In a state of war: COVID-19 and psychiatric support

This article was exclusively written for The European Sting by one of our passionate readers, Dr. Unsa Athar. The opinions expressed within reflect only the writer’s views and not necessarily The European Sting’s position on the issue.

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As the pandemic of COVID-19 keeps on digging deeper roots in the world, we as health care providers need to perform a dual role. Not only do we have to deal with the ongoing crises, but also evaluate and plan for the future. As the global toll of cases rises, every aspect of health care delivery is coming face to face with its shortcomings. The field of Psychiatry stands unique from the rest of the world of medicine in several ways. The major hurdle that the psychiatric health care system has to face is still the under-estimation of the burden of disease. It has been estimated that the burden of psychiatric illnesses occupies a whopping 32.4% of years lived with disability.¹ This unrivaled burden of disease calls for an unparalleled deliverance of care. The management of inpatient psychiatric facilities involves interactions with fellow patients and doctors on a varying level. Therapy, watchful medication intake, group activities, etc. are some of the most important management tools. Combating with contagious diseases that require social distancing, quarantine and social isolation is creating havoc in the inpatient psychiatric units.²  Questions are being raised and attempts are being done to deal with the flaws in the inpatient facilities. While there are no doubts that psychiatric associations shall try their best to manage the inpatient psychiatric units, attention must also be paid to the outpatient system of care. Outdoor departments are being shut down. Government officials are urging people to not visit a hospital for a non-emergency situation. Elective surgeries are being suspended and relatively stable patients are being discharged. These preventive measures protect the hospitals from becoming a hub of infection spread, which is what we need to do so that our health care providers can fight the pandemic as first-line responders.³ Looking at this objectively, what we should be concerned about is an acute rise in mental illnesses. Patients who are fighting their illnesses with a carefully monitored drug regimen might end up getting neglected. Access to basic psychiatric medication shall become more difficult as the pandemic rises. Some people rely entirely upon cognitive-behavioral and other such therapies for their diseases. An inability to get appointments on time will trigger many patients of anxiety disorders and major depressive disorders. Social isolation and loneliness have always been a major problem for people with serious mental illness.⁴ And pushing them further into social distancing without a game-plan might trigger acute episodes of conditions such as mania and schizophrenia. We have been seeing multiple social media outlets, blogs and websites trying to play their part., for instance, The Mighty.⁵ Regular posts appear on such sites to help people find that sweet spot where they can manage their mental health along with taking necessary precautions for the prevention of COVID-19. The need of the hour, however, is an active participation of psychiatrists, psychologists, and all mental health care providers. Instilling hope in psychiatric patients has always been a great strategy.⁴ And this can be done by showing to our patients that they have not been abandoned. Their physicians still have them in their thoughts as a priority. Some practical actions need to be taken that can help outpatient psychiatric patients. These may include: Forming guidelines or standard operating procedures (SOPs) for telemedicine/virtual consultation regarding regular psychiatric or psychologist appointments: Forming an online system of appointments for patients enrolled in an outpatient psychiatric unit can be a life-saving strategy. Doctors and psychotherapists can thus stay in touch with their patients for tweaking medication or hearing out their concerns. Having an outlet to get in touch with doctors will patients with serious psychiatric conditions. And in these dark times, stressors and triggers are all around. Being able to catch them and process them timely will save us from a substantial number of psychiatric emergencies. All psychiatric facilities should ensure the conveyance of a clear message to their patients and the public in general. And the message should be as simple as ‘We are here for you.’ Special attention must be paid to low- and middle-income countries, as they are already less equipped with resources to handle any health-care emergency let alone the psychiatric ones. A global approach towards making SOPs can help psychiatrists belonging to such countries. Ensuring the availability and delivery of psychiatric medication: Evidence has repeatedly proven that compliance with a medication regimen leads to a lesser number of relapses. This has been seen in major psychiatric illnesses like schizophrenia, where non-adherence to the prescribed often lands the patient in the emergency department.⁶ In these times of uncertainty, where workplaces are being shut down and the economies are collapsing due to the pandemic, psychiatric patients must have a sustainable supply of their pills. Hospitals and pharmaceutical companies must ensure the availability of stock for all kinds of psychiatric medications. The spiral of mental illness is like a vicious cycle. You need one trigger that sets off a chain reaction that might eventually lead to the patients not feeling well enough to go out and get their medications. Thus, a system for delivery at the patients’ doorsteps must also be made, taking all the necessary precautions of course. The pandemic will be over soon enough if we all grasp the importance of prevention and flattening the curve.⁷ Good leaders always prepare for the repercussions and sequelae of the war before the war is over. The world is at war right now. And we as health care providers are the stake-holders. We need to be ready for all the non-COVID19 related burden on our health care system during and after the pandemic. Joining hands, figuratively, with our patients seems like the only way to ensure that. References

1. Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness. The Lancet Psychiatry, 3(2), 171-178.
2. Coronavirus on the Inpatient Unit: A New Challenge for Psychiatry – Medscape – Mar 16, 2020
3. Toner  E, Waldhorn  R. What US Hospitals should do now to prepare for a COVID-19 pandemic. Published February 27, 2020. Accessed March 13, 2020. http://www.centerforhealthsecurity.org/cbn/2020/cbnreport-02272020.html
4. Fortuna, K. L., Ferron, J., Pratt, S. I., Muralidharan, A., Aschbrenner, K. A., Williams, A. M., … & Salzer, M. (2019). Unmet needs of people with serious mental illness: perspectives from certified peer specialists. Psychiatric Quarterly, 90(3), 579-586.
5. https://web.facebook.com/TheMightySite/?_rdc=1&_rdr
6. Downey, V. A., & Zun, L. S. (2017). Non-compliance in the Emergency Department: Is there a difference between medical and psychiatric patient’s reasons and use of the Emergency Department. The American journal of emergency medicine, 35(12), 1961.
7. Roser, M., Ritchie, H., & Ortiz-Ospina, E. (2020). Coronavirus Disease (COVID-19)–Research and Statistics. Our World in Data.

About the author Dr. Unsa Athar is a graduate of King Edward Medical University, Lahore. She has been an avid lover of acting, reading and writing. She is currently working in the field of community medicine and public health and aims to create awareness regarding psychiatric disorders in order to end the stigmatization. She dreams of the day when walking into a therapist office wouldn’t be frowned upon by the society that she dwells.