Correspondence Address:
Dr Mikyas Tilahun
Lebeza Psychiatry Clinic, Amanuel Mental Specialized Hospital, Addis Ababa
Ethiopia

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Since the announcement of COVID-19 as a pandemic by the World Health Organization in March 2020, the virus is spreading at an alarming rate globally without any effective treatment. As of August 2020, the number of people infected by COVID-19 globally has reached more than 21 million with more than 700,000 deaths, while in Africa, a million people have been infected with COVID-19 and 25,000 deaths have been recorded.[1] The impact of this pandemic was seen across the whole sphere of social interactions, economy, and public health. About three billion people are confined at homes or in quarantine around the world that had negative psychological effects such as posttraumatic stress symptoms, confusion, and anger that will be worse in already vulnerable groups like patients with mental illness.[2]

Even before the pandemic, mental illness is the leading noncommunicable disorder in terms of burden with 11% of the total burden of disease in Ethiopia. There are only two mental health hospitals in the country, and the number of psychiatrists is 0.08/100,000.[3] Mental health service is highly centralized which is difficult to access for those living in rural areas and the overflow of patients to these limited specialized centers. Since the pandemic, managing psychiatric patients by conventional methods was disrupted because of the state of emergency imposed to contain the virus and the fear of going to health-care services which further worsens the burden of the already existing centralized and poorly organized mental health services.

Despite challenges, studies have reported potential interventional approaches that could be effectively applied during COVID-19. One of the psychological intervention strategies proposed is telehealth (through video conferences, E-mail, telephone, or smartphone apps).[4],[5] In Ethiopia, there are handfuls of private mental health clinics, and since the outbreak, the services had been significantly disrupted. This particular problem encouraged us to start an alternative system using telehealth to treat the already existing patients and new clients in our private practice. As of our knowledge, this approach has never been attempted in our country for patients with mental illness.

From April 2020, we started our new program by initially upgrading our existing website to accommodate information about the new services, bookings, and choice of therapist for our clients. At the same time, we opened accounts in different banks that our clients could access by mobile banking systems and advertised the new services through different social media platforms. Staff members were trained regarding customer handling, appointments and each therapist was provided a new mobile SIM cards that are equipped with Internet access.

Initially, about 640 patients started using online video conference and audio calls according to their choices. One hundred patients are still using these alternative services, while the majority of clients did not continue to use the services. Some of the feedback we received includes the difficulty of making payments online since most are not familiar using this system, frequent disruption of Internet connections, the additional cost during long hours of audio calls, and not satisfying as directly talking to their doctor. The challenges we encountered were poor Internet access, difficulty in assessing physical reactions during the interview, some patients contacting without scheduled programs, and increased burden of responsibilities at home.

Clients that were satisfied with the service reported that the new approach limits the viral transmissions, convenience with the scheduled, easy access for patients and their families to contact health-care provider from their home. The staff members were also satisfied to work from home which greatly decreased the risk of exposure, allowed them an opportunity to spend time at home, and helped them access new patients who could not come to the service because of stigma and some patients outside the country.

 Conclusion

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