Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: framework synthesis of international experiences and responses

Abstract

Purpose The COVID-19 pandemic has many potential impacts on people with mental health conditions and on mental health care, including direct consequences of infection, effects of infection control measures and subsequent societal changes. We aimed to map early impacts of the pandemic on people with pre-existing mental health conditions and services they use, and to identify individual and service-level strategies adopted to manage these. Methods We searched for relevant material in the public domain published before 30 April 2020, including papers in scientific and professional journals, published first person accounts, media articles, and publications by governments, charities and professional associations. Search languages were English, French, German, Italian, Spanish, and Mandarin Chinese. Relevant content was retrieved and summarised via a rapid qualitative framework synthesis approach. Results We found 872 eligible sources from 29 countries. Most documented observations and experiences rather than reporting research data. We found many reports of deteriorations in symptoms, and of impacts of loneliness and social isolation and of lack of access to services and resources, but sometimes also of resilience, effective self-management and peer support. Immediate service challenges related to controlling infection, especially in inpatient and residential settings, and establishing remote working, especially in the community. We summarise reports of swiftly implemented adaptations and innovations, but also of pressing ethical challenges and concerns for the future. Conclusion Our analysis captures the range of stakeholder perspectives and experiences publicly reported in the early stages of the COVID-19 pandemic in several countries. We identify potential foci for service planning and research.

Impact on mental health care and on mental health service users of the COVID-19 pandemic: a mixed methods survey of UK mental health care staff

“…Our questionnaire was by necessity an ad hoc and not an established and validated tool. Omissions were noted as the study progressed: it was assumed that impacts of the “lockdown” for service users were negative, but positive experiences are noted too, for example of reduced pressure or easier access for people who struggle to travel [ 13 ]. More importantly, we designed the questionnaire early in the pandemic when the evidence of differential effects on some ethnic groups was less striking [ 19 ]: closed questions do not focus on this, although these effects and issues of racism are included in open-ended responses on concerns for the future.…”

“…The lead developer of the questionnaire, SJ, an academic and practising inner London psychiatrist, read key sources identified in an accompanying rapid review of relevant literature [ 13 ], including academic and professional journals, news media, and organisational websites, and followed relevant social media topics. The drafting of the questionnaire was further informed by the NIHR Mental Health Policy Research Unit (PRU) working group for this study (about 30 people, including clinicians, researchers, and people with relevant lived experience), and the PRU Lived Experience Working Group.…”

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

“…The pervasive contagion, along with the consequent widespread fear and the necessary containment measures to limit the outbreak (e.g. quarantine and lockdown), is likely to lead psychological consequences in the general population, but the distress in people with pre-existing psychiatric conditions is likely to have been greater [ 1 , [3] , [4] , [5] ]. Although general literature provides evidence of a greater susceptibility of psychiatric patients to environmental stress related to trauma [ 1 , 6 , 7 ], a recent review focusing on the psychological impact of quarantine included only one study considering mental illness as a risk factor [4] .…”

“…Although general literature provides evidence of a greater susceptibility of psychiatric patients to environmental stress related to trauma [ 1 , 6 , 7 ], a recent review focusing on the psychological impact of quarantine included only one study considering mental illness as a risk factor [4] . Studies suggest that psychiatric patients seem to be at high risk of infection, due to pre-existing disorders, unhealthy lifestyle, cognitive impairment or reduced level of awareness of the risk [ 3 , 8 , 9 ]. In contrast, recent findings from United Kingdom (UK) indicated that mentally-ill patients were at lower risk of contracting the infection compared to general population [10] .…”

“…During the emergency, a number of psychiatric emergency units were converted to Covid-19 services, and professionals were re-designated to work there. Moreover, many community services, where patients typically spend several hours a day finding immediate help for their problems, were severely restricted or temporarily closed [ 3 , 13 , 14 , 16 ]. A general decrease of hospitalisations in inpatient units, as well as in psychiatric consultations, was also observed [17] , [18] , [19] , [20] , [35] .…”