COVID-19 effect on mental health: patients and workforce
Authors: Victor Pereira-Sanchez, Frances Adiukwu, Samer El Hayek, Drita Gashi Bytyçi, Jairo M Gonzalez-Diaz, Ganesh Kudva Kundadak, Amine Larnaout, Marwa Nofal, Laura Orsolini, Rodrigo Ramalho, Ramdas Ransing, Mohammadreza Shalbafan, Joan Soler-Vidal, Zulvia Syarif, Andre Luiz Schuh Teixeira, Mariana Pinto da Costa
Journal: The Lancet Psychiatry (2020)

The coronavirus disease 2019 (COVID-19) outbreak has raised several concerns regarding its mental health effect on patients with psychiatric disorders and the health-care workforce.1Yao H Chen J-H Xu Y-F Patients with mental health disorders in the COVID-19 epidemic.Lancet Psychiatry. 2020; 7: e21Summary Full Text Full Text PDF PubMed Scopus (977) Google Scholar, 2Lai J Ma S Wang Y et al.Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.JAMA Netw Open. 2020; 3e203976Crossref Scopus (4874) Google Scholar Worldwide, psychiatrists are navigating a fast, unpredictable tempest, in developing plans to respond to their own mental health needs and those of their country's population. We are a group of 16 early career psychiatrists connected by the Early Career Psychiatrists Section of the World Psychiatric Association,3Pinto da Costa M Early career psychiatrists—history, 2020 and beyond.World Psychiatry. 2020; 19: 127-128Crossref PubMed Scopus (37) Google Scholar working across different WHO regions in countries (other than China) that have been severely affected by COVID-19. The pandemic led us towards a collective endeavour to share our country-specific experiences, plans, and concerns. Early career psychiatrists are crucial in the medical response to COVID-19. Although we are ready to provide help to those in need, we are made to count on insufficient access to WHO-standard personal protective equipment and training when trying to safely support others' mental health face-to-face. Furthermore, feelings of uneasiness or ill-preparedness arise when countries start redeploying mental health-care professionals to general medical care for patients with COVID-19 in overwhelmed health-care systems (table and appendix).TableOverview of challenges and opportunities for early career psychiatrists by countryTelepsychiatry availabilityRedeploymentPPE access and trainingNigeriaNot yet availableNot yetAccess to PPE and training in placeUSARegulations restricting the use of telepsychiatry have been loosened nationwide; wide availability of online conferencing toolsIncipientAccess to PPE and training in placeBrazilRegulations restricting the use of telepsychiatry have been loosened nationwide; used more in the private sector than in the public sectorNot yetVariable training and access to PPEColombiaBureaucratic roadblocks to deploymentNot yetAccess to PPE and training in placeParaguayIncipient and restricted; telephone hotlines already enabledNot yetPoor and variable access to PPE and trainingEgyptTelepsychiatry via online conferencing tools; predominant in the private sectorNot yetPoor training and access to PPEIranOnline individual and group psychotherapy (including groups for health care professionals); telephone hotlinesOngoingAccess to PPE and training in placeLebanonRestricted accessVoluntaryAccess to PPE and training in placeTunisiaIncipient telepsychiatry through online conferencing platforms and telephone consultationNot yetPoor access to PPE and variable trainingItalyMore available in the private sector than in the public sector; mainly through telephone hotlines, conferencing tools, and social mediaVariableVariable training and access to PPEKosovo*Kosovo is not recognised as a member state by WHO.Emergent use of telephone hotlines and online psychotherapyVoluntaryPoor access to PPE and variable trainingPortugalEmergent teleconsultation services for health professionals and patientsIncipientAccess to PPE in place with variable trainingSpainTelephone consultation for health professionals and outpatient servicesOngoingVariable training and access to PPEIndiaInformal telephone, messaging, and conferencing psycychotherapy for individuals and groupsLikelihood of imminentVariable training and access to PPEIndonesiaUse of popular online conferencing tools; online psychological first aidNot yetAccess to PPE in place without trainingSingaporeUse of online conferencing tools for educational, research, and clinical work; telephone hotlines widely usedNot yetAccess to PPE and training in placeInformation on telepsychiatry, redeployment, and PPE at April 1, 2020. Redeployment=transfer of psychiatrists to other medical duties in the care of patients with COVID-19. PPE=personal protective equipment.* Kosovo is not recognised as a member state by WHO. Open table in a new tab Information on telepsychiatry, redeployment, and PPE at April 1, 2020. Redeployment=transfer of psychiatrists to other medical duties in the care of patients with COVID-19. PPE=personal protective equipment. Telepsychiatry (ie, providing mental health care remotely, using telecommunications such as telephone or video conferencing tools) in several settings is suddenly being introduced or massively expanded to serve patients with pre-existing disorders, health professionals on the frontline, and the general population, during a time of uncertainty, misinformation, and physical distancing.4Zhou X Snoswell CL Harding LE et al.The role of telehealth in reducing the mental health burden from COVID-19.Telemed J E Health. 2020; (published online Mar ch 23.)DOI:10.1089/tmj.2020.0068Crossref Scopus (742) Google Scholar Still, telepsychiatry is scarce in several low-income and middle-income countries, posing challenges for health-care workers and patients where face-to-face care is not safe because of the risk of virus infection. We also perceive that attention given to the public's mental health during the outbreak came late, and overlooked vulnerable populations, such as refugees, people without secure housing, people living in overcrowded spaces, and patients with severe psychiatric disorders. Apart from disrupting usual mental health care, the COVID-19 pandemic could lead to further psychological trauma. The huge toll such trauma can take on medical professionals, which can include delusional episodes and suicidality, in countries as deeply struck by COVID-19 as Italy is of particular concern. Psychiatric sequelae could be reduced by the early involvement of mental health professionals in drawing up comprehensive public health policies and in supporting the health-care workforce. Many early career psychiatrists are part of the millennial generation familiar with technology,5Bernstein CA Bhugra D Next generation of psychiatrists: what is needed in training?.Asian J Psychiatr. 2011; 4: 88-91Crossref PubMed Scopus (14) Google Scholar and are channelling this strength to deliver far-reaching telepsychiatry, share online mental health-promotion resources, and connect with colleagues worldwide. Thanks to social media and the internet, international associations of early career psychiatrists are providing educational resources (eg, real-time news, journal clubs, and webinars), and group emotional support for peers. Colleagues in countries with a recent history of humanitarian and public health crises (eg, the epidemics of Zika virus disease in the Americas and Ebola virus disease in Africa), bring their experience of providing mental health care during and after such disasters, and those in countries with an earlier onset of the COVID-19 outbreak share the lessons already learned there. The spontaneity, resilience, and solidarity with which many colleagues have joined forces is inspiring. Early career psychiatrists are an essential resource in the mental health management of the COVID-19 pandemic and its aftermath. Mental health authorities are called to count upon early career psychiatrists, warranting the training and resources to enable us to safely and effectively work for our patients, colleagues, and communities. We express our gratitude to all early career psychiatrists taking risks to care for their patients, and we invite them to seek peer support and join forces both locally and across the world. We declare no competing interests. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Download .pdf (.16 MB) Help with pdf files Supplementary appendix Patients with mental health disorders in the COVID-19 epidemicMore than 60 000 infections have been confirmed worldwide in the coronavirus disease 2019 (COVID-19) epidemic, with most of these cases in China. Global attention has largely been focused on the infected patients and the frontline responders, with some marginalised populations in society having been overlooked. Here, we write to express our concerns with regards to the effect of the epidemic on people with mental health disorders. Ignorance of the differential impact of the epidemic on these patients will not only hinder any aims to prevent further spread of COVID-19, but will also augment already existing health inequalities. Full-Text PDF