The coronavirus disease 2019 (COVID-19) pandemic will present an unprecedented stressful effect on patients and healthcare systems worldwide. Because there is currently no vaccine or treatment for the underlying infection, current health efforts focus on providing prevention and screening, maintaining continuity of treatment for other chronic conditions, and ensuring access to appropriately intensive services for people with the more serious symptoms.
Disasters disproportionately affect poor and vulnerable populations, and patients with serious mental illness may be among the most affected.
High rates of smoking in this population may increase the risk of infection and confer a worse prognosis among those who develop the disease. Residential instability and homelessness can increase the risk of infection and make it difficult to identify, track, and treat those who are infected.
People with serious mental illness who are employed may have difficulty taking time off from work and may lack sufficient insurance coverage to cover testing or treatment. Small social networks can limit opportunities to get support from friends and family if people with serious mental illnesses become ill. Taken together, these factors may lead to elevated infection rates and poorer prognoses in this population.
What strategies are available to mitigate the outcome of this epidemic among patients with serious mental illness?
Federal preparedness policies developed in the wake of complex disasters have increasingly embraced the notion of whole-community preparedness , which supports building and supporting structures at multiple levels to prepare and respond, particularly for vulnerable populations. Within the public mental health system, this includes engagement with mental health service users, clinicians, and federal and state policies.
Support for patients with serious mental illnesses
People with serious mental illnesses should receive up-to-date and accurate information about strategies to mitigate risk and know when to seek medical treatment for COVID-19. Patient-oriented materials developed for general populations will need to be adapted to address limited health literacy and challenges in implementing physical distancing recommendations due to poverty and unstable living situations.
Messaging will need to ensure that those seeking care will not face penalties regarding cost or immigration status. Patients will need support to maintain healthy habits, including diet and physical activity, as well as self-management of chronic mental and physical health conditions.
It will also be important to address the psychological and social dimensions of this epidemic for patients. Worry could exacerbate and be exacerbated by existing anxiety and depressive symptoms.
Physical distancing strategies critical to mitigating disease spread may also increase the risk of loneliness and isolation in this population. Those who become ill may face a double stigma associated with their infections and their mental health conditions. For any patient, psychological symptoms will arise in a unique personal and social context that must be considered when developing a treatment plan.
Empower mental health clinicians
Mental health clinicians are often the main point of contact with the broader healthcare system for their patients with serious mental illness, and as such will represent the first responders to the COVID-19 pandemic for many of these people. . Mental health clinicians need training to recognize the signs and symptoms of this illness and develop knowledge of basic strategies to mitigate the spread of the illness in both their patients and themselves. Clinicians should have conversations with their patients about how best to implement the strategies.
Clinicians will need support to maintain their own safety and well-being.
Whenever possible, services should be delivered via telehealth rather than in person, and when in-person visits are necessary, in individual rather than group formats. Child and elder care should be available for mental health clinicians who work additional shifts. Support from colleagues will be essential to maintain physical, mental and social well-being, especially if the pandemic is long-lasting.
Strengthening mental health care systems
The COVID-19 pandemic is likely to put great pressure on community mental health centers and state psychiatric hospitals. These facilities have limited capacity to detect or treat medical conditions, and few have existing relationships with local or state public health agencies. It is critical that these organizations develop continuity of operations plans to ensure they can maintain vital functions in the face of staff illness or shortages of psychotropic medications.
Clinics will need protocols to identify and refer patients at risk of infection and self-quarantine strategies for clinicians who develop symptoms of the disease. Adequate environmental protections must be available, including well-ventilated spaces, easy access to handwashing, and personal protective equipment. Institutional settings, including state psychiatric hospitals, nursing homes, and long-term care facilities, will be at particularly high risk for outbreaks and will need to ensure they have contingency plans to detect and contain them if they occur.
Expanding mental health policies
The coming weeks will see a wave of new federal laws and regulations and state policies developed to mitigate the health and economic outcomes of the COVID-19 outbreak. These policies will have particular urgency for populations with serious mental illness due to their elevated risks. State mental health authorities will play a critical role in creating and administering policies related to COVID-19 in their state hospitals and community mental health clinics.
The role of social policies , such as the Supplemental Nutrition Assistance Program, housing support, and paid sick leave for hourly employees will be vital to ensuring the health and well-being of this population.
The COVID-19 pandemic will create unprecedented health and social challenges both in the US and internationally. People with serious mental illness will be at exceptionally high risk during this period, as will the public mental health care system central to delivering their care. Careful planning and execution at multiple levels will be essential to minimize the adverse outcomes of this pandemic for this vulnerable population.
