Supporting mental health in a time of crisis

Close to half of Americans are worried about contracting COVID-19, and 40% are concerned about becoming seriously ill or dying, according to a nationwide poll by the American Psychiatric Association in March 2020.¹ More a third say the virus is having a serious impact on their mental health.

In a survey of 1210 Chinese citizens from 194 cities conducted in January 2020, 16.5% were experiencing moderate to severe symptoms of depression, and 28.8% moderate to severe anxiety.²

Given such data, psychiatrists are almost as much key workers as the physicians who are dealing at a population level with the physical consequences of COVID-19 infection. Psychiatrists also have a more specific role – that of supporting their existing patients who are particularly susceptible to depression and anxiety.

The pandemic’s short and long-term effects on mental health will be profound

Patients especially vulnerable

People with mental health problems are a large and vulnerable section of society. This vulnerability arises from a number of factors:³

The risk of infection is high for people living in institutions. More generally, the chance of complications is increased by comorbidities, stigma and barriers to quickly accessing healthcare.³ There may also be individual factors such as cognitive impairment, and reduced awareness of risk and the need for personal protection.³

Duan and Zhu⁴ emphasize the need for national governments to plan for integrated psychological crisis interventions taking into account the severity of symptoms and place of treatment, including isolation units and quarantine at home. Attention should be paid to the prevention of mental ill-health, acute treatment, and follow up if needed.

Healthcare professionals faced with life or death decisions

In terms of preventing distress, Wang et al² noted from their survey that the adverse impact of the pandemic was felt less severely by people who had up-to-date and accurate health information and by those who had adopted precautions such as handwashing and wearing masks. So it seems that enabling people to feel they have some control over what happens is helpful.

Unparalleled challenge to wellbeing of HCPs

Given the correct equipment, healthcare professionals working with the critically ill can be protected against infection. But the psychological consequences of having to make daily life and death decisions are more difficult to deal with. The rationing of ventilators is described in the New England Journal as “the toughest triage” doctors are ever likely to face.⁵ When such decisions violate a physician’s moral or ethical code, the “moral injury” can be profound.⁶

Suggestions for how the mental health consequences can be mitigated include preparing staff honestly for decisions they will have to make, providing forums in which the emotional challenges can safely be discussed, and supportive supervision.⁶