This section details measures countries are taking to deal with the COVID-19 outbreak in mental health settings internationally.
It also includes resources for psychiatrists developed by international and national organisations, such as those produced by the American Psychiatric Association.
If you are aware of any other international resources or policies, please contact Zoé Mulliez, Policy & Campaigns Manager (firstname.lastname@example.org).
This page will be updated as we receive more and new information. We encourage you to check it back regularly. Last update: 26 March 2020.
Managing mental health during the COVID-19 pandemic: Resources from the WHO
- The World Health Organisation (WHO) Mental Health Department has published guidance on "Mental health and psychosocial considerations during the COVID-19 outbreak" (PDF) as support for mental and psychological well-being during the COVID-19 outbreak.
- Another set of resources, including flyers to help people cope with stress, can be found on the WHO Regional Office for the Eastern Mediterranean website. You can also read the following documents: Coping with stress during COVID-19 and Helping children cope with stress during COVID-19.
- You can also watch a live-streamed Q&A session on mental health during COVID-19 with Aiysha Malik, Technical Officer at the WHO's Mental Health and Substance Use Department on Twitter, Facebook, and LinkedIn.
- UNICEF, WHO and the International Federation of Red Cross and Red Crescent Societies (IFRC) produced a guide for preventing and addressing social stigma associated with COVID-19 (PDF) .
COVID-19 mental health resources from the WPA and the WEF
The World Psychiatric Associates (WPA) invite all psychiatrists to share what they are doing to support their communities, so that they, in turn, can share it with their global network via their website. Their goal is to build a library of information that will be helpful to you. Some links to trusted sources and resources are already available.
Meanwhile, the World Economic Forum (WEF) has collected insights from people around the world on managing mental health during the COVID-19 outbreak.
Other sources to access COVID-19 information
Updated information from the WHO about COVID-19 is available through:
- COVID-19 general website with country and technical guidance, tips to protect yourself, trainings on COVID-19 preparedness, travel advice, and more
- COVID-19 news and COVID-19 situation reports with up-to-date announcements
- Strategic preparedness and response plan for COVID-19 to support national preparedness and response to the epidemic
- COVID-19 course series for health professionals on responding to COVID-19
- COVID-19 Social media cards: please share via your social channels or retweet from WHO channels.
In Australia, new restrictions came into effect following considerable media debate that the Government should have more stringent measures. Many doctors were at the forefront of this call. For all the latest information, you can visit: www.health.gov.au (Australia) and www.health.govt.nz. (New Zealand).
Resources published by the Australian Government seem to be focused on primary care.
Psychiatrists are concerned about the vulnerable in their communities as well as trying to maintain their services. The Government has introduced new item numbers to allow telehealth and telepsychiatry for affected and vulnerable patients, which is positive but may not yet be far reaching enough.
Phoenix Australia – Centre for Posttraumatic Mental Health has developed some useful tip sheets to support health practitioners and community members after the spread of the virus.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) closely monitors the constantly changing circumstances. It has cancelled its annual Congress which was supposed to be in May in Hobart.
France is working on a COVID-19 guidance for psychiatric services.
We have been liaising with people working at the French Department of Health and Social Care and the the WHO Collaborating Centre for Research and Training in Mental Health based in Lille.
They explained that:
- they are following generic rules such as the WHO guidelines on COVID-19 and mental health
- they apply the same rules for all healthcare professionals and for patients, considered as citizens, therefore all the rules to access care are the same
- confinement is mandatory for all older people and in long-term care services for older people, and for all vulnerable people in care settings
- rules aren’t set up nationally, they are set up by Trusts according to national guidelines (but not mental health specific) and the local context.
There are a number of measures that are currently in place in Germany, mostly imposed by the Government and partly put in place by psychiatrists.
- It is not allowed anymore for patients to have visits (hence less administrative work, less supervision of visits).
- No conferences, continued education, meetings.
- For forensic outpatients: reduction in frequency of visits both to the department and home visits, prioritisation of contact to high risk cases, replacement of in-person contact with telephone contact.
- Visits to other outpatient departments (for medical reasons) mainly via videoconferencing or phone.
- The courts and Probation have also cut down on their work which means less staff to escort patients there.
- Less escorted leave.
Hong Kong is actively adopting a containment policy and the general public adopts three key measures: universal masking, hand hygiene and social distancing.
The overall principles of healthcare services are to close all non-essential services, minimise human traffic flow in those essential services, identify those with infectious risks in these essential services and protect patients and staff from infections. Psychiatric hospitals have limited how patients circulate on the units even if no one is infected.
Staff has been asked to use personal protective equipment (PPE) according to WHO recommendations (PPE is conserved through cutting non-essential services). They must respect social distancing rules in wards and outpatient units. Some have set up plastic screens or barricades around each sitting area
Visits to China or overseas are quarantined at home or in camps. There is a system that allows clinicians to check whether a patient has recently passed through the different border checkpoints in Hong-Kong with the exact dates of these activities in the past 30 days.
Staff from closed non-essential services are deployed to essential services. All in-house training, local or overseas conferences and training workshops have stopped or been replaced by online training or conferences. All large face-to-face meetings have been replaced by Zoom meetings.
Hong-Kong has set up the following rules for psychiatric services:
- Reduction of specialist outpatient clinic volume by actively inviting patients for drug refill without face-to-face medical consultation.
- Keeping day hospital attendances to a minimum (closing the service but maintaining daily tele-care only if at all possible). Closing all voluntary services in hospital premises.
- Surveillance of all outpatients for FTOCC (Fever, Travel history, Occupation, Custering of cases and Contact with suspected or infected COVID-19 patients). Special cohort and consultation arrangements for those with FTOCC positive cases once identified in the outpatient clinics during times of registration.
- Stringent screening criteria for admission into in-patient wards from the community and other hospitals (FTOCC screening). Prompt discharge of in-patients back to the community once stabilised.
- Masking and hand sanitisation before entry into clinical areas. Hand sanitisation for patients and staff when moving from one area to another in the same ward.
- Thorough cleansing of consultation rooms after use by staff for patient consultation.
- COVID-19 tests for patients with suspected COVID-19 infection.
- Cohorting in-patients into seven-day blocs with no contact between the different blocs (or cohort of patients using different wards) including facilities especially toilets and shower facilities.
- Online or tele-care for psychological and social services for outpatients as far as possible. Online or telephone support by community nurses and case managers for patients assessed to be low in risks of violence to self or others. Only individual therapy work with all group therapies banned.
- Daily temperature and respiratory symptom monitoring.
- Meals in dining rooms with all patients facing one direction.
- No visitors to wards but tele-care or video-conferencing with patients for visitors if needed.
- No cooked food from visitors allowed for patients.
- All patients and staff in wards receiving flu vaccination.
- Prompt transfer of patients to general hospital for isolation when there is a high index of suspicion of COVID-19 infection and no day or home leave allowed.
In Italy, measures vary according to the areas. In some areas they have opened dedicated COVID-19 wards, in other areas they are enforcing strict measures in psychiatric hospitals: no visits, no trips out, zero or minimal group activities, social distancing, etc. Also in some areas patients receive a chest X-ray, a swab and CRP test before being admitted.
The advice we received based on what happens in Italy is to:
- adopt a range of measures (having dedicated COVID-19 wards, putting in place isolation measures and more testing)
- stress the need for individual protections both for clinicians and patients
- devote a big effort to discharge patients from hospitals and managing them in different settings, as staying in hospital could be lethal in some cases
- ensure psychiatric hospitals caring for COVID-19 patients have provisions to rapidly transfer deteriorating patients to A&E.
Resources published by the American Psychiatric Association (APA)
To provide support in response to COVID-19, APA created an information hub with authoritative and timely resources. The resources cover both the physical impact of the coronavirus and its potential mental health and psychosocial issues. We would recommend reading the following documents:
- Coronavirus and Mental Health: Taking Care of Ourselves During Infectious Disease Outbreaks (APA)
- Taking Care of Patients During the Coronavirus Outbreak: A Guide for Psychiatrists (Center for the Study of Traumatic Stress, CSTS). A helpful article providing advice on what psychiatrists can do to support their patients, including staying informed, correcting misinformation, educating, informing about stress reactions, identifying and supporting high-risk patients, taking care of yourself and your loved ones.
- Helping Patients Manage the Psychological Effects of Quarantine and Isolation (CSTS)
- How Healthcare Personnel Can Take Care of Themselves (CSTS)
- Supporting the Mental Health of Patients During COVID-19: A Guide for Healthcare Personnel (CSTS)
- Supporting Patients During Quarantine or Confinement (CSTS)
- Care for Critically Ill Patients With COVID-19 (JAMA Insights: Clinical Update, March 11, 2020)
- Tips For Social Distancing, Quarantine, And Isolation During An Infectious Disease Outbreak (Substance Abuse and Mental Health Services Administration, SAMHSA)
- Mitigating Risks for Contagion Stigma (APA Blog)
APA is also producing webinars to provide up-to-date information as the situation evolves. If you are interested, please visit this webpage.
New Telehealth rules
Rules regarding the practice of telepsychiatry have changed quickly in the US. To access APA's collection of resources on telepsychiatry, use the links below:
- APA Information on New Telehealth Rules (New guidance from CMS, updated 3/17/20)
- APA Telepsychiatry Toolkit
- Best Practices in Videoconferencing-Based Telemental Health Guide (APA and American Telemedicine Association)
Johns Hopkins University
Johns Hopkins University is actively monitoring the COVID-19 pandemic. Below is the advice we received regarding psychiatric services:
- Patients suspected to have COVID-19 should be isolated in a room with a closed door, with healthcare professionals taking into account their psychiatric needs (e.g. constant observation).
- Staff should call the centralised command centre where the Hospital Epidemiology and Infection Control team gets involved. They say whether the patient needs to be tested.
- If the patient is infected, they will likely be transferred into a floor with negative pressure rooms. Staff would coordinate psychiatric nursing needs with the receiving unit, based on the patient’s clinical needs.
- Only one adult visitor per patient is allowed.
Johns Hopkins University has also created a helpful COVID-19 tracking map.