COVID-19 disease emergency operational instructions for Mental Health Departments issued by the Italian Society of Epidemiological Psychiatry

Abstract

During the current COVID-19 disease emergency, it is not only an ethical imperative but also a public health responsibility to keep the network of community psychiatry services operational, particularly for the most vulnerable subjects (those with mental illness, disability, and chronic conditions). At the same time, it is necessary to reduce the spread of the COVID-19 disease within the outpatient and inpatient services affiliated with Mental Health Departments. These instructions, first published online on 16 March 2020 in their original Italian version, provide a detailed description of actions, proposed by the Italian Society of Epidemiological Psychiatry, addressed to Italian Mental Health Departments during the current COVID-19 pandemic. The overall goal of the operational instructions is to guarantee, during the current health emergency, the provision of the best health care possible, taking into account both public health necessities and the safety of procedures. These instructions could represent a useful resource to mental health providers, and stakeholders to face the current pandemic for which most of Mental Health Departments worldwide are not prepared to. These instructions could provide guidance and offer practical tools which can enable professionals and decision makers to foresee challenges, like those already experienced in Italy, which in part can be avoided or minimised if timely planned. These strategies can be shared and adopted, with the appropriate adjustments, by Mental Health Departments in other countries.

In-patient psychiatry management of COVID-19: rates of asymptomatic infection and on-unit transmission

“…The in-patient psychiatric services of NYU Langone Health started to change their approach to in-patient treatment in response to the COVID-19 pandemic in the first week of March 2020. The changes made, outlined below, are largely consistent with recently published guidelines/recommendations 6,[10][11][12][13] and remained in place throughout the period described.…”

“…9 In the context of the COVID-19 outbreaks on in-patient psychiatric units, several authors have proposed guidelines for changes in care delivery aimed at reducing on-unit transmission and management of COVID-19 among psychiatry in-patients. 6,[10][11][12][13] We report the experience at NYU Langone Health in implementing these measures with the goal of balancing the, at times, opposing forces to provide quality care for patients' mental health while protecting their physical health.…”

Optimizing psychiatric care during the COVID‐19 pandemic

“…In Italy, where the community spread is greater than in Denmark, guidelines recommend even stricter measures (8), including that front desk and care personnel must wear personal protection equipment. In Wuhan (China), if a patient is at risk or corona-positive, the patient must be put in isolation for 14 days and must wear a surgical mask (6).…”

Mental Health Planning During the COVID-19 Crisis: A Systematic Review of Online International Strategies and Recommendations

“…In this new environment, it is likely that the balanced MH care model [24] must be adapted considering the problem of dealing with the community-based care paradigm in a situation where safe distance between people may be mandatory. [25] describe a proposal for MH care provision during the pandemic: 1) outpatient care should be mainly provided online by telephone or videoconference; 2) in case of crisis, users could access acute MH care in hospitals; 3) day care services will be closed during the pandemic, when necessary online interventions like telephone monitoring and face-to-face home visits should be available; 4) clinical emergencies will be admitted in inpatient units, although length of stay is kept to a minimum and, whenever possible, crisis should be treated outside the hospital; and 5) short and longterm residential care facilities will provide care normally but without admitting new patients, with exceptions as an alternative to inpatient care. Special prevention measures, such as training in the use of personal protection equipment, must be available at any time or place.…”