Mental Health Support in the Time of Crisis: Are We Prepared? Experiences With the COVID-19 Counselling Programme in Hungary

Abstract

The Coronavirus disease 2019 (COVID-19) posed unexpected global economic and societal challenges. These include a heavy impact on mental health due to fast changing lockdown and quarantine measures, uncertainty about health and safety and the prospect of new waves of infections. To provide crisis mental health support during the pandemic, Eötvös Loránd University in Hungary launched a specialist online counselling programme, consisting of one to three sessions. The programme was available to all university members between 4th March and 25th May 2020. Overall, 47 clients received support. In this paper we discuss challenges reported by clients, key features of providing a brief mental health intervention online, reflect on counsellor experiences and give recommendations on how mental health services could be developed in the time of crisis. Most clients had challenges with developing a daily routine under quarantine; and many had hardship related to finances, housing, and distance learning. Common mental health consequences included fear from the virus and stress, anxiety, and fatigue due to the interruption to everyday life. In some cases, more complex conditions were triggered by the pandemic. Examples include addictive behaviours and symptoms of depression or psychosis. However, referring cases beyond the competency of counselling proved to be a challenge due to the closure of specialist services. Counsellors observed three key features to the online delivery of a brief crisis mental health intervention: [1] an explicit problem-oriented approach to counselling; [2] challenges of building rapport online; and [3] frames of online counselling. Counsellor experiences often overlapped with those of clients and included challenges of working from home and adjusting to online counselling methods. The possibility of online counselling allowed that mental health care could take place at all during the pandemic. Client experiences reflect findings from previous literature. Like other mental health initiatives launched to tackle COVID-19, the intervention's effectiveness was not measured given the unexpected context and short time frame for programme development. We recommend the use of impact measurement tools to develop mental health services in crises. Meanwhile, the pandemic brought to attention the need to better understand online delivery models. Counsellors should have access to training opportunities on online counselling and managing work-life balance in a remote setting. The COVID-19 counselling programme in Eötvös Loránd University, Hungary is an example of providing online mental health counselling in the time of crisis. Clearly, more studies are needed discussing delivery models and effectiveness of mental health interventions during the pandemic. Experience and knowledge sharing across practitioners should be encouraged to improve how the field reacts to unexpected, high risk events and crises.

Adhoc Setup of an Online Mental Health Self-Help Program During the COVID-19 Pandemic: Description of the Development and Implementation Processes and Analysis of Its Users’ and Usage Profiles

“…Similar interventions as the ones we provided have been shown in a recent review to be effective for the self-guided treatment in depression or anxiety (Fischer et al, 2020;Zhang et al, 2021) and potentially useful during the COVID-19 pandemic. The process of digitalizing mental health treatment during the COVID-19 pandemic has been taken on in many countries all over the world, which is also mirrored in corresponding publications (Liu et al, 2020;Rossi et al, 2020;Drissi et al, 2021;Farris et al, 2021;Szlamka et al, 2021), and is proving to be an effective way for other types of treatment. The available literature describe different projects and approaches, from individual and smaller scale programs (Zhang et al, 2020;Szlamka et al, 2021) to government initiated widely broadcasted ones (He et al, 2020).…”

“…The process of digitalizing mental health treatment during the COVID-19 pandemic has been taken on in many countries all over the world, which is also mirrored in corresponding publications (Liu et al, 2020;Rossi et al, 2020;Drissi et al, 2021;Farris et al, 2021;Szlamka et al, 2021), and is proving to be an effective way for other types of treatment. The available literature describe different projects and approaches, from individual and smaller scale programs (Zhang et al, 2020;Szlamka et al, 2021) to government initiated widely broadcasted ones (He et al, 2020). In general, the use of online mental health services over the past 1.5 years has facilitated the development of public emergency interventions (Madanian et al, 2020;Smith et al, 2020).…”

“…Nevertheless a needs-based and evidence-informed “whole system strategy” following the proposed e-Health Strategy Development Framework has not been widely implemented to date ( Scott and Mars, 2013 ). However, the COVID-19 crisis has accelerated the development and research on e-mental health programs ( Calkins, 2021 ; Drissi et al, 2021 ; Szlamka et al, 2021 ). At the time our online mental health self-help program was put into operation, to the best of our knowledge, there was no comparable e-health offer in Austria.…”

The Opportunities and Challenges of the First Three Years of Open Up, an Online Text-Based Counselling Service for Youth and Young Adults

“…This poses a challenge to the counsellor to establish rapport, assess needs, reduce risk, and relieve distress within a short period of time. Compared to verbal communication, text exchanges entail a time lag, which, together with the lack of non-verbal feedback and contextual clues, can also give rise to communication barriers and negatively impact rapport building [ 23 , 24 ]. Similar to tradition single-session therapy [ 25 ], these characteristics of synchronous online text-based counselling require the skill to carefully, yet rapidly, cultivate a therapeutic relationship with the user, identify workable presenting problems, develop a realistic yet meaningful goal, and provide appropriate follow-up and referral information.…”

Effectiveness of an online versus face-to-face psychodynamic counselling intervention for university students before and during the COVID-19 period

“…During this period, the students suffered from anxiety and depression as well as social dysfunctions [ 6 , 7 ], stress, concentration disorders, and psychosomatization [ 8 ]. At the same time, students reported concerns about the lack of social activities and their future career opportunities, especially those who were closer to graduation [ 9 ].…”