Lockdown in a specialised rehabilitation unit: the best of times

Abstract

Specialised rehabilitation units offer inpatient multi-disciplinary rehabilitation for individuals with severe and enduring mental illness. A cornerstone of therapy is the work in the community through further education and community organisations. However, coronavirus restrictions have meant that such external supports are no longer available for the duration of the crisis. This has led to opportunities for developing new ways of offering rehabilitation within hospital environments. This article describes some of the new initiatives developed. The benefits of the lockdown for service users are also discussed. Many found the cessation of visits from family members with whom they had an ambivalent relationship helpful. The lockdown improved relationships between patients on the unit and encouraged a greater feeling of community. The lockdown has also emphasised the importance of team self-awareness and an awareness of the nature of the treatments offered.

Schizophrenia during the COVID-19 pandemic

“…Interestingly, one narrative article reported that in a specialized psychiatric rehabilitation unit, the lockdown was perceived positively by the patients, as this improved the relationship with the staff of the unit, encouraging a greater feeling of community and emphasized self and treatment awareness. Some patients also perceived the lockdown as helpful, as it brought the cessation of visits from family members with whom they had ambivalent relationships [ 29 ].…”

Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review

“…d) Clinics seem to run efficiently, as telepsychiatry reduces the time required for custody care providers to escort patients from housing units to treatment areas. e) Waiting rooms appear less congested than before 10 Gannon 2021 [ 40 ] Case study US Distinct clinical populations, including general child and adolescent, intellectual and developmental disability, geriatric, general adult, addiction medicine, and psychotic disorders Videoconferencing Remote diagnostics and evaluation, accessibility to services, privacy of care providers and patients, flexibility of services, care delivery mode via technology a) attendance increased; b) telehealth is a welcomed alternative; c) patients with anxiety, low mood, trauma, memory impairment, or psychotic spectrum disorders found telehealth less stressful d) for care providers seeing home environment of patients is beneficial (real-time observations) e) mobility of care providers allowed more flexibility and availability f) billing procedures are challenging; g) technology issues: lack of adequate hardware from care providers; h) privacy concerns of care providers 11 Glancy 2020 [ 41 ] Qualitative Ireland Individuals with severe chronic and enduring mental health illnesses Face to face/ videoconferencing Care delivery mode via technology a) physical isolation helped patients to have more space for reflection; b) self-awareness improved; c) sense of camaraderie was created 12 Guinart 2020 [ 42 ] Quantitative US Patients in psychiatric centres Videoconferencing Remote diagnostics and evaluation, privacy of care providers and patients, flexibility of services, care delivery mode via technology a) high levels of satisfaction with telepsychiatry services; b) the option of telepsychiatry should remain tailored to individual patient needs and be the result of shared decision; c) subjects were more likely to strongly agree to consider using telepsychiatry in the future when using video; d) lack of closeness; e) fear of reduction in the doctor’s ability to detect subtle signs of body language, nonverbal cues, and/or physical signs of disease could be some of the reasons behind this preference 13 Haderlein 2022 [ 43 ] Qualitative US VA Primary Care-Mental Heal...…”

“…3. For those who did not know the patients well before the lockdown restrictions, building a good rapport with patients was challenging and sometimes impossible [ 31 , 42 , 58 ] Accessibility to services N = 25 [ 31 – 41 , 43 , 44 , 46 , 47 , 49 – 56 , 58 , 62 ] Accessibility of services means the ability of patients to receive medical care and engage with care providers when needed 1. Remote support was provided for those who resided in communal group accommodation (current and ex-substance users) which was a barrier for individuals to have enough space and place during remote meetings [ 32 ].…”

“…[ 46 ] 4. Where the mental health services were provided in a closed unit due to COVID, it allowed patients to have uninterrupted treatment which was appreciated by patients [ 41 ]. 5.…”

“…It included removing barriers to accessing care such as time, money spent on travelling to and from a clinic, physical difficulty of travelling, safety issues and waiting times in clinics 1. By removing barriers such as time and money spent on travelling to and from clinic, patients and care providers were able to accommodate treatment considering individual needs [ 46 ] Satisfaction with telehealth N = 21 [ 26 – 33 , 37 , 38 , 41 – 44 , 46 – 51 , 56 , 59 ] Studies reported patients’ and care providers' satisfaction with care delivered in a remote format (patients = 15 studies; care providers = 6 studies) where both patients and care providers rated their overall assessment of mental health services delivered via telehealth 1. Twelve studies demonstrated high satisfaction rates among patients and care providers highlighting that the care delivered was of appropriate standard followed by positive overall experiences [ 31 , 37 , 39 – 41 , 52 , 56 , 58 – 62 ] 2.…”