Mass management of mental health issues during COVID-19 pandemic: the role of professional volunteer groups; an Iranian experience

Several reports, including the studies published in recent issues of the International Journal of Mental Health, have shown the impact of the COVID-19 pandemic on mental health among the general population (Bui et al., 2021; Letourneur et al., 2022), healthcare workers (Al-Amer et al., 2021; El-Tallawy et al., 2022), and special groups (Danquah and Mante, 2022; Noltemeyer et al., 2022; Nyashanu et al., 2021). In order to cope with the post-pandemic situation and reduce the complications for different populations, a variety of strategies and actions have been taken by governmental or non-governmental organizations all over the world. Here, we share our experience in managing COVID-19-related mental health issues in the context of professional volunteer groups in Iran.

According to the World Health Organization (WHO), by the end of 2021, global coronavirus infections have stood at about 278 million confirmed cases. The growing number of confirmed and suspected cases, quarantine difficulties, the overwhelming workload on staff, shortage of personal protection equipment, and lack of effective medications may all challenge the mental health of the general population and healthcare workers. The COVID-19 pandemic has triggered various mental disorders, such as stress, anxiety, and depression in the general population and healthcare workers that require timely intervention to improve the condition (Al-Amer et al., 2021; Bui et al., 2021). Previous studies are reporting multiple measures in response to mental health issues in limited target populations during COVID-19, including psychological counseling, hotlines, screening, and managing stress and depression via online platforms (Liu et al., 2020; Naal et al., 2020; Nahandi et al., 2020; Rajkumar, 2020; Zhang et al., 2020). However, there is a limited number of articles reporting organized systemic volunteer activities targeting various populations managed by university faculties or governmental authorities, particularly in developing countries. In low and middle-income countries, governments may not have a mature enough healthcare infrastructure to meet this challenge alone, showing the importance of volunteer groups.

Coronavirus outbreak management in Iran is an exceptional experience in the current situation. Serial financial and political crises coupled with immature infrastructures and disaster management strategies in Iran, as a developing country, have challenged the government to take urgent and appropriate action, especially on epidemic-related mental health issues. On the other hand, high rates of internet access, smartphone availability, and social media usage have provoked the formation of several specialist and non-specialist volunteer groups during the pandemic. Volunteer movements are a part of Iranian social culture and have played an undeniable role in our historical crises. However, these volunteer groups usually last only for a short time as the government does not actively support nor quickly legalize their presence.

Mashhad is the second most populous city in Iran, with a population of around 3 million. The city hosts more than 35 million annual visitors and pilgrims, which makes infection control and mental health management extremely challenging (Deputy of Pilgrims Affairs 2020, Statistical Center of Iran 2016). From the beginning of the outbreak, a great number of local psychologists and psychiatrists have formed a volunteer group under the supervision of university academics and started a comprehensive movement in four certain subgroups according to their specialty and interest. Here we briefly discuss our experience in different subgroups of this volunteer movement during the first six months of announcing COVID-19 as a pandemic by the WHO.

The public education subgroup planned to produce contents and trainings to tackle challenges such as infection prevention, limitation of social psychological trauma, stress management, familial conflict management, effective communication with children, behavioral activation, and self-care skills, all oriented according to the COVID-19 pandemic and quarantine situation. Our team used facilities in the Mashhad medical university’s public relations department, virtual education systems, local newspapers, radio stations, TV channels, and also social networks to produce and broadcast 21 video clips, 11 podcasts, 2 newspaper interviews, 8 hours of radio programs, 9 TV talk sessions, and also several lines of lectures, educational pamphlets, and Short Message Service (SMS). Moreover, our team launched multiplatform social media pages and shared a total of 17 podcasts, 176 video clips, and 178 text files (educational pamphlets, articles, protocol papers, guidelines, brochures, and booklets).

Producing protocols and trainings to be used by the professionals and organizing team was done in the protocol development and specialists’ education subgroup. Among such productions are protocols for remote counseling hotline, psychological first aid, management of mental health issues in frontline healthcare workers, modified Balint groups, and addressing psychological needs of the general population and COVID-19 cases, including their families. In total, we developed four protocols, eight educational documents, and a related book chapter to be used by healthcare workers involved in managing the COVID-19 related mental health issues.

Moreover, we have planned specific psychological interventions for the general population, victims, and healthcare personnel using available scholarly documents adjusted for local needs and cultural issues. Hospitalized COVID-19 patients and also healthcare workers have been provided with online and in-place volunteer counseling with respect to infection control protocols. We could hold a total of 135 virtual, hotline, and in-person consultation sessions for the general population, healthcare workers, and COVID-19 patients and their families. Furthermore, we established five series of online Balint group therapy for frontline medical staff and dedicated psychological support sessions for the families who lost members due to COVID-19 infection. Our team also provided 420 hours of psychiatric clinical consultation for COVID/Intensive Care Unit (ICU) wards.

Members in the research and study subgroup have been continuously reviewing available literature and designing projects to locate and respond to the local requirements in order to scientifically adjust ongoing measures. Studies to assess and predict probable local mental health demands in the future of the pandemic were undertaken; in this phase, we could successfully register and start 25 research studies and finalize a web-based application for the assessment of mental health issues in healthcare workers. A number of these studies have been published, and others are in the submission and peer review process to be published in local and international journals (Salimi et al., 2021; Shahini et al., 2021).

The above-mentioned activities were continuously monitored and managed in a managerial group consisting of volunteer university professors in order to remain homogenous, follow protocols, address all the local needs, and prevent interference between groups.

According to the significance of voluntary activities, particularly in low and middle-income countries where there are limited available financial and human resources and there is a need for timely coordinated activities, we wished to share our experiences in forming a collaborative volunteer-governmental expert group. Meanwhile, we would also like to ask our colleagues in low and middle-income countries to do so and report related experiences in order to provide a comprehensive resource for managing upcoming issues in the current and probable future epidemics.

Acknowledgments

The authors wish to thank Mashhad University of Medical Sciences and local TV and radio stations for having provided us with their facilities. The authors thank psychiatrists, psychologists, and psychiatry residents involved in the project, also Syed Mohammed Naqvi for revising the final manuscript.

Disclosure statement

The authors declare that they have no conflict of interest.