The impact of the COVID-19 outbreak on the medico-legal and human rights of psychiatric patients

Abstract

The COVID-19 pandemic has raised significant concerns for population mental health and the effective provision of mental health services in the light of increased demands and barriers to service delivery [1]. Particular attention is being directed toward the possible neuropsychiatric sequelae of both COVID-19 and of the stringent societal mitigation steps deployed by national governments, concerns that are informed by historical increases in the incidence of psychotic disorders following influenza pandemics [2]. However, so far there has been scant attention paid to other important areas of psychiatry during COVID-19, including medico-legal aspects and human rights. In this paper, we discuss the legal implications for psychiatry of the COVID-19 pandemic and report a novel situation in which psychiatric patients may experience diminution of their statutory protections. We believe that this represents a paradigm shift in psychiatric care and that the consideration of the fundamental rights of psychiatric patients as “less important” than infection control measures compel mental health professionals to “advocate for … patients and their caregivers” in this time of crisis [1].

Effects of the lockdown on the mental health of the general population during the COVID-19 pandemic in Italy: Results from the COMET collaborative network

“…The score at the DASS-depression subscale (e.g., "I felt that I had nothing to look forward to") is divided into normal (0-9), mild (10)(11)(12), moderate (13)(14)(15)(16)(17)(18)(19)(20), severe (21)(22)(23)(24)(25)(26)(27), and extremely severe depression (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). The score at the DASS-anxiety subscale (e.g., "I was worried about situations in which I might panic and make a fool of myself") is divided into normal (0-6), mild (7-9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19), and extremely severe anxiety . The score at the DASS-stress subscale (e.g., "I tended to over-react to situations") is divided into normal (0-10), mild (11)(12)(13)…”

“…Given the high level of contagiousness, as well as the lack of appropriate treatments and vaccines, almost all countries have adopted confinement measures, including lockdown, home isolation and physical distancing [5]. While most of the clinical and research efforts have been directed to reduce the effects of the virus on physical health [6][7][8], its short-and long-term effects on mental health are causing a second wave of pandemic, which has been mostly neglected [9][10][11]. Furthermore, the pandemic represents a traumatic event which has differential effects at individual and population levels.…”

Organisation and Timeline of Measures in French Psychiatric Establishments during the First Wave of the COVID-19 Epidemic: EvOlu’Psy Study

“…Some psychiatric hospitals in China systematically isolated all new patients for 14 days before admitting them to speci c hospital departments [42]. The COVID-19 crisis appears to have had a disproportionate effect on the loss of civil and political rights of persons with mental and cognitive disorders, which must nonetheless be considered absolute to guarantee respect of the person's fundamental rights [43]. French public establishments appear to have done a better job of considering the issue of patients' rights than the private facilities.…”

One year after the COVID-19: What have we learnt, what shall we do next?

“…In order to facilitate treatments in isolated wards because of the COVID-19, a discontinuation of judges' visits to patients was observed in many countries, including Germany and France. Thome et al [7] raised the point that this is also a damageful reduction of rights of patients being hospitalized that should not be accepted, the need for a "pandethics" being put to the forth.…”

“…Three articles of this collection listed advices and recommendations to protect and defend the rights of patients with severe mental disorders in the circumstances of a pandemic [7], to organize basic principles of mental healthcare during the COVID-19 pandemic [8], and to help the general population to reduce stress and cope with related aspects such as confinement and lockdown [9].…”