Patient engagement - COVID-19 guidance for clinicians
The NHS has developed general guidance on patient engagement, and this page will be updated as new guidance is developed.
We are also working on guidance specific to liaison mental health and secure care settings, as well as other areas as issues emerge.
It is important that healthcare professionals continue to consider the impacts of some patient’s “stress busters” that might have relevance to Covid-19 and advise patients accordingly. Two of the most relevant are cigarette smoking and alcohol.
Smoking
As COVID-19 attacks the lungs, patients who smoke should be encouraged to give up smoking as a priority at this time. For a significant number, stopping smoking will be potentially life-saving. Healthcare professionals should continue to provide Very Brief Advice (VBA) and strongly encourage patients who smoke to move at least to less harmful alternatives at this time, including:
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Nicotine Replacement Therapy (NRT): patches, lozenges, gum, tablets and more
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Varenicline – this is a safe, approved drug that helps many people beat nicotine addiction; they need to be on it for two weeks before their quit date
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Vaping with Electronic Cigarettes (E-cigs)
Where there isn't already a ban on smoking within a Mental Health Trust, access to smoking on hospital grounds for in-patients needs to be considered against the risks of increased social contact by facilitating this.
There is also a particular link between smoking and the reduction of plasma levels of some psychotropic medications. Ceasing smoking will normalise enzyme activity and cause plasma levels of some drugs to rise over a week or so. Dose reduction will be necessary to avoid drug toxicity.
Where a respiratory infection occurs, clinicians should assume that smoking will reduce suddenly and act accordingly in relation to dosages of some drugs. More details on COVID-19 and psychotropic medication can be found here.
Alcohol use
While some activities which suppress the immune system are necessary because of other significant medical issues, there are others where they have no medical value and should be discouraged with an even greater emphasis at this time.
Alcohol use is such an example and healthcare professionals should, as with smoking offer brief advice to patients who drink alcohol outside of current guidelines. All mental health professionals are trained in recognising withdrawals from alcohol dependent patients.
Public Health England has published Guidance for the public on the mental health and wellbeing aspects of coronavirus
Advise people who self-isolate to stay connected and to maintain their social networks as much as possible. Even in situations of isolation, they should try as much as possible to keep their personal daily routines.
During times of stress, advise people who self-isolate to pay attention to their own needs and feelings, and to engage in healthy activities that they enjoy and find relaxing. Encourage them to exercise regularly, keep regular sleep routines and eat healthy food.
A near-constant stream of news reports about an outbreak can cause anyone to feel anxious or distressed. Advise people who self-isolate to seek information updates and practical guidance at specific times during the day from health professionals and WHO website and to avoid listening to or following rumours that can make them feel uncomfortable.
Those who have to self-isolate can be encouraged to do the following activities to stay well during isolation: communicate with people by phone, text, messaging, listen to the radio and music, read, exercise, practise mindfulness, meditation, relaxation techniques and/or religious practice, vary your routine, sleep by night, organise activities for others, etc.
Those who have to self-isolate can be encouraged to avoid spending too much time on screen, reading news from unreliable sources, sitting or lying around the house, smoking, spending long periods on their own when they can make contact with others.
Mind has published a range of ideas for people to stay well. Meanwhile, YoungMinds has published Parents Helpline experts’ advice on what parents can do if their child is worried or anxious about coronavirus.
Other resources for better mental health during restrictions include:
One of our key roles as mental health professionals is to help in both managing and reducing anxiety among our colleagues and patients. Clearly, in the current climate this is very difficult.
To help with this, it is important that psychiatrists and healthcare professionals adopt a measured, realistic, balanced approach and find the time to continue to support each other. Despite concerns about spreading infection, it remains a key task for psychiatrists to find ways in which to communicate and maintain connections with their patients.
Recommendations for keeping calm while planning for a potential outbreak include:
Increase a sense of control - the team are in a safe pair of hands.
Reassurance and planning.
Keeping communication channels open and regularly updated.
Realistic preparation and escalation plan, with a clear understanding of the circumstances in which this escalation plan may be needed.
Support to managers who are making plans and will be encountering significant stresses.
Tolerate uncertainty without rushing to fixed conclusions
Recognising anxiety is inevitable, and tolerating this reality, without an inappropriate rush to action.
As well as this, it will be important to remind all staff and patients of the low mortality rate for much of the population associated with COVID-19, while not being unrealistic about the risks.
T here are some very helpful resources from the intensive care society with downloadable posters which are specifically created, for example https://www.ics.ac.uk/ICS/Education/Wellbeing/ICS/Wellbeing.aspx?hkey=92348f51-a875-4d87-8ae4-245707878a5c
The College is working on more ways to support staff in mental health services and will post details as this work progresses.
Guidance has been published by Public Health England (PHE) for parents and carers on looking after the mental health and wellbeing of children or young people during the coronavirus (COVID-19) outbreak.
The advice is to help adults with caring responsibilities look after the mental health and wellbeing of children or young people, including those with additional needs and disabilities, during the coronavirus (COVID-19) outbreak.