Protecting the mental health of healthcare workers in Pakistan using telehealth during the COVID-19 pandemic

Rida E Fatima1 , Ramsha Akhund2, Zainab Nadeem2, Afifa Nisar1
  1. Student, 5th year MBBS, Fatima Jinnah Medical University, Lahore, Pakistan.
  2. Student, 4th year MBBS, Aga Khan University, Karachi, Pakistan.

Corresponding Author: Rida e Fatima, Final year MBBS student, Fatima Jinnah Medical University, Lahore, Pakistan.
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Submission: May 12, 2020
Acceptance: Sep 30, 2020
Published: Oct 12, 2020

© Author(s) (or their employer(s) 2020. Re-use permitted under CC BY. No commercial re-use. Published by Pak J Surg Med. 

Article Citation:  Fatima RE, Akhund R, Nadeem Z, Nisar A. Protecting the mental health of healthcare workers in Pakistan using telehealth during the COVID-19 pandemic. Pak J Surg Med. 2020;1(3):e198. doi: 10.37978/pjsm.v1i3.198

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The role of telehealth and its effect on reducing mental health burden from COVID-19 is of pressing concern. Telehealth is defined as the delivery of health education, health care, and health information sciences using remote technologies.[1] The psychological impact of the COVID-19 must be identified within the group of health care workers. Telemental health services are an area that requires imminent intervention for the support of health care workers in Pakistan, subjected to applicability and feasibility. The World Health Organization (WHO) announced the novel coronavirus as a Public Health Emergency of International Concern (PHEIC) on 30 January 2020.[2, 3] With the number of confirmed COVID-19 cases toppling over 284,000 in Pakistan on 10 August 2020, the numbers may rise.[4] However, the impact on health care workers is yet to be measured on various levels in Pakistan. The psychological symptoms related to the COVID-19 infection have already been identified and assessed at the population level. These include first paranoia, and second anxiety-driven panic buying.[5] By substitution, these may apply to healthcare workers in Pakistan. The unpredictability and uncertainty of pandemic outbreak are yet to be evaluated in terms of international public health and the under-preparedness of health facilities in Pakistan. Health care workers in Pakistani healthcare centers have been under immense psychological and physical pressure with a high risk of contracting the virus, and inadequate personal protective equipment.[6]

The psychological pressure also relates to the lack of contact with family members as workers are urged to limit interaction to prevent the spread of COVID-19. The stigma towards contracting the infection and transmitting it to others aggravates mental health problems, which not only affects the decision-making ability of the healthcare worker but also influences the overall well-being. The need of the hour for telemental health purposes is first to build a team for mental health intervention, producing concrete online courses for the psychological impact of pandemics to guide solely health care workers.

Second, a psychological assistance hotline is required for healthcare workers to discuss struggles relating to patients, families, and themselves in their narrative. Lastly, telemedicine-based practices by counseling psychologists must be promoted to healthcare workers for support and enabling catharsis.

Examples that support the effectiveness of telemental health services such as text-messaging, depression, PTSD, anxiety, online forums, videoconferencing, and smartphone apps have been useful in promoting the delivery of mental health services.[7] While many individuals are aware of the mortality and transmissibility rates of COVID-19, the nation must be cognizant of the impact on the mental health of healthcare workers, in a short and long-term basis.


  1. World Health Organization. COVID 19 public health emergency of international concern (PHEIC) global research and innovation forum: towards a research roadmap. 2020. World Health Organization Geneva. Available from: health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum
  2. Rana W, Mukhtar S, Mukhtar S. Mental health of medical workers in Pakistan during the pandemic COVID-19 outbreak. Asian J Psychiatr. 2020 Apr 7;51:102080. doi: 10.1016/j.ajp.2020.102080. Epub ahead of print. PMID: 32283512; PMCID: PMC7139243.
  3. Government of Pakistan. COVID-19 Health Advisory Platform by Ministry of National Health Services Regulations and Coordination [Internet]. 2020 [cited 11 May 2020]. Available from:
  4. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open. 2020 Mar 2;3(3):e203976-.
  5. Bashshur RL, Shannon GW, Bashshur N, Yellowlees PM. The Empirical Evidence for Telemedicine Interventions in Mental Disorders. Telemed J E Health. 2016 Feb;22(2):87-113. doi: 10.1089/tmj.2015.0206. Epub 2015 Dec 1. PMID: 26624248; PMCID: PMC4744872.
  6. Sarfraz A, Sarfraz Z, Anwer A, Sarfraz M, Siddiq J. Availability, Satisfaction and Use of Personal Protective Equipment Among Healthcare Workers: A Cross-Sectional Assessment of Low- and Middle-Income Countries. J Occup Environ Med. 2020 Sep 18. doi: 10.1097/JOM.0000000000002028. Epub ahead of print. PMID: 32956236.
  7. Minetaki K, Akematsu Y, Tsuji M. Effect of e-health on medical expenditures of outpatients with lifestyle-related diseases. Telemedicine and e-Health. 2011 Oct 1;17(8):591-5.


The authors wishes to acknowledge Zouina Sarfraz, Fatima Jinnah Medical University for guiding on the writing process. The Authors also acknowledges Dr. Azza Sarfraz, Research Associate at the Department of Pediatrics and Child Health, Aga Khan University, Pakistan for the help in proofreading this letter.

Author Contribution

RF: Conceptualization Project administration, Writing (original draft), Writing (review and editing).
RA, ZN & AN: Writing (original draft).

Conflict of Interest

The Authors Declared No Conflict of interests.


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Manuscript Processing

Submission: PJSM-2020-000198-O-12-May-2020
Acceptance: 30-Sep-2020
Publication: 12-Oct-2020

Editorial Team

This article has been subjected to extensive editing and double blind peer review process. The following editors were involved in editing of this article;
Lead Editor: S. Kazmi
Editors: K. Zahra, AA Sheikh
Bibliography: S. Firdous

Publisher’s Note

The views and opinion expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company.