Objectives: Providing medical care during a global pandemic exposes healthcare workers (HCW) to a high level of risk, causing anxiety and stress. This study aimed to assess the prevalence of anxiety and psychological distress among HCWs during COVID-19.Methods: We invited HCWs from 3 hospitals across the United Arab Emirates (UAE) to participate in an anonymous online survey between April 19–May 3, 2020. The GAD-7 and K10 measures were used to assess anxiety and psychological distress. Logistic regression models assessed associations between knowledge, attitude, worry, and levels of anxiety and psychological distress.Results: A total of 481 HCWs participated in this study. The majority of HCWs were female (73.6%) and aged 25–34 years (52.6%). More than half were nurses (55.7%) and had good knowledge of COVID-19 (86.3%). Over a third (37%) of HCWs reported moderate/severe psychological distress in the K10 measure and moderate/severe anxiety (32.3%) in the GAD-7, with frontline workers significantly reporting higher levels of anxiety (36%). Knowledge of COVID-19 did not predict anxiety and psychological distress, however, HCWs who believed COVID-19 was difficult to treat and those who perceived they were at high risk of infection had worse mental health outcomes. Worry about spreading COVID-19 to family, being isolated, contracting COVID-19 and feeling stigmatized had 1.8- to 2.5-fold increased odds of symptoms of mental health problems. Additionally, HCWs who felt the need for psychological support through their workplace showed increased odds of psychological distress.Conclusion: HCWs in the UAE reported a high prevalence of psychological distress and anxiety while responding to the challenges of COVID-19. The findings from this study emphasize the public, emotional and mental health burden of COVID-19 and highlight the importance for health systems to implement, monitor, and update preventive policies to protect HCWs from contracting the virus while also providing psychological support in the workplace.

Aims and MethodThe aim of the study was to examine the association between the assessment of need by staff and by severely mentally ill patients using the Camberwell Assessment of Need in a semi-rural setting (Maidstone, n=50) and an inner-city area (Camberwell, n=127). Staff and patients were interviewed separately. We specifically examined differences in the total number of needs between Camberwell and Maidstone, differences in the number of unmet needs and differences in the level of agreement between staff and service users.ResultsPatients in Maidstone had fewer needs than those in Camberwell according to both staff (4.9 v. 5.8) and patients (4.2 v. 6.3), fewer unmet needs rated (staff, 1.1 v. 1.5; patients, 1.0 v. 1.9) and a greater level of concordance between staff and patients.Clinical ImplicationsThe needs of severely mentally ill patients were greater in the inner-city area compared with the semi-rural one. The fact that agreement between staff and service users was less in the inner-city area also suggests that more stable staff–patient relationships existed in the rural area.

In their otherwise excellent review of the Equality Act 2010 and mental health, 1 the authors did not highlight how the Department of Health currently discriminates against people with mental health problems. The National Health Service (NHS) constitution has incorporated the Equality Act in terms of access to NHS care, including on the grounds of disability. However, a fundamental right of the constitution is that of choice. Section 2a states 'You have the right to make choices about your NHS care and to information to support these choices. The options available to you will develop over time and depend on your individual needs'. 2 Since April 2009, patients have had a right to choose the service that provides their treatment when they are referred for their first outpatient appointment with a consultant-led team. Patients can review outcome data, specialist expertise and user feedback for a service, discuss it with their general practitioner, and be referred for an elective medical or surgical problem to any NHS consultant-led service across the country. However, the Department of Health excludes patients detained under the Mental Health Act 1983, military personnel and prisoners. It also excludes services where speed of access to diagnosis and treatment is important, for example emergency admissions and maternity services. However, under this clause it also excludes elective mental health services. This appears to be discriminatory under the Equality Act for people with mental health problems who are disabled by their disorder. So anyone with a mental disorder who is disabled and has had treatment locally cannot by right obtain a referral to a specialist mental health service. Most National Institute for Health and Clinical Excellence guidelines on mental disorders envisage stepped care. Where treatment has failed, the next step is onward referral to more intensively delivered cognitive-behavioural therapy (e.g. more frequent, longer sessions with more experienced therapists) or to specialised pharmacological advice that may not be available from a local community mental health team or psychology service. Patients with mental disorders who are disabled therefore have the right to choose where they have treatment for their cancer, for example, but not for their mental disorder. Access depends entirely on the vagaries of local funding panels. The legal right to choice of elective care should be extended to mental health services, or withdrawn from surgery and medicine. The present discrimination is unconscionable.

Patients who suffer from mental illness, and are a risk to themselves, to other people or at risk of self neglect. Such patients can be detained under section 5(2), if they are already admitted to hospital and express their wish to leave against medical advice.