Some showing drugs withdrawal symptoms

Younten Tshedup

Coming home from abroad after a long time and then getting confined in a room for 21 days can be torturous if not testing the patience. It could be worse if one is dependent on contraband substances.

Although a handful, there are cases at some quarantine centres where people, mostly students, are showing withdrawal symptoms to drugs. To tend to that too, the national mental health and psychosocial response team is working with Bhutan Narcotics Control Agency (BNCA) and has devised a standard operating procedure (SOP).

Psychiatrist Dr Chencho Dorji, who is called to deal with the mental pressure of those in quarantine facilities, said the symptoms can range from physical pain to mental instabilities. “For the physical pain, we can give painkillers, but the psychological pain would remain, which would require long term treatment.”

The response team that was established earlier this month to provide psychosocial support to those affected by the Covid-19 pandemic is also considering to provide long term support to all substance abusers who would need help in the future.

While the number of such cases for now is manageable, Dr Chencho Dorji said, “We don’t know for sure how many people would return with drug related issues in the future.”

In preparation for a worst-case scenario, he said that plans to establish a special quarantine centre for drug abusers with mental health issues is also being considered.

The hostels at the Department of Youth and Sports (DYS) in Thimphu has been identified to function as cohort quarantine with online drug-screening facilities. “For mild cases, we could manage and treat them at the centre but should there be severe cases, we will have to extract them and treat them separately.”

For now, he said that the mobile health teams spread across the country are facilitating all those with any forms of withdrawal at the quarantine centres. “There are patients who ask for substitution drugs, but we provide them with other non-addictive medicines to calm their anxiety and help them fall asleep.”

Incidents of people in quarantine demanding for tobacco and alcohol and cautioning officials on duty with suicide threats if they denied their demands were also reported.

Officials also found out that all those people jumping quarantine are addicts who out of desperation commit the mistake. “It is a difficult situation for them but there is nothing much we can do to help them here,” said Dr Chencho Dorji.


Understanding those in quarantine

There are some reports of those in quarantine not cooperating or getting restless, some even to the extent of getting involved in vandalism, Dr Chencho Dorji said that these are extraordinary times and the stress and scare people are feeling are only a normal reaction to an abnormal situation.

“Different people respond to stress differently. While majority of us are scared due to the virus, there are people who could get affected more than others in such times.”

He said that people in quarantine are put under restriction. The scare of testing positive to the virus while under a lockdown situation adds more stress to a person’s mental health.

Upon the command of His Majesty The King, he said that the mental health and psychosocial response team was formed to protect the mental wellbeing of the people in quarantine besides providing them with food and lodging services.

With majority of the people in the quarantine being youth, he said that spending long hours on internet was not healthy. “Through different interventions, we have devised several healthy ways a person could spend their time in the quarantine,” he said. “With all the time they have, people can now indulge themselves in doings activities they didn’t have time for before.”

There is an opportunity for people to come out as a better person at the end of the 21-day quarantine period, he said.


Changing behaviour

“While world leaders are being rundown in current scenario, imagine the toll this pandemic would have on a small country like our, if we are not prepared,” said Dr Chencho Dorji.

The psychiatrist said that there is a dilemma between putting forward the facts and informing the public versus calming their fears amid the pandemic scare.

While there is a need to scare the public so that they can abide by the dos and don’ts of the situation, there is also the need to clam them down.

“Our people have a tendency to forget after a while, which then makes them carefree,” he said. “While there is no need for a panic and mass hysteria, people should always remain cautious.”

He said that while changing people’s mindset is an ideal approach, it would be very difficult. “This is why the approach now is to change their behaviour. This is why the restrictions and the recent curfew were imposed by the government,” he said. “Although a bit authoritarian, we need this now because people are not able to think for themselves.”

Meanwhile, besides devising 12 SOPs for efficient management of the situation, the taskforce has also trained about 1,500 Desuups and frontline workers on psychological first aid to cater to any person requiring assistance.