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We wrote 6 points which were deleted.

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TOPIC: DOMESTIC ABUSE (physical, psychological, emotional etc.)

Domestic Abuse -

1. The facts:

1. Close proximity to family members at this time can lead to further cases of domestic violence.

2. Emotional and financial burden in current times lead to a greater incidence of violence, causing further chaos and uncertainty.

3. In many ways, due to the lockdown, there are limited options to seek help while leaving the house.

4. Due to lack of privacy, it may be difficult to make calls asking for help.

5. Lack of police interference at this time, hospitals are overburdened/cannot respond to abuse.

6. Overuse of social media sometimes leads to neglect of family members living in proximity.

1. Excessive use of social media can further fuel anxiety, depression and other mental health conditions which the individuals might already be facing.

7. Violence in the home can also lead to adverse health and mental health outcomes, including a higher risk of chronic disease, depression, post-traumatic stress disorder, and risky sexual and substance use behaviors.

1. Myths:

1. Being in a house full of domestic violence is an inevitability, COVID isolation will make it worse, and there is nothing that can be done.

2. Hopelessness amidst the chaos leads to aggression which needs venting, regardless of whomever it is vented on.

2. PLAN: (technically we are to make a plan as to how would we mobilize resources- we are acting like psychologists here)

1. While screening for COVID-19, also have a mechanism to screen for any form of abuse within the family or area!!

STRATEGIC PLAN:

While screening for COVID-19, also have a mechanism to screen for any form of abuse within the family or area!!

1. Create a safety plan. Try to create a situation in which you may have fluid cash in hand, along with other vital documents.

2. Appeasment. Given the stakes, try as much as one can to avoid any triggering actions to the perpretatror, and aim to alleviate any possible tensions.

3. Get support. Whether  through friends, family, or mental health counselors, talk to them about your situation. Make sure you are in a safe space (eg. abuser is asleep or downstairs watching tv on loud) whilst making such calls.

4. For psychological abuse, try relaxation techniques, acknowledge how you feel, communicate with abuser

5. Advertise helplines that are working out there to help people talk about their problems and providing support to those who have been abused.

6. Involve media to interview psychologists

7. Create a safety word that can be understood by the abused when a situation is about to get more hazardous.

8. Remove any potential weapons (eg. gun, knife) and store them/hide them so that the abuser can not gain access to them.

Evidence-Based Data: https://www.psychologytoday.com/us/blog/love-lies-and-conflict/202004/trapped-home-domestic-abuse-during-the-pandemic

https://www.psychologytoday.com/us/blog/why-bad-looks-good/202004/5-steps-prevent-domestic-violence-during-quarantine

https://www.nytimes.com/2020/04/06/world/coronavirus-domestic-violence.html

https://www.apa.org/topics/covid-19/domestic-violence-child-abuse

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Zaid Hussain One Above All
He will save us all, His power prevents this from being deleted
Zehra Naseem
Zara Hussain
Usman Waraich
Mazin
Taimur
Zeeshan Mota
Zafar Aleem Suaar
zainab nadeem
zainab khan
Amrah Hashmi
Usman Ali
Zaiba Dawood
Shirin Jalaluddin
waqqas haroon Chaudhary
You are a 4th year MS who has been asked to be a part of community-based project. You have been assigned a task of developing a strategic plan to address the common CAMH related concerns generated by fear of pandemic and its consequences in children, adolescents and their parents.

•
Using at least one legitimate/evidence based reference, develop a draft strategic plan using an online tool Padlet.

We need to answer this

Reference Articles:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734852/
https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159970
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2764730
CAMH problems:
1)  Kids' mental health is affected by the academic schedule standstills. This leads to problems like anxiety among adolescents specifically since a few of them are at critical points in life where they are making goals and deciding career pathways  all of which have come to a halt

2) kids are not able to meet their friends, play and do other social activities that they would do before. This causes them to be upset and since some of them don't understand the importance of social distancing due to lack of proper guidance for example, this could lead to mental distress.
3) Children will look to their parents or caregivers for answers and explanations, parents will be bombarded with information that is hard to digest and perhaps not completely factual.
4) Some children will be isolated in an already abusive environment. Sometimes going to school relieves children and adolescents of the daily mentally distressing issues as home and now that schools are closed, the kids have to deal with these issues including abuse every day.

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In Pakistan, with a population of 169 million, the allocation to adult mental health is hardly 1% of the annual health budget, and there is no specific allocation for children and adolescents. The provision of child and adolescent mental health services is very fragmented nationally.

This paper highlights the status of child and adolescent psychiatry services in Pakistan and makes some suggestions on how to develop them within the available resources.

Current situation

The current situation in Pakistan is that there is no formal referral pathway to psychiatric services for children. Children with mental and behavioural problems present to general practitioners in the community or to psychiatric out-patient departments, where they are seen by general adult psychiatrists, most of whom have little if any formal training in child psychiatry. However, it would not be improper to hypothesise that children reach these services after attending spiritual and faith healers.

The more common referrals involve neuropsychiatric and neurodevelopmental disorders, including behavioural sequelae of epilepsy and brain injury, pervasive developmental disorders, attention-deficit hyperactivity disorder, Tourette syndrome, early-onset psychosis, other psychoses, psychosomatic/dissociative disorders, eating disorders, depression, anxiety and obsessive-compulsive disorders.

If children require admission, they stay on general adult psychiatric wards with adults who are acutely mentally unwell. The staff have very little formal training in managing children. Hence, the burden falls on the parents and carers to look after and manage them, leading to further anxiety and distress, especially if a parent has to take time off work.

Future directions and possible solutions

Developing paediatric-psychiatric liaison services

In Pakistan, in order to make use of scarce resources and still provide an appropriate in-patient setting, a suitable model could be for admissions to be to the paediatric ward, but with full support from the psychiatric team. Each adult psychiatry department could set up a paediatric liaison facility. Where the child is acutely disturbed and is difficult to manage in the paediatric ward, there could be a designated area on the psychiatric ward, preferably away from adult patients.

Lack of communication among existing paediatric and psychiatric specialties needs to be addressed through integration. One way to establish services would be to hold joint departmental meetings once a month, to which ward nurses, psychologists and local general practitioners should also be invited, to increase their awareness of psychiatric disorders in children. Attendance at paediatric ward rounds and joint teaching sessions, journal clubs, case presentations and so on would allow a clearer understanding of the issues faced by all involved.

Establishing multidisciplinary teams

In child psychiatry, an ideal team consists of professionals from different disciplines, including psychiatrists, psychologists, occupational therapists, nursing staff, family therapists, teachers and psychotherapists. There are usually close links with paediatricians and local social services.

In Pakistan, it is difficult but not impossible to develop a multidisciplinary team. Currently, teams consist mainly of psychiatrists, psychologists and nurses. Many units have occupational therapy as part of the in-patient experience and this is an area that could be developed in a more structured way. Psychiatrists working in adult psychiatric units attached to a general hospital (which is now the usual arrangement) often have good links with teams in the rest of the hospital and frequently receive and send referrals to them. Similar links could be developed with local paediatricians, where a child psychiatry service is to be developed.

Foreign aid

Given the shortage of specialist child psychiatry services, one way forward could be for child and adolescent psychiatrists trained abroad to join with local psychiatrists. Working as a team, they could develop culture-specific guidelines. This would be especially helpful if there were clear protocols for the management of various mental health problems in children. Currently this is happening in an ad hoc way (Rahman et al, 2000). The help of other organisations could be enlisted in achieving this; for example, the Royal College of Psychiatrists has its Volunteer Programme for Senior Psychiatrists and Specialist Registrars, which aims to match senior professionals working in the UK with departments in different parts of the world looking to develop expertise in particular areas (see http://www.rcpsych.ac.uk). The South Asian Forum for Psychiatry provides training in various countries; this will also prove to be a useful resource in providing training in child and adolescent mental health services.

Similarly, the Higher Education Commission of Pakistan welcomes foreign-trained professionals who are willing to contribute to service development in the country.

Another example worth mentioning is DRIP - Disaster Relief by Irish and Pakistani doctors (see http://www.dripireland.org). A voluntary organisation of Pakistani-origin doctors living in Ireland, DRIP is developing emergency medical services in Pakistan and extending its input to all branches of medicine with a view to introducing culturally appropriate protocols and guidelines in all the fields of medicine. Local and foreign experts will provide a platform for future developments in the field. DRIP has recently established an adult and child psychiatry branch.

Training of health professionals

Medical training at undergraduate and postgraduate levels needs both to create awareness and to stress the importance of child and adolescent psychiatry.

Joint problem-based training sessions with paediatricians and psychiatrists needs to be rolled out in teaching set-ups, with a view to developing liaison services.

Nurses need to be trained in the management of children with psychiatric disorders. They should develop counselling skills and be able to run structured and unstructured groups. These skills can be imparted to them during their training years by psychologists and psychiatrists.

There is also a question of training general practitioners (GPs). The aim would be to increase their awareness of protocols and referral pathways. It should be made mandatory for GPs to do 6 months of psychiatry to obtain their licence. Currently, 1-week programmes in psychiatry for GPs are conducted at Fountain House, Lahore, which is affiliated with the World Psychiatric Association's section on education (these contribute to the GPs' programme of continuing medical education).

In Pakistan mental health professionals need first to identify their area of special interest in treatment modalities, such as cognitive-behavioural therapy, family therapy, psychotherapy, education or occupational therapy. They then need to develop their interests by pursuing the appropriate training. The Royal College of Psychiatrists is looking to offer short periods of training to appropriately qualified individuals.

In hospitals, heads of departments have been organising training programmes and inviting local and foreign speakers, in this way keeping staff abreast of innovative and exciting developments in the field. Overseas Pakistani psychiatrists can be a useful source of training. At the Institute of Psychiatry at Rawalpindi General Hospital, email consultation and supervision with child psychiatrists in the UK has proved to be a very useful resource (Rahman et al, 2006). Similar set-ups could be developed in other parts of the country.

Involvement of the community

Discharge plans need careful consideration to ensure that all supports and follow-up plans are in place. In Pakistan the family and carers take on this role. Family psychoeducation for the early identification of symptoms of relapse is desirable, especially when families live in areas where they cannot easily come for regular follow-up. This information needs to be provided by the treating mental health professionals. Training/psychoeducation of the community is being carried out by mental health professionals in a number of areas; for instance, a programme in Lahore involving mothers, Imams (religious leaders) and teachers is running an awareness campaign on psychiatric disorders.

Given the importance of school in the lives of children, teacher training is another area to focus on. Several voluntary organisations, such as Amin Maktab and the National Society for Emotionally and Behaviourally Handicapped Children, have been running outreach programmes, training parents and local community volunteers.

Research and audit

There is a need to develop robust research projects to identify the prevalence of childhood mental illness. (Currently the lead author is conducting one such project in a teaching hospital in Lahore.) A summary of significant international epidemiological studies concluded that the rate and range of psychiatric symptoms in children is similar in lower- and higher-income countries (Fayyad et al, 2001). However, the prevalence of child mental health problems in Pakistan is higher than has been reported in studies from other countries (Syed et al, ). Research in the area of understanding the psychopathology of mental disorders in children in our cultural context needs to be explored (Nikapota, 1991). Furthermore, 'needs assessment' of the target population is another area worth exploring.

Conclusion

In Pakistan, the national annual budget for mental health is far below what would be necessary to meet the needs of the population. There are very few child mental health facilities in the country (Syed et al, ).

Collaborative working between professionals managing children needs to be strengthened. Management guidelines have to be developed, as this will enable good clinical care and also facilitate research and audit. Research is needed to identify the prevalence, psychopathology and needs of mental health problems in children and priorities for management. Psychiatrists trained abroad could be a source of support and training, preferably on a longer-term basis, through email consultation and supervision. The transfer of skills through workshops and short training courses also is effective.

Children lacking in mental health have an adverse effect on the country's productivity, economic stability and viability. Recent research from Karachi, Pakistan, has highlighted effective models of utilisation of scarce child mental health resources within the current health and educational setup (Syed et al, ). Policy-makers in the face of lack of finances and resources need to make decisions based on the efficacy of proposed and evaluated interventions which are not only beneficial to the population in question but also cost-effective.

References

Gadit, A. A. (2007) Comparison between a developed and a developing country. [Journal of Medical and Biological Sciences, 1, 1-7. Google Scholar]

Park, K. M-E. (2002) Up to one fifth of the world's children has mental or behavioral problems. UN Chronicle, Jun-Aug Seehttp://www.un.org.pk/gmc/chronicle-bah-prob.htm (last accessed August 2008).

Rahman, A., Nizami, A., Minhas, A., et al. (2006) E-mental health in Pakistan: a pilot study of training and supervision in child psychiatry using the internet. [Psychiatric Bulletin, 30, 149-152. Google Scholar]

Syed, E. U., Hussein, S. A. & Yousafzai, A. W. (2007b) Developing services with limited resources: establishing a CAMHS in Pakistan. [Child and Adolescent Mental Health, 12, 121-124. Google Scholar]

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Child and adolescent mental health services in Pakistan: current situation, future directions and possible solutions

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Worldwide, mental disorders are on the increase (Gadit, ) and an estimated 10-20% of children have one or more mental or behavioural problems (Park, ). There is an urgent and serious need to pay attention to the mental health needs of children ...

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plan to address the common CAMH related concerns generated by lockdown and its consequences in children, adolescents and their parents.

what is camh?
What is life?

Common Concerns
- academic interruptions, graduation delays, alteration of plans leading to anxiety and stress
-isolation and lack of social interaction, people with existing mental health problems who rely on external comfort of friends are deprived of that solace
-lack of general structure and routine can put people in a bad mental space and make them anxious
-general underlying fear when it comes to thinking about the future and
Plan Requirements
-  E-learning since school are closed
E-learning requires smartphones and internet
IT staff and technology

Socio-Cultural Elements
Smartphone's are not used by kids
Lack of excess to internet and technology
Myths that should be addressed
- E-learning is not productive
E-learning is not feasible
E-learning is expensive
-

Plan
E learning via online video call
Internet homework
Research articles

Source
https://www.camh.ca/en/health-info/mental-health-and-covid-19
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plan to address the common CAMH related concerns generated by lockdown and its consequences in children, adolescents and their parents.

what is camh?
What is life?

Common Concerns
- academic interruptions, graduation delays, alterat

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ASAP!