part of the efforts towards prevention and treatment, and should create opportunities for feedback – questions, suggestions, comments, etc from those who may have been exposed to the infection.