The enormity of the coronavirus disease-2019 (COVID-19) pandemic has overwhelmed most health services and has placed health care service providers under unprecedented stress. The rapidity of spread, uncertain clinical course, and unavailability of effective treatment make clinical decisions cognitively demanding. Extended work hours inside uncomfortable protective gears, improper hydration, with conflictual health systems and patients at work; and social stigma and isolation after it ends, have created an unending downward spiral of mental health in care providers. Care providers are at increased risk of developing mental health problems in form of burnout, stress reactions, anxiety, depression, and post trauma stress. Concerted strategies for managing the mental health of care providers are urgently needed at individual and systems level. A plethora of strategies, developed from previous experience of crisis management, need to be made available to care providers through accessible mediums of delivery. This paper explores the mental health problems encountered by health care personnel and examines various strategies which need to be implemented to manage them.

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Objective To assess the implementation of a mobile dispensing service to improve opioid users’ access to methadone maintenance therapy. Methods In March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service. Findings The number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9-month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients’ adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites. Conclusion It is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic.

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