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 Table of Contents  
Year : 2021  |  Volume : 37  |  Issue : 1  |  Page : 129-130

A pyramidal, stepped care model with disaster color coding to address the psychosocial well-being of COVID.19 patients using telephone counseling

1 Department of Psychiatry, Government Medical College, Thrissur, Kerala, India
2 Department of Community Medicine, Government Medical College, Thrissur, Kerala, India
3 Department of Principal, Government Medical College, Thrissur, Kerala, India

Date of Submission25-Jun-2020
Date of Decision03-Aug-2020
Date of Acceptance18-Aug-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Smitha Ramadas
Additional Professor, Department of Psychiatry, Government Medical College,Thrissur - 680 010, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.ijsp_178_20

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How to cite this article:
Ramadas S, Areekal B, Sumesh T P, Andrews M A. A pyramidal, stepped care model with disaster color coding to address the psychosocial well-being of COVID.19 patients using telephone counseling. Indian J Soc Psychiatry 2021;37:129-30

How to cite this URL:
Ramadas S, Areekal B, Sumesh T P, Andrews M A. A pyramidal, stepped care model with disaster color coding to address the psychosocial well-being of COVID.19 patients using telephone counseling. Indian J Soc Psychiatry [serial online] 2021 [cited 2023 Feb 6];37:129-30. Available from: https://www.indjsp.org/text.asp?2021/37/1/129/312863


The coronavirus disease 2019 (COVID-19) pandemic has led to a multidimensional crisis across the globe. The first case of COVID-19 in India was confirmed in Thrissur district in Kerala[1] and successfully managed in the Government Medical College hospital, Thrissur, a tertiary care teaching hospital in the state of Kerala in India. The tiny state of Kerala is unique among other Indian states due to its high literacy rate, social equality, and health indices at par with the Western world, though economic resources are way behind.[2]

Due to the high infectivity rate and high basic reproduction number (R0) of COVID-19, primary contacts and health-care providers are at great risk of contracting the infection. The COVID-positive cases and suspects, admitted in hospital, are kept in isolation and therefore separated from their relatives and friends. They face various mental health issues. Disconnected from their kith and kin, some of whom are also infected, their apprehension levels are high.

There is a deficit of health-care providers to meet this unprecedented health crisis. Moreover, COVID care in hospital which necessitates wearing of personal protective equipment by health-care providers hampers rapport building and expression of empathy toward patients. Therefore, their mental health support systems, from relatives and professionals, are compromised. Nevertheless, they are a group which requires priority mental health support and psychosocial care.

Hence, we devised a pyramidal, stepped care model with disaster color coding to address the psychosocial well-being of the patients, using telephonic counseling. This is a collaborative approach by the departments of psychiatry and community medicine (CM). The model is described in [Figure 1]. All the hospitalized COVID-positive or -suspected patients, are contacted daily telephonically by the team in CM, comprising interns and residents, supervised by consultants and their well-being inquired. The same call is then handed over to the counselor of the mental health and psychosocial care team. This “welcome call” is utilized by the counselor to briefly introduce the availability and services of the team. The counselors recently recruited by the state for specific COVID care are trained by mental health professionals of the institution for the delivery of COVID-related mental health services. These calls are termed “green calls” of the mental health and psychosocial team. If the patient expresses severe distress, these calls are extended and brief mental health interventions are given by the counselors. These calls are then termed “yellow calls.” If the pathological level of distress is suspected, the calls are handed by a professional psychiatric social worker and/or a clinical psychologist. They are termed “orange calls.” Patients with suicidal ideas and anxiety or depressive disorders and patients who require psychotropic medications are managed by the psychiatrist and they are termed “red calls.” This approach has the advantage that every patient is screened telephonically by the counselor, by which a window is also opened to the patients for further help. Not everybody would need a formal mental health intervention. Such patients are dealt by the counselors, which spares the services of core mental health professionals. One of the difficulties encountered were by the patients who did not pick up the calls. Even after repeated calls if the patient fails to answer, the inquiry would be done through the ward staff, and arrangements for further services were done.
Figure 1: Stepped model of COVID care. PSW = Psychiatric social worker, CP = Clinical psychologist

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Kerala ravaged by severe floods in the past 2 consecutive years is familiar with the disaster color codes, which are used to color code the telephone calls. Professionals, health-care workers, and laymen can relate to these color codes easily. Such a stepped care approach is beneficial in a resource-poor setting, whose economy has further nosedived due to the pandemic. Patients, although in isolation, get their mental health and psychosocial issues addressed, without the risk of the spread of infection, using simple technology. Mental health care enhances physical health and coping too. This model can be replicated in other COVID care centers with scarce human resources to address the mental health and psychosocial issues of patients in isolation.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Andrews MA, Areekal B, Rajesh KR, Krishnan J, Suryakala R, Krishnan B, et al. First confirmed case of COVID-19 infection in India: A case report. Indian J Med Res 2020;151:490-2.  Back to cited text no. 1
[PUBMED]  [Full text]  
Varghese BT. The Kerala Model of health care delivery and its impact on Oral cancer care during the COVID 19 pandemic. Oral Oncol. 2020;106:104769.  Back to cited text no. 2


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