Bhugra D.

Carta M. G.

Nardi A. E.

English

Archivio istituzionale della ricerca - Università di Cagliari

EDITORIALNew technologies for social inclusion of people withpsychosocial disabilities in the era of COVID-19 andbeyondMauro G. Carta,10000-0003-0706-9687 Antonio E. Nardi,20000-0002-2152-4669 Dinesh Bhugra31Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy. 2Laboratório Pânico e Respiração,Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. 3Institute of Psychiatry, Psychologyand Neuroscience, King’s College London, London, United Kingdom.The impact of social isolation on mental well-being iswell known. Isolation and loneliness can affect individualsas well as those around them, and this is especially thecase during the COVID-19 pandemic. Since the use ofnew technologies is increasing in the pandemic, it is worthlooking at how this is likely to change future clinicalpractice.Social isolation affects health and is a known determi-nant of premature mortality.1 Negative stress due to socialisolation affects hormonal and immunological responsesand could induce epigenetic alterations.2 On the otherhand, improving social networks has been found toimprove health.2Poverty and other social determinants are associa-ted with social isolation. A poor social network and adiagnosed psychiatric disorder are interlinked, and theirco-occurrence combines their effects.3 Although, intheory, online social networks should be able to providea degree of support, this does not appear to be the case.Paradoxically, using Facebook and other social networkshas been linked with poor perceived health, especiallymental health and increased BMI.4 Shaya et al.4 pointout that ‘‘The negative associations of Facebook usewere comparable to or greater in magnitude than thepositive impact of offline interactions, which suggests apossible tradeoff between offline and online relation-ships.’’4 Although increased use of online social networksleads to poor mental health, certain psychiatric disorders,such as attention deficit hyperactivity disorder, socialphobia, hostility, depression, and suicidal ideation, havebeen linked to problematic Internet use and excessive useof online social networks.5 These associations should beexplored further to clarify the impact of social media onwell-being and health.There is little doubt that the amount of social supportderived from social media is difficult to measure. Thenumber of ‘‘friends,’’ ‘‘likes’’ or ‘‘followers’’ does not equateto social support. Although social media contact is oftendifficult to measure, the emotional support received inface-to-face contact can be assessed. Comparing onlineand face-to-face contact is difficult, perhaps becauseindividuals with a large circle of friends may be morelikely to use social media more frequently, as well asenjoy better health.5Research on the use of communication technologies inmedicine, clinical psychology and psychiatry is growing,including increasing evidence about online interventionsfor psychiatric disorders such as depression, anxiety andposttraumatic stress disorders, autism, and addictions.6Given that they have been found effective as add-ontreatments for mental health disorders, smartphone apps,videoconferencing, online forums, text-messaging ande-mails are being increasingly used for assessment andtherapy in tele-mental health/e-mental health programsduring the pandemic.6Although some interesting studies have been publishedon complex and integrated social inclusion treatmentsfor young and old people with psychosocial disabilities,this body of knowledge has not yet entered the dailyarmamentarium of psychiatrists and mental health reha-bilitation services.2 The reasons for this delay are many,varying from lack of expertise to ethics, confidentiality,and privacy issues to a lack of training in specific com-petencies. Thus, although it has been shown that Internetsocial networks can help reduce social isolation during thepandemic, challenges remain.The COVID-19 pandemic has led a dramatic increasein social isolation due to quarantining and self-isolationprotocols. This has had devastating consequences foreveryone but, above all, for those who were alreadyvulnerable, such as people with psychosocial disabilities.7Inevitably, many mental health day centers have closed,‘‘whereas in residential facilities, patients who usually arefree to come and go [y] have had to be confined in thefacilities [y] These changes have produced considerablestresses on people with severe mental disorders.’’7 Italyis one of the most burdened countries by COVID-19and has also seen one of the best-known human rightsCorrespondence: Mauro G. Carta, Dipartimento di Scienze Medichee Sanità Pubblica, Università degli Studi di Cagliari, SS 554, 09042Monserrato, Cagliari, Italy.E-mail: mgcarta@tiscali.itSubmitted May 27 2020, accepted May 31 2020, Epub Aug 31 2020.How to cite this article: Carta MG, Nardi AE, Bhugra D. Newtechnologies for social inclusion of people with psychosocialdisabilities in the era of COVID-19 and beyond. Braz J Psychiatry.2021;43:231-232. http://dx.doi.org/10.1590/1516-4446-2020-1175Braz J Psychiatry. 2021 May-Jun;43(3):231-232doi:10.1590/1516-4446-2020-1175Brazilian Psychiatric Association00000000-0002-7316-1185movement in history regarding mental health. However,associations of mental health service users and familymembers have reported that people with psychosocialdisabilities are being abandoned due to the lockdown andquarantine. Consequently, mental health professionalsand patients worldwide have found themselves using arange of methods, such as telephone and Internet, tocommunicate.8 This shift has been assisted by guidelinescreated by ad hoc consensus conferences or publichealth care systems. Nevertheless, many professionalshave had little previous professional experience withthese methods, and for some intervention types, efficacyand effectiveness studies are lacking or inadequate.Professionals are having to learn hurriedly, as they go,and often with limited resources. Paradoxically, thisexperience has opened a new world for most profes-sionals and users. A way of communicating that, undernormal circumstances, would have been complementaryhas now become the main channel for giving andreceiving support, and it can access people who weredifficult to reach with normal tools.One of the few certainties that will remain after thisCOVID-19 pandemic ends is that social media hasbecome a permanent, and often preferential, form ofsocial contact. We live in a world of uncertainties, withweak predictions about what awaits us in the comingyears. The advent of a vaccine may well restore a versionof the world we knew (leaving only the pandemic’sdevastating geo-political-economic consequences). How-ever, new waves of viral disease will radically change theway we live and communicate. In our medical work andmental health practice, one of the few things that is certainis that our means of communication have changed.People have discovered how Internet-based communica-tion technologies can help overcome social isolation and,thus, they will continue to use it. This means that a robust,ethically controlled field of experimentation about thesemethods must grow and develop. Hence, proper ethicalguidelines must be developed by professionals fromvarious mental health sectors, especially regarding con-fidentiality and privacy issues. Tele- and e-mental healthtraining with clearly defined competencies is an importantfirst step, and we encourage regulatory bodies andnational organizations to collaborate in its development.DisclosureThe authors report no conflicts of interest.References1 Berkman LF, Syme SL. Social networks, host resistance, and mor-tality: a nine-year follow-up study of Alameda county residents. Am JEpidemiol. 1979;109:186-204.2 Aiello AE. Invited commentary: evolution of social networks, health,and the role of epidemiology. Am J Epidemiol. 2017;185:1089-92.3 Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N,et al. An overview of systematic reviews on the public health con-sequences of social isolation and loneliness. Public Health. 2017;152:157-71.4 Shakya HB, Christakis NA. Association of Facebook use with com-promised well-being: a longitudinal study. Am J Epidemiol. 2017;185:203-11.5 Guedes E, Sancassiani F, Carta MG, Campos C, Machado S, KingAL, et al. Internet addiction and excessive social networks use: whatabout Facebook? Clin Pract Epidemiol Ment Health. 2016;12:43-8.6 Zhou X, Snoswell CL, Harding LE, Bambling M, Edirippulige S, Bai X,et al. The role of telehealth in reducing the mental health burden fromCOVID-19. Telemed J E Health. 2020;26:377-9.7 de Girolamo G, Cerveri G, Clerici M, Monzani E, Spirogatti F, StaraceF, et al. Mental health in the Coronavirus Disease 2019 emergency-the Italian response. JAMA Psychiatry. 2020 Apr 30. doi: http://10.1001/jamapsychiatry.2020.1276. Online ahead of print.8 Ćosić K, Popović S, Šarlija M, Kesedžić I. Impact of human disastersand COVID-19 pandemic on mental health: potential of digital psy-chiatry. Psychiatr Danub. 2020;32:25-31.Braz J Psychiatry. 2021;43(3)232 MG Carta et al.

New technologies for social inclusion of people with psychosocial disabilities in the era of COVID-19 and beyond

https://iris.unica.it/bitstream/11584/366914/1/New%20technologies%20for%20social%20inclusion%20of%20people%20with%20psychosocial%20disabilities%20in%20the%20era%20of%20COVID-19%20and%20beyond.pdf

New technologies for social inclusion of people with psychosocial disabilities in the era of COVID-19 and beyond

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