Psychiatric Social Work Consultations for Persons with Neurological disorders in a Tertiary Care Hospital during COVID-19 Lockdown: A Retrospective Observational Study

How to Cite the Article: Kuppusamy C, Noorudin M, Papanna HKD, Mohanan KJP, Ezhumalai S. Psychiatric Social Work Consultations for Persons with Neurological disorders in a Tertiary Care Hospital during COVID-19 Lockdown: A Retrospective Observational Study. Indian J Psychiatr Soc Work 2021;13(1):Epub. Kuppusamy et al: PSW consultations for persons with neurological disorders Indian Journal of Psychiatric Social Work, 2021;13(1): Epub 2 Covid-19 lead to disruptions of health services in general and neurological services in particular. It has driven a rapid re-organisation of health care services, affecting clinical care for patients with chronic neurological diseases. Lockdown was imposed to restrict people’s movement to contain the rapid spread. There were no public transport facilities such as buses, trains, and flights. Hence, there was no means to access the health care facilities by using the public transport system. However, certain essential services were allowed to function and exempted from complete closure, such as hospitals, pharmacies, and other essential transport services. Worldwide one billion people are affected by neurological conditions. About 30 million people suffer from neurological disorders (excluding neuro-infections and traumatic injuries) in India. The largest contributors of neurological DALYs in India is Stroke (37.9%), headache (17.3%), epilepsy (11.3%), cerebral palsy (5.7%), encephalitis (5.3%). Considering the magnitude of the problem and highly infectious nature of the covid-19 infection, delivering health care during a pandemic was challenging for both COVID-19 affected individuals, as well those with other acute and chronic neurological conditions. The available human resource to treat neurological conditions in low and middleincome countries were inadequate. Presently, there are only 1,200 neurologists registered with the Indian Academy of Neurology in India. Few hospitals employ social workers in neurology settings such as NIMHANS, Bangalore, AIIMS, New Delhi, JIPMER, Pondicherry, SCTIMST, Trivandrum, Vimala Medical College, Thrissur, St. Johns Medical College, Narayana Health city, Bangalore and CMC, Vellore. Presently NIMHANS has two psychiatric social work consultants, two psychiatric social workers, two psychiatric social work trainees posted in neurology. Most neurological disorders are affecting the patients’ day-to-day functioning, making them dependent for ADL. Sudden onset of the neurological illness, disabling nature, and lack of awareness about the disease conditions among patients and family members would have made them seek neurological consultation during the complete lockdown. Patients who sought neurological consultation from other states such as West Bengal, Bihar, and other faraway states got stranded in Bangalore. Lockdown affected persons with neurological disorders in terms of continuity of care, follow-up, physiotherapy and neurorehabilitation services. Worldwide, Covid-19 caused a shortage of medical supplies such as personal protective equipment (PPE), beds, and staff. The covid-19 pandemic has altered neurological health care delivery in many ways. Many neurological patients received tele-consultation and telephone follow-ups. Studies indicate that people from marginalised and poor socioeconomic status have been severely affected during the pandemic. Black race patients faced more mortality and morbidity due to stroke. Patients hospitalised with covid-19 at non-academic medical centres had worse outcomes than those at academic medical centres. Patients with Parkinson disease, those with lower incomes had worse access to health care. Neurological services were disrupted mild (26%) to moderate (30%), and complete (13%) in 43 countries. The most affected services were neuro-rehabilitation, neurology emergency care. The most cited reason for the disruption of neurological services was travel restriction and closure of services. Medicines were distributed using a novel approach, and disruption services were mitigated by telemedicine. Cross-sectoral services for neurological disorders such as communitybased services, residential long-term care, daycare, special school educational programmes for children, interventions for caregivers, and services by non-governmental organisations were most disturbed, followed by emergency and acute care. The degree of disruption of health services was moderate in most studies. Covid-19 pandemic affected neurology workflow in four areas: in-patient care, out-patient care, research. Parkinson’s patients with a lower income had more significant difficulties in getting medications and physiotherapy, tele-consultation, digital divide, structural barriers in health care. The causes of disruptions in health care services during the pandemic are (1) closure of out-patient services as per Government order; (2) decrease in out-patients visiting the hospital (3) non-availability hospital beds (4) insufficient staff to provide services due to quarantine/self-isolation (5) clinical staff Kuppusamy et al: PSW consultations for persons with neurological disorders Indian Journal of Psychiatric Social Work, 2021;13(1): Epub 3 shifted to provide Covid-19 management or emergency care; (6) insufficient personal protective equipment (PPE) to provide services; (7) disruption of supply chains resulting in unavailability essential medicines, medical diagnostics (8) travel restrictions hindering access to a health care facility for patients (9). Other reasons. Preparation of a functional re-organisation plan, strategies for hospitalisation and emergency care, telephone consultations, providing care at a unit outside the hospital for priority patients, and periodical in-patient treatments, and the use of telephone service for patients with epilepsy were the operative decisions taken for providing neurological care during the COVID-19 pandemic. In Pakistan, there was less admission in neurology, PCR tests were done less than 50% in the hospital before admission in neurology wards, 45% of hospitals started tele-health services for clinically stable neurology patients, 72% of hospitals reduced the number of attendants accompanying neurology patients. Nearly half of the patients reported that overall care of their neurological disease during the pandemic was inappropriate, substantial delay in accessing neurological care, information received about the impact of COVID-19 on their neurological disease insufficiently reliable, one-fourth experienced longer waiting times to consult neurologist after lockdown, and deterioration in their psychological wellbeing, delay in clinical trials and disinvestment is neuroscience research. There was limited access, hospital visits were allowed for patients’ relatives and increase in email correspondence and phone calls by neurology out-patients enabling telemedicine to reach them. Given the magnitude of problem and disruption of health care services the study aimed to examine the pattern of psychiatric social work consultations for persons with neurological disorders during covid-19 lockdown. This paper reports nature and range of psychiatric social work services, provided at neurology department during the complete lockdown. MATERIALS AND METHODS The study was retrospective observational in nature. A retrospective chart review was used. Data were analysed from a neurology inpatient referral registry maintained by the psychiatric social work team. Patients referred from three neurology units during lockdown from April 2020 to June 2020 were considered for the study purpose. Lockdown in India commenced on 24th March 2020 and lasted till 30th June 2020. The data was gathered from a referral registry during August 2020. All the patients who received psychiatric social work consultations during the lockdown period were included. Persons who received more than one psychiatric social work consultation were considered as one patient for counting the number and reducing the potential source of bias. Missing data were cross verified with patients’ files available in the medical record department. The study was conducted at the tertiary care neuroscience teaching hospital in Bangalore. There are six units in neurology. About 92 patients referred for psychiatric social work consultations from three neurology units were considered. Frequency and percentages were used to describe the data.