Psychiatry during the Covid-19 pandemic: a survey on mental health departments in Italy

Abstract

Background To date, very few nationwide studies addressing the way in which mental health services are addressing the current pandemics have been published. The present paper reports data obtained from a survey relating to the Italian mental health system conducted during the first phase of the Covid-19 epidemic. Methods Two online questionnaires regarding Community Mental Health Centres (CMHC) and General Hospital Psychiatric Wards (GHPW), respectively, were sent to the Heads of all Italian Mental Health Departments (MHDs). Statistical analysis was carried out by means of Chi Square test with Yates correction or the Fisher Exact test, as needed. Results Seventy-one (52.9%) of the 134 MHDs and 107 (32.6%) of the 318 GHPWs returned completed questionnaires. Less than 20% of CMHCs were closed and approx. 25% had introduced restricted access hours. A substantial change in the standard mode of operation in CMHCs was reported with only urgent psychiatric interventions, compulsory treatments and consultations for imprisoned people continuing unchanged. All other activities had been reduced to some extent. Remote contacts with users had been set up in about 75% of cases. Cases of COVID positivity were reported for both staff members (approx. 50% of CHMCs) and service users (52% of CHMCs). 20% of CMHCs reported cases of increased aggressiveness or violence among community patients, although only 8.6% relating to severe cases. Significant problems emerged with regard to the availability of personal protective equipment (PPE) for staff members. A reduced number of GHPWs (− 12%), beds (approx.-30%) and admissions were registered (87% of GHPWs). An increase in compulsory admissions and the rate of violence towards self or others among inpatients was reported by 8% of GHPWs. Patient swabs were carried out in 50% of GHPWs. 60% of GHPWs registered the admission to general COVID-19 Units of symptomatic COVID+ non-severe psychiatric patients whilst COVID+ severe psychiatric patients who were non-collaborative were admitted to specifically set up “COVID-19” GHPWs or to isolated areas of the wards purposely adapted for the scope. Conclusions The pandemic has led to a drastic reduction in levels of care, which may produce a severe impact on the mental health of the population in relation to the consequences of the expected economic crisis and of the second ongoing wave of the pandemic.

Emergency Psychiatric Consultations During and After the COVID-19 Lockdown in Italy. A Multicentre Study

“…To our knowledge, this is the first Italian national-level study to investigate the impact of pandemic COVID-19 on psychiatric consultations in emergency departments. In Italy, few studies have focused on the organizational aspects related to the emergency, describing the changes that occurred to curb the difficulty of managing psychiatric patients and caregivers (16,18,20,21). Early data from mental health departments in Lombardy during the lockdown were also analysed with great timing (22)(23)(24), suggesting a substantial decrease in psychiatric consultations.…”

“…In this context, the outbreak of COVID-19 pandemic has produced significant challenges on the mental health organization (15)(16)(17)(18). On March 8, 2020, a government decree introduced in Italy a number of restrictions to counteract the spread of the pandemic.…”

Further Adaptations and Reflections by an Assertive Community Treatment Team to Serve Clients with Severe Mental Illness During COVID-19

“…For example, an observational study in Italy of 205 clients with SMI indicated that clients were four times more likely to perceive high COVID-19 pandemic-related stress and had two to three times higher risk of severe anxiety and depressive symptoms when compared to non-psychiatric participants (Iasevoli et al, 2020 ). Also in Italy an observation was made that those affected by SMI seemed to have faced the acute phase of the epidemic in the same way as any other Italian citizen, that is adapting quite well given the unprecedented behavioral regulations imposed by the situation (Carpinieloo et al, 2020 ). We informally polled our team members about how we perceived our clients’ symptoms were during the pandemic compared to before the pandemic.…”

An Italy-China Collaboration for Promoting Public Mental Health Recommendations During the COVID-19 Pandemic

“…Moreover, susceptibility to mental health problems was compounded by the experience of dramatic life events, such as bereavement, unavailability of final farewell in terminal situations, and parental separation due to confirmed or suspected infection. Another important behavioral change caused by the lockdown and the parallel closure of many outpatients mental health services and day-centers was represented by the sudden increase in the amount of time spent face-to-face between a patient and his/her family members, increasing the risk of relapse, higher levels of symptoms, and poorer functioning in patients with psychotic disorders (10).…”