Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice

Abstract

Background: The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations. Methods: The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the "EPA Ambassadors", on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19. Results: While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients

Training and education in digital psychiatry: A perspective fromAsia‐Pacificregion

“…In particular, the topic mainly suggested by participants to be included as an essential tool is telepsychiatry. Obviously, this increasing perceived need by clinicians may be also determined by the current COVID‐19 pandemic and necessary restrictive measures and adaptations needed in the mental health services and infrastructures which indeed forced clinicians to reduce or discontinue in‐person consultations (Unützer et al, 2020), access to mental health care and services by patients, despite an increasing demand and request for de novo psychiatric onset due to the COVID‐19‐related situation (Chen et al, 2020; D'Agostino et al, 2020; Fagiolini et al, 2020; Fiorillo et al, 2020; Giallonardo et al, 2020; Gorwood & Fiorillo, 2021; Li et al, 2020; McIntyre & Lee, 2020; Rojnic Kuzman et al, 2021). In fact, accordingly, our findings reported a moderate increase in the frequency use of digital psychiatry interventions (e.g., e‐health, e‐mental health, telemedicine, telepsychiatry, digital psychiatry, DHIs) by participants who reported an elevation up to 21%–50% compared to their previous clinical practice, after the COVID‐19 outbreak (Stewart & Appelbaum, 2020).…”

COVID-19-Related Mortality Risk in People With Severe Mental Illness: A Systematic and Critical Review

“…The same applies to the impact of the type of care/facility on the treatment outcomes for persons with SMI with COVID-19, particularly during the first wave of the COVID-19 pandemic. At the beginning of this pandemic, in the U.S. ( 71 ) and in Europe ( 72 ) many inpatient psychiatric facilities created psychiatric COVID-19-positive units (PCU). When tested positive, psychiatric patients were transferred to these units, where they were treated medically for their COVID-19 illness by internists and medical nurse practitioners.…”

“…Only if patients showed signs of respiratory distress, such as shortness of breath or chest pain, they were transferred to a medical emergency room for further evaluation ( 71 ). The organization of PCU, however, varied considerably across countries and over time ( 72 ). Therefore, it remains unknown what the effect is of the type of care/facility on COVID-19-related mortality figures in these persons.…”

Case Series: Managing Severe Mental Illness in Disaster Situation: the Croatian Experience After 2020 Earthquake

“…It is well-known that low levels of accessibility of mental health services increase the inequality in the provision of adequate care for people with SMI (36). The mental health services in general became less accessible during the pandemic in the majority of countries (33,34). It was also noted that SMI patients had a higher level of morbidity and mortality due to COVID-19, and one of the explanations lies in the inadequate accessibility and provision of mental health services for SMI patients (37).…”

“…After the earthquake, the psychiatric department within the "Dr. Ivo Pedišić" general hospital was repurposed for non-psychiatric use. The earthquake and COVID-19 pandemic resulted in only emergency services being maintained (33,34). Emergency medical service (EMS) staff is usually not sufficiently trained in mental health care (35) The structure of CMHT members was adopted from RECOVER-E project and adjusted to reflect local needs and opportunities (31).…”