The current pandemic is a huge challenge for mental health care providers for several reasons:
- there will be an increase in treatment provision due to anxieties and uncertainties in the general population,
- many community care services have been shut down or completely closed in response to public health instructions,
- some people with mental disorders are not able to adhere to public health restrictions,
- most clients live in the community nowadays and their mental health needs and their basic needs must be met,
- the provision of mental health care in general and the therapeutic alliance in particular is difficult to do while adhering to infection control (masks, gowns etc.),
- mental health care providers across the western world have been unprepared for the current situation - similar to the rest of public and private institutions.
To gather and to share information, documents and links (e.g. guidance, recommendations), Bern University Hospital for Mental Health, Switzerland, has set up a website that collects useful information, currently in German, English and French.
https://www.upd.ch/de/forschung/psychiatrische-rehabilitation/pandemiebewaeltigung-psychiatrie.php
If you are interested in collaborating and discussing the best way to conduct mental health care during the crisis, please visit our website and/or respond to this post.
Regards,
Dirk Richter
Mental health care in the COVID issue is very effective idea and it is highly recommended. The solve is not far away to fight this Coronavirus beast.
I served as an AF ER medic during Vietnam. Here are my observations. I was trained and participated in mass casualty triage. We remember the some we lost more than the many we saved. Here the front-line clinicians will lose a # of patients. So, they will require a persisting clinical debriefing to deal w/ their own trauma.
See my attached article.
Rich
I am very interested in participating in this global project. I can be reached "[email protected]"
Rich
Dear all, many thanks for your contributions. What concerns me most in these days, is the dilemma we have to solve between infection control and therapeutic alliance. On one hand mental health services are part of the entire (public) health system that works in order to contain or to mitigate the virus spread. On the other hand, I have the impression that we haven't got a real solution for how to conduct person-centered care given the restrictions in daily life and in psychiatric settings. And we have to be aware that this situation will probably last for months, if not years according to the latest simulation study
Article Projecting the transmission dynamics of SARS-CoV-2 through t...
In addition, I hear from across Europe that service users now try to avoid mental health care services and institutions. By not having sufficiently staffed and equipped outreach resources, there is a risk that service users become abandoned at home while being isolated, lonely and suffering from anxiety. Inpatient care, however, is not an adequate alternative at the moment, I guess. There you will face restrictive environments and, more importantly, a higher risk of becoming infected. New data from EU countries show that about fifty percent of deaths happen in care homes, especially care homes for the elderly.
https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/?subscribe=success#blog_subscription-3
Once the virus is inside the institution, you have a real problem. And a lot of hospitals and care homes have already been closed due to high infection rates of both, service users and staff.
Any ideas for possible solutions?
Best,
Dirk
I believe another issue will be an increase in domestic violence.
Video teleconferencing is working pretty well as are between session assignments to research and practice mindfulness techniques and critical thinking.
Uncertainty, fear, anxiety and the same confined upset situation can trigger various emotional reactions such as somatic symptoms, depression, anger and others. Therefore, it is important that there are communication spaces, either therapeutic care centers in which people feel listened to and can express what they are feeling due to confinement, that there are open lines for any emergence of an emotional nature. We as mental health promoters must be aware and offer our services even if it is virtual or online to whoever needs it.
Regards.
Ultimately, we must be mindful of our humanness. Patricia's call for communication space is paramount given our new limited socialization opportunities. We cannot 'win' against any virus if that victory leads to the marginalization of basic human needs. Escapism will continue to be an avoidant coping mechanism, but will not be able to compensate in the long term. Clinicians can benefit others by fostering deep and meaningful interactions built on basic Rogerian principles; congruence, empathy and unconditional positive regard.
@Patricia and Derrick: what could these spaces look like? Can we really provide person-centered care under these circumstances?
The situation in the US has deepened our political divide due to Trump vs the medical clinicians and virologists.
Here is my attached article in this regard.
Rich
@Dirk Ritcher,
This is indeed wonderful initiative. Appreciate your efforts. I agree that the pandemic has worsened the condition of those who are undergoing psychiatric treatment and putting many individuals at risk of developing mental disorders.
Any pandemic create immediate psychological reactions such as fear, anxiety, over vigilance etc and can be managed by talking about these symptoms and guidance on dealing with them.
Therefore, lay counselling support for general population and specialized psychological and psychiatric support to persons with mental illness is necessary. Also, regular follow-up sessions for persons undergoing psychiatric treatment is essential and ensure they take appropriate precautions to prevent them from infections. Along with these, mental health services post lockdown and post pandemic is crucial. Long-term mental health care services is required.
I am very interested in participating in this global project. Let me know if I can be of any help.
With many collaborators from Switzerland, I have drafted some ideas about how mental health services should be organized in order to be adapted to the pandemic. You can find our submitted paper as preprint here:
Deleted research item The research item mentioned here has been deleted
Our above mentioned preprint has now been accepted by the Swiss Archives of Neurology, Psychiatry and Psychotherapy; you will find it here:
Article Therapeutic alliance, social inclusion and infection control...
This is an important initiative.
Here is another relevant link for your reference:
Article PREparedness, REsponse and SySTemic transformation (PRE-RE-S...
from our team of collaborators.