Community Mental Health Care Delivery During the COVID-19 Pandemic: Practical Strategies for Improving Care for People with Serious Mental Illness

Abstract

The COVID-19 pandemic has presented a formidable challenge to care continuity for community mental health clients with serious mental illness and for providers who have had to quickly pivot the modes of delivering critical services. Despite these challenges, many of the changes implemented during the pandemic can and should be maintained. These include offering a spectrum of options for remote and in-person care, greater integration of behavioral and physical healthcare, prevention of viral exposure, increased collaborative decision-making related to long-acting injectable and clozapine use, modifying safety plans and psychiatric advance directives to include new technologies and broader support systems, leveraging natural supports, and integration of digital health interventions. This paper represents the authors' collaborative attempt to both reflect the changes to clinical practice we have observed in CMHCs across the US during this pandemic and to suggest how these changes can align with best practices identified in the empirical literature.

Implications of the COVID-19 pandemic for patients with schizophrenia spectrum disorders: narrative review

“…Supplementary Table 1 available at provides a summary of characteristics of the included studies in this review. 2,4-50…”

“…Kopelovich et al 20 described changes in healthcare delivery across the USA, and made suggestions to better align these changes with current standards of practice. They discussed the use of multimodal service delivery, including a combination of telehealth, in-person clinics, community outreach, other digital interventions and warm lines.…”

The impact of Covid-19 pandemic on community-oriented mental health services: The experience of Friuli Venezia Giulia region, Italy

“…The high level of integration between primary, community and tertiary elements of healthcare may enhance the flexibility of services, making the need for rapid reorganisation more feasible [5] . Further, being used to personalised and tailored approaches may allow the reconversion of interventions, also with the aid of telepsychiatry [ 13 , 29 , 32 ]. In this context, a community-based model may reduce feelings of isolation and loneliness of patients and, thus, prevent the risk of relapses [18] .…”

“…Although only 82 patients were tested for Covid-19 on a total number of 20,551 MHDs’ users, it is likely that patients with severe mental disorders (SMD), who have frequent contacts with mental health services, were administered swab tests after being identified by MHDs. In a community-based context, mental health professionals often represent a primary contact point with general healthcare for their patients with SMD and, thus, in many cases act as first responders during the pandemic [32] . When tested, however, only 6% of MHDs’ users suspected to have Sars-Cov-2 tested positive for the illness.…”

“…Another possible explanation of the good response to the pandemic emergency in FVG MHDs may be related to a rapid reorganization of services and staff [ 5 , 32 ]. Although operative recommendations were delivered to MHDs only at the end of April 2020, when the pandemic was showing a slight deceleration, the great majority of changes in routine practice were applied during the acceleration phase.…”