Post Publication Independent Review of

"Online mental health services in China during the COVID-19 outbreak"

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Post Publication Independent Review of "Online mental health services in China during the COVID-19 outbreak"

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Post Publication Independent Review of

Online mental health services in China during the COVID-19 outbreak

Shuai Liu, Lulu Yang, Chenxi Zhang, Yu-Tao Xiang, Zhongchun Liu, Shaohua Hu et al.

Published: February 18, 2020 DOI:

Review Comments:

1. Quote "Since January, 2020, the National Health Commission of China have published several guideline documents, starting with the notification of principles for emergency psychological crisis intervention for the COVID-19 epidemic on January 26, then the notice on establishing psychological assistance hotlines for the epidemic on February 2, and most recently, guidelines for psychological assistance hotlines during the COVID-19 epidemic on February 7.3" End of Quote. This article points to an additional load on the National Health System in areas related to psychiatry.

2. Quote " The popularisation of internet services and smartphones, and the emergence of fifth generation (5G) mobile networks, have enabled mental health professionals and health authorities to provide online mental health services during the COVID-19 outbreak." End of Quote. Capability to provide solutions exist and is not a burden to create as a new health infrastructure.

3. Quote "One such multicentre survey involving 1563 medical staff, with our centre at Nanfang Hospital, Southern Medical University (Guangzhou, China) as one of the study sites, found the prevalence of depression (defined as a total score of ≥5 in the Patient Health Questionnaire-9) to be 50·7%, of anxiety (defined as a total score of ≥5 in the Generalized Anxiety Disorder-7) to be 44·7%, of insomnia to be 36·1% (defined as a total score of ≥8 in the Insomnia Severity Index), and of stress-related symptoms (defined as a total score of ≥9 in the Impact of Events Scale-Revised) to be 73·4%. These findings are important in enabling health authorities to allocate health resources and develop appropriate treatments for medical staff who have mental health problems." End of Quote. Every Nation may not have the same percentage distribution, but this can be taken as a ground truth model or as an evolutionary model. Surveys and Analysis may need to be done afresh, as variations might be manifested due to variations in demographies, ethnicities, populations, etc.

4. Quote "Secondly, online mental health education with communication programmes, such as WeChat, Weibo, and TikTok, has been widely used during the outbreak for medical staff and the public. In addition, several books on COVID-19 prevention, control, and mental health education have been swiftly published and free electronic copies have been provided for the public. " End of Quote. These options can be explored.

5. Quote "As of February 8, 29 books associated with COVID-19 have been published, 11 (37·9%) of which are on mental health, including the “Guidelines for public psychological self-help and counselling of 2019-nCoV pneumonia”, published by the Chinese Association for Mental Health" End of Quote. The Ministry or Department of Health/Health Research can take a call whether the same guidelines can be used generically or unique guidelines need to be issued for the Nation.

6. Quote "Finally, online psychological counselling services (eg, WeChat-based resources) have been widely established by mental health professionals in medical institutions, universities, and academic societies throughout all 31 provinces, municipalities, and autonomous regions in mainland China, which provide free 24-h services on all days of the week. Online psychological self-help intervention systems, including online cognitive behavioural therapy for depression, anxiety, and insomnia (eg, on WeChat), have also been developed. In addition, several artificial intelligence (AI) programmes have been put in use as interventions for psychological crises during the epidemic. For example, individuals at risk of suicide can be recognised by the AI programme Tree Holes Rescue,5 by monitoring and analysing messages posted on Weibo, and alerting designated volunteers to act accordingly." End of Quote. Seems to be good and feasible solutions. Can be implemented generically or with unique guidelines designed for the Nation.

7. Quote "online mental health services being used for the COVID-19 epidemic are facilitating the development of Chinese public emergency interventions, and eventually could improve the quality and effectiveness of emergency interventions." End of Quote. These may be solutions that can help to prepare for handling future health outbreaks, and also for handling unexpected contingencies that arise. For instance, the migrant labourers mass exodus to their native places from their place of work, caused inconvenience both to the migrant labourers and also to the health system which was enforcing a 21 day lockdown with reference to containing the spread of COVID-19, causing the Prime Minister of India to issue an apology as an immediate damage control measure to prevent it from spiralling out of control.

The absence of such counselling services fuelled the hundreds and thousands of migrant laborers to hit the roads on a massive scale, while the Central & State Govts were preparing to handle it, the issue exploded even before & while the Central Govt. could authorize & was authorizing the State Governments to use the Disaster Relief Fund to provide immediate relief.

Everytime, the Prime Minister cannot pitch in with an apology to save the situation, and such a precedence should not be set. The Office of the Prime Minister should always be let to maintain its dignified standing in the National and International Levels, and the Prime Minister should not be forced into a situation as issuing an apology, and such a precedence should not be set too. Consequently, such counselling services may need to be treated as an immediate priority and established nationwide, via radio, television and internet channels of communication, to prevent outbreak of unexpected outcomes during National/International Level Disasters/Emergencies/HealthCalamities.

Humble Thanks to His Excellency Hon'ble Dr. Harsh Vardhan, Union Minister for Health & Family Welfare, Science & Technology and Earth Sciences, Government of INDIA

for reciprocating (within 240 seconds, amidst the COVID-19 National containment & treatment protocols) the communications titled "A faint beam of light at the end of the tunnel.... ", which is a continuous set of Post Publication Independent Reviews of Research Articles on COVID-19, submitted to the Govt. of INDIA


1. Screenshot (below)

2. Copy of Communication as pdf file (below)

3. (this webpage)

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Thanks from HE Honble Dr Harsh Vardhan.pdf

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Annexure to IJBST Journal Group Editorial Policy: