The Impact of the COVID-19 Pandemic on the Management of Mental Health Services for Hospitalized Patients in Sibiu County-Central Region, Romania.

INTRODUCTION: The COVID-19 pandemic brought a burden and represented a challenge for the Romanian medical system. This study explored the consequences that COVID epidemiological measures had on the quality of the mental health care provided to hospitalized patients in a regional psychiatric hospital in Romania. MATERIALS AND METHODS: Both patient-level and hospital-level indicators were considered for this comparative retrospective study. On the one hand, we extracted patient-level indicators, such as sociodemographics, diagnosis, admission, and discharge dates for 7026 hospitalized patients (3701 women, average age = 55.14) from hospital records. On the other hand, for the hospital-level indicators, we included indicators referring to the aggregated concept of mental health services, such as case mix index, length of stay, bed occupancy rate and patients' degree of satisfaction. Data extracted covered a period of two years (1 March 2019-28 February 2021) before and during the first year of the COVID-19 pandemic. RESULTS: We found that, compared to the pre-pandemic period, the pandemic period was marked by a drastic decrease in hospitalized patient admissions, coupled with an increase in emergency-based admissions. Other management indicators, such as the case mix index, the number of cases contracted/performed, and the degree of patient satisfaction, decreased. In contrast, the average length of stay and bed occupancy rate increased. CONCLUSIONS: The COVID-19 pandemic, especially in the first year, raised multiple difficult issues for the management of psychiatric hospitals. It imposed an application of strict measures designed to face these new and unprecedented challenges. Our findings offer a detailed snapshot of the first year of the COVID-19 pandemic in terms of its impact on mental health services and suggest some future directions. Implications for hospital management are discussed.

Connection of Suicidal Behavior with COVID-19: Clinical Cases

The spread of the coronavirus infection has led to significant changes in people's lives. Prolonged isolation, fear of infection, frustration, changing the usual stereotype life style, lack of information, loss of revenues, and fear of stigmatization, as well as the disease itself have all influenced people's emotional and physical well-being. The impact of the viral infection itself on the human body, as well as the perception of a new reality, in some cases led to the formation of reactive, organic, or the exacerbation of existing chronic mental disorders. People with mental health problems are most susceptible to environmental influences and react acutely to rapidly changing circumstances. Often in critical situations, in a state of despair, patients see only one way to solve all problems — voluntary retirement committing taking own life. In this article, we present clinical cases that are descriptive in nature and are intended to illustrate the connection between depressive experiences and suicidal behavior amongst patients in a crisis situation when external circumstances were the reason for suicide attempts: loneliness as a result of restrictive measures, fear of infection or the disease itself, and the reason was a mental disorder that debuted earlier or re–emerged as a result of a viral infection. We have presented three clinical cases. All patients suffered from a new coronavirus infection of various severities and were treated in a psychiatric hospital, where they were transferred from an infectious diseases hospital or hospitalized directly in connection with suicidal actions. In each case, attention was paid to the organizational measures carried out, with an emphasis on the need for earlier screening of mental disorders, prevention of suicidal behavior in providing assistance to this contingent, and the development of the interaction between general medical and psychiatric services by the type of integrative care. The study is of interest to a wide range of specialists providing care to patients with COVID-19 or similar pathologies. © 2022, Eco-Vector LLC. All rights reserved.

Increased anxiety and stress-related visits to the Shanghai psychiatric emergency department during the COVID-19 pandemic in 2020 compared to 2018-2019.

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a significant and far-reaching impact on mental health. The psychiatric emergency department (PED) is pivotal in the management of acute and severe mental illnesses, especially anxiety-and stress-related disorders. Aims: This study aimed to evaluate whether changes in the frequency or patients' demographics of visiting the PED occurred during the COVID-19 pandemic among individuals with anxiety and stress-related disorders. Methods: This cross-sectional study used data on PED visit counts from the largest psychiatric hospital in China between 2018 and 2020 (before and during the COVID-19 pandemic). Data from 2020, representing the COVID-19 pandemic period, were extracted from electronic medical records and compared using descriptive statistics for the same periods in 2018 and 2019. Results: The number of PED visits related to anxiety and stress disorders per year increased from 83 in 2018 to 136 (63.9% increase) in 2019 and 239 (188.0% increase) in 2020. Compared to that in 2018 and 2019, the proportion of PED visits in 2020 among patients with anxiety and stress disorders increased significantly. Patients with anxiety-and stress-related disorders during PED visits in 2020 were younger than those in 2018 and 2019 (three-year groups: F = 9.124, df = 2, p < 0.001). Conclusion: Despite the epidemic-policy barriers against PED visits, PED care seeking has increased, thereby underscoring the need for crisis prevention services for patients with stress and anxiety disorders.

Application of "Internet +" pharmaceutical consultation services in psychiatric hospital during the epidemic.

This study explored the application value of "Internet +" pharmacy service on psychiatric hospital during the COVID-19 epidemic. During the epidemic, as of December 31, 2020, the number of online pharmacist consultations increased to 149 cases (82.78 %). At the same time, patients had various types of consultation questions, mainly involving adverse drug reactions, drug selection, usage and dosage, persistence of long-term medication, drug distribution, etc. Due to the particularity of psychiatric hospital, pharmaceutical consultation services mainly focus on nervous system drugs. The results indicated that the demand for "Internet +" pharmaceutical consultation services has increased significantly during the COVID-19 epidemic.

Building and Landing the Plane While Flying: How New York State Addressed the Needs of People With Serious Mental Illness During the COVID-19 Pandemic.

New York State was the epicenter for COVID-19 in Spring 2020 when little was known about the pandemic. Dire circumstances necessitated New York State's (NYS) public mental health system to rapidly pivot, adapt, and innovate its policies and procedures to ensure continuous high-level care to individuals with serious mental illness (SMI), a population especially vulnerable to both the physical and psychosocial sequelae of COVID-19. NYS rapidly adopted emergency measures to support community providers, expanded the capacity of its State-Operated facilities, created policies to promote improved infection control access, collaborated to enhance the public-private continuum of service to support people with SMI, and broadened the use of new technologies to ensure continued engagement of care.

Difficulties of healthcare workers encountered under cohort isolation in a psychiatric hospital during the COVID-19 pandemic: A qualitative study.

This study examined the experiences of healthcare workers who were quarantined within the psychiatric wards due to COVID-19 and analyzed those experiences with a consensual qualitative research method. Participants experienced (a) difficulties due to the specificity of a mental hospital, including a lack of protocols, noncompliance with quarantine guidelines among patients with severe mental illness, and a shortage of institutions capable of containing confirmed COVID-19 patients with severe mental illness. Furthermore, (b) difficulties related to isolation of the cohort itself included a workforce shortage, physical problems, fear of infection, limited facilities, guilt toward newly confirmed cases, exhaustion, and distress caused by separation from family. The participants also described (c) difficulties related to external factors, including administrative orders and the perceived stigma, and (d) positive experiences. Appropriate support is needed during the COVID-19 pandemic to reduce the difficulties among healthcare workers in psychiatric hospitals. This includes preparation for future scenarios, facilities, and workers in response to outbreaks of infection in psychiatric hospitals that cause unique risks and challenges among those workers.

Recognition and Treatment Challenges of Acute Clozapine Withdrawal Syndrome: A Case Report.

The limited psychiatric bedspace due to the COVID-19 pandemic and the lack of access to an up-to-date medication regimen delayed the recognition of the diagnosis and treatment for a 40-year-old man with schizoaffective disorder, bipolar type, who traveled from his home city and abruptly discontinued his prescription of clozapine. He developed a cholinergic rebound syndrome including delirium and extrapyramidal symptoms (EPS). The delay included time spent in two different medical hospitals: one awaiting psychiatric bedspace, and secondly, when the patient's cholinergic rebound syndrome was misdiagnosed as acute alcohol withdrawal. Once the etiology was recognized, he was promptly treated with anticholinergic medication (benztropine) and retitrated to his outpatient dose of clozapine leading to the resolution of symptoms including delirium and EPS. This case will discuss the challenges of continuity of care in delirious, psychotic, or otherwise confused patients, including contributions from the COVID-19 pandemic. A medication card or other improvements in medication databases that may reduce delays in treatment are discussed.

Practical guidelines for management of patients with suspected or confirmed COVID-19 hospitalized in a child and adolescent psychiatric ward. / Wytyczne postepowania z pacjentami hospitalizowanymi w oddziale psychiatrii dla dzieci i mlodziezy z podejrzeniem zachorowania lub z potwierdzonym zachorowaniem na COVID-19.

The novel coronavirus disease (COVID-19) epidemic - in addition to its many widely described negative consequences - has created achallenge for the mental health care system in every country, including Poland to safely manage psychiatric disorders in addition to preventing and treating COVID-19. In Poland, online mental health services are provided for the outpatients. Still there are patients with severe psychiatric disorders who have suspected or confirmed COVID-19 and need to be treated in a psychiatric hospital. The Department of Child and Adolescent Psychiatry of the Medical University of Warsaw was appointed by local authorities to hospitalize childrenwith mental disorders and with confirmed or suspected COVID-19. This created an urgent need to adapt our department for treating COVID-19 infected patients. As far as we know no guidelines for psychiatric hospitals management during the COVID-19 pandemic are available in English. In this manuscript, we present our guidelines regarding safe management of patients with suspected or confirmed COVID-19 in the Department of Child and Adolescent Psychiatry of the Medical University of Warsaw.

The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time-series analysis.

AIMS: The coronavirus disease 2019 (COVID-19) pandemic and ensuing restrictions have negatively affected the mental health and well-being of the general population, and there is increasing evidence suggesting that lockdowns have led to a disruption of health services. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic, entailing the suspension of all non-essential activities and a complete ban of tobacco and alcohol sales. We studied the effect of the lockdown on mental health care utilisation rates in private-sector care in South Africa. METHODS: We conducted an interrupted time-series analysis using insurance claims from 1 January 2017 to 1 June 2020 of beneficiaries 18 years or older from a large private sector medical insurance scheme. We calculated weekly outpatient consultation and hospital admission rates for organic mental disorders, substance use disorders, serious mental disorders, depression, anxiety, other mental disorders, any mental disorder and alcohol withdrawal syndrome. We calculated adjusted odds ratios (OR) for the effect of the lockdown on weekly outpatient consultation and hospital admission rates and the weekly change in rates during the lockdown until 1 June 2020. RESULTS: 710 367 persons were followed up for a median of 153 weeks. Hospital admission rates (OR 0.38; 95% confidence interval (CI) 0.33-0.44) and outpatient consultation rates (OR 0.74; 95% CI 0.63-0.87) for any mental disorder decreased substantially after the introduction of the lockdown and did not recover to pre-lockdown levels by 1 June 2020. Health care utilisation rates for alcohol withdrawal syndrome doubled after the introduction of the lockdown, but the statistical uncertainty around the estimates was large (OR 2.24; 95% CI 0.69-7.24). CONCLUSIONS: Mental health care utilisation rates for inpatient and outpatient services decreased substantially after the introduction of the lockdown. Hospital admissions and outpatient consultations for alcohol withdrawal syndrome increased after the introduction of the lockdown, but statistical uncertainty precludes strong conclusions about a potential unintended effect of the alcohol sales ban. Governments should integrate strategies for ensuring access and continuity of essential mental health services during lockdowns in pandemic preparedness planning.

Strategies for COVID-19 transmission control and mitigation in a psychiatric hospital in Mexico.

In the context of the emerging COVID-19 pandemic, one of the great challenges is to generate effective strategies for the control of nosocomial infections, specifically in psychiatric hospitals with populations considered at risk (older adults or individuals with comorbidities). This article describes the strategies for prevention, containment and treatment of infection transmission implemented during a COVID-19 outbreak that occurred in July 2020 in a psychiatric hospital of the State of Mexico. The population was comprised by women with prolonged hospital stay (mean = 24 years), mostly geriatric (mean = 64 years), with various psychiatric disorders and comorbidities. In total, 19 COVID-19-positive cases were diagnosed, out of which thirteen had mild symptoms and six were asymptomatic. There were no alterations in mental state, psychiatric symptoms or underlying diseases. Algorithms were developed for the management and treatment of suspected/confirmed COVID-19 cases. Finally, the generation of comprehensive strategies, quick and timely actions, as well as adequate management of human resources favoring interdisciplinary work, were deemed to have contributed to contain and mitigate the COVID-19 outbreak, which constitutes a precedent in the psychiatric field with institutionalized patients.

En el contexto de la emergente pandemia de COVID-19, uno de los grandes desafíos es generar estrategias eficaces de control de infecciones nosocomiales, específicamente en hospitales psiquiátricos con población considerada de riesgo (adultos mayores o con comorbilidades). En el presente artículo se describen las estrategias de prevención, contención y tratamiento de contagio, a partir de un brote de COVID-19 ocurrido en julio de 2020 en un hospital psiquiátrico del Estado de México. La población estuvo constituida por mujeres con estancia hospitalaria prolongada (media = 24 años), en su mayoría geriátricas (media = 64 años), con trastornos psiquiátricos diversos y comorbilidades. En total se diagnosticaron 19 casos positivos de COVID-19, de los cuales 13 cursaron con sintomatología leve y seis resultaron asintomáticos. No se presentaron alteraciones en el estado mental, en la sintomatología psiquiátrica ni en las enfermedades de base. Se realizaron algoritmos para el manejo y tratamiento de los casos sospechosos o confirmados de COVID-19. Finalmente, se consideró que la generación de estrategias integrales, acciones rápidas y oportunas, así como una adecuada gestión de recursos humanos favorecedora del trabajo interdisciplinario contribuyeron a contener y mitigar el brote de COVID-19, constituyéndose en un precedente en el ámbito psiquiátrico con pacientes institucionalizadas.

The psychological impact of lockdown on psychiatric hospital staff

The Covid-19 pandemic could lead in the long run to depressive disorders, anxiety, or at-risk consumption among health professionals, even those working outside of specialized Covid-19 units. We assessed the experience of 197 staff members in a psychiatric hospital during the first lockdown. The data suggest anxious and depressive symptoms for a significant part of the hospital staff during the lockdown. Women, nurses and assistant nurses, and staff who were off work tended to have higher anxiety and depression scores. A lack of information about the health situation was a significant risk factor for depression and anxiety. Our study points to exhaustion among health professionals during the first wave of the pandemic, even those working outside of specialized Covid-19 units. At-risk healthcare workers need close monitoring during and at the end of the pandemic, in order to prevent anxious, depressive, or post-traumatic stress disorder symptoms, and early treatment should be provided if necessary. All hospital staff seem to require clear and accurate information throughout the health crisis, in order to reduce the risk of psychological distress. © 2021 John Libbey Eurotext. All rights reserved. La crise sanitaire liée à la Covid-19 pourrait entraîner chez les professionnels de santé une détresse émotionnelle et des troubles anxiodépressifs, et cela même en dehors des unités de soins prenant en charge la Covid-19. Nous avons évalué 197 membres du personnel d’un hôpital psychiatrique au moyen d’une enquête en ligne, durant le premier confinement de la pandémie de Covid-19. Les femmes, les infirmiers et aides-soignants et les personnes en arrêt de travail présentaient davantage de manifestations anxiodépressives. Par ailleurs, le manque d’information sur la situation sanitaire était un facteur de risque de dépression et d’anxiété. Les facteurs de risques identifiés suggèrent la nécessité de prendre en charge précocement les personnes à risque et d’assurer un suivi rapproché et une information du personnel soignant afin de prévenir les troubles anxiodépressifs. © 2021 John Libbey Eurotext. All rights reserved.

Youth transitioning from inpatient psychiatric care: Ecological perspectives on reintegration and discharge planning

This qualitative case study was developed to provide a better understanding of facilitated coordinated procedures and collaborations, during and after discharge, among all members of a youth's environment that may potentially decrease or eliminate rehospitalization and promote successful long-term outcomes. Mental illness does not affect only the youth or person afflicted;mental illness seeps into every environment where youth grow and develop (Gathright, et. al, 2016;Hall & Dubois, 2020;Hoagwood et al., 2007, James et. al, 2010).The key theoretical framework utilized within this study is attributed to Urie Bronfenbrenner's ecological and bioecological theory of human development (Bronfenbrenner, 1974, 1977, 1979). Additionally, this study also incorporated research from Epstein (1995) and Epstein et al.'s (2002) research.This qualitative study utilized a multiple-case design (Stake, 2006;Yin, 2014). The required amount of six participants were recruited, three from each separate case. One caregiver, one school representative, and one community agency representative were identified for two separate youth cases discharged from two separate inpatient psychiatric hospitals in Pennsylvania. For this study, the researcher developed structured and semi-structured interview questions that varied in length by the role of the participant. As a result of the COVID-19 pandemic, the study site was established virtually through the HIPAA-compliant platform GoToMeeting. After the data had been collected, it was organized, reviewed, coded, and analyzed according to procedures recommended by Creswell (2014) and Tesch (1990).Findings indicate that participants of this current study understood the significance of their roles within this discharge planning process, but also shared their perspectives and experiences of the challenges and barriers they encounter that inhibit this process. These participants not only realized the challenges but also had a common premise for making the collaborative process better. Recommendations for current and future key members were provided along with ideas for future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

An Outbreak of Breakthrough Infections by the SARS-CoV-2 Delta Variant in a Psychiatric Closed Ward.

BACKGROUND: A rapid decline in immunity and low neutralizing activity against the delta variant in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinees has been observed. This study describes an outbreak of coronavirus disease 2019 (COVID-19) breakthrough infections caused by the SARS-CoV-2 delta variant in a psychiatric closed ward. METHODS: Data from epidemic intelligence service officers were utilized to obtain information regarding demographic, vaccination history, and clinical data along with SARS-CoV-2 PCR test results for a COVID-19 outbreak that occurred in a closed psychiatric ward. RESULTS: Among the 164 residents, 144 (87.8%) received two doses of vaccines and 137 (95.1%) of them received ChAdOx1 nCoV-19 vaccine. The mean interval between the second vaccination and COVID-19 diagnosis was 132.77 ± 40.68 days. At the time of detection of the index case, SARS-CoV-2 had spread throughout the ward, infecting 162 of 164 residents. The case-fatality ratio was lower than that in the previously reported outbreak before the vaccination (1.2%, 2/162 vs. 6.9%, P = 0.030). Prolonged hospitalization occurred in 17 patients (11.1%) and was less prevalent in the vaccinated group than in the unvaccinated group (8.5% vs. 25.0%, P = 0.040). CONCLUSION: The findings of this study highlight that while vaccination can reduce mortality and the duration of hospitalization, it is not sufficient to prevent an outbreak of the SARS-CoV-2 delta variant in the present psychiatric hospital setting.

Characteristics of patients in inpatient psychiatry during the COVID-19 pandemic.

To date, there have been limited publications examining the characteristics of psychiatric patients with COVID-19 in an inpatient setting. In this retrospective cohort review, we attempted to categorize the differences between patients admitted to the COVID unit versus the non-COVID unit using data from a community hospital located on Long Island, NY. We found that patients admitted to the COVID-19 unit had on average longer lengths of stay, were more likely to belong to non-white racial groups, and were less likely to be smokers.

Strategies for COVID-19 transmission control and mitigation in a psychiatric hospital in Mexico

In the context of the emerging COVID-19 pandemic, one of the great challenges is to generate effective strategies for the control of nosocomial infections, specifically in psychiatric hospitals with populations considered at risk (older adults or individuals with comorbidities). This article describes the strategies for prevention, containment and treatment of infection transmission implemented during a COVID-19 outbreak that occurred in July 2020 in a psychiatric hospital of the State of Mexico. The population was comprised by women with prolonged hospital stay (mean = 24 years), mostly geriatric (mean = 64 years), with various psychiatric disorders and comorbidities. In total, 19 COVID-19-positive cases were diagnosed, out of which thirteen had mild symptoms and six were asymptomatic. There were no alterations in mental state, psychiatric symptoms or underlying diseases. Algorithms were developed for the management and treatment of suspected/confirmed COVID-19 cases. Finally, the generation of comprehensive strategies, quick and timely actions, as well as adequate management of human resources favoring interdisciplinary work, were deemed to have contributed to contain and mitigate the COVID-19 outbreak, which constitutes a precedent in the psychiatric field with institutionalized patients.

High Concentration and Frequent Application of Disinfection Increase the Detection of Methicillin-Resistant Staphylococcus aureus Infections in Psychiatric Hospitals During the COVID-19 Pandemic.

The tolerance of certain multi-drug resistant bacteria to disinfectants may be promoted while the requirements of environmental disinfection have been raised in the high-risk areas of medical institutions during the COVID-19 pandemic. The current research addressed the mechanisms underlying a sharp increase in the detection of methicillin-resistant Staphylococcus aureus (MRSA) observed in a closed-management unit of elderly patients with mental disorders in 2020 as compared with the previous 4 years. We first conducted microbial detection in staff-hand and environment and a molecular epidemiology analysis, rejecting the hypothesis that the MRSA increase was due to an outbreak. Afterward, we turned to disinfectant concentration and frequency of use and analyzed the varied MRSA detection rates with different concentrations and frequencies of disinfection in 2020 and the previous 4 years. The MRSA detection rate increased with elevated concentration and frequency of disinfection, with 1,000 or 500 mg/L two times per day since January in 2020 vs. 500 mg/L 2-3 times per week in 2016-2019. When the disinfectant concentration was reduced from 1,000 to 500 mg/L, the MRSA detection decreased which indicated a modulatory role of disinfectant concentration. With a sustained frequency of disinfection in 2020, the MRSA detection rate was still higher, even after May, than that in the previous years. This suggested that the frequency of disinfection also contributed to the MRSA increase. Overall, the MRSA detection was augmented with the increase in disinfection concentration and frequency during the COVID-19 epidemic, suggesting that highly-concentrated and highly-frequent preventive long-term disinfection is not recommended without risk assessments in psychiatric hospitals.

Adoption of measures by psychiatric hospitals to prevent SARS-CoV-2.

This article analyzes the scientific evidence on the measures adopted by psychiatric hospitals to prevent COVID-19 contamination among hospitalized people. It refers to a literature review in the MEDLINE/PUBMED, Web of Science, and EMBASE databases. There was the incorporation of studies describing measures used to prevent the spread of COVID-19 among patients admitted to psychiatric institutions. The research articles that evaluated patients in partial follow-up at health facilities were excluded. Between 13 selected studies, two thematic categories were established: Measures adopted to reduce the transmission of COVID-19 in the admission of psychiatric patients; Measures adopted to reduce the transmission of COVID-19 during hospitalization of psychiatric patients. There are similarities and differences in the measures adopted by psychiatric hospitals. It was noted that admission and isolation policy for 14 days was a consensus. However, the testing method for screening Sars-CoV-2 differs between the realities. Concerning hospitalization, there is a similarity in the use of technologies in the care of psychiatric patients. In contrast, there is no standardization in the measures taken since, due to their structure; psychiatric hospitals have restrictions on the adoption of distance rules.

Cet article analyse les preuves scientifiques sur les mesures adoptées par les hôpitaux psychiatriques pour prévenir la contamination au COVID-19 chez les personnes hospitalisées. Il fait référence à une revue de la littérature dans les bases de données MEDLINE/PUBMED, Web of Science et EMBASE. Il y a eu l'incorporation d'études décrivant les mesures utilisées pour empêcher la propagation du COVID-19 parmi les patients admis dans des établissements psychiatriques. Les articles de recherche évaluant les patients lors d'un suivi partiel dans les établissements de santé ont été exclus. Entre 13 études sélectionnées, deux catégories thématiques ont été établies : les mesures adoptées pour réduire la transmission du COVID-19 lors de l'admission de patients psychiatriques ; mesures adoptées pour réduire la transmission du COVID-19 lors de l'hospitalisation des patients psychiatriques. Il existe des similitudes et des différences dans les mesures adoptées par les hôpitaux psychiatriques. Il a été noté que la politique d'admission et d'isolement pendant 14 jours faisait l'objet d'un consensus. Cependant, la méthode de test pour le dépistage du Sars-CoV-2 diffère selon les réalités. Concernant l'hospitalisation, il existe une similitude dans l'utilisation des technologies dans la prise en charge des patients psychiatriques. En revanche, il n'y a pas de standardisation dans les mesures prises car, en raison de leur structure, les hôpitaux psychiatriques ont des restrictions sur l'adoption de règles de distance.

Admission of a minor to a psychiatric hospital under Polish law. Part I. / Przyjecie maloletniego do szpitala psychiatrycznego w mysl polskiego prawa. Czesc I.

Within the scope of mental health protection, numerous practical problems arise concerning the issue of providing health services to a minor. Admission of a minor to a psychiatric hospital is associated in practice with numerous doubts. This part of the article describes the conditions of admission to hospital with the consent of the patient. It distinguishes and accurately describes situations where a minor is under or over 16 years of age. In addition, it explains situations where there is a contradiction of declarations of will by legal guardians in relation to admission, their inability to perform legal acts, or a contradiction of the statements of the minor and guardian. It also addresses the aspect of receiving written consent during the COVID-19 epidemic.

Challenge and strategies of infection control in psychiatric hospitals during biological disasters-From SARS to COVID-19 in Taiwan.

Psychiatric hospitals play an important role in supporting patients with mental illness to relieve symptoms and improve functioning in a physically and psychologically safe environment. However, these hospitals are also vulnerable to emerging infectious diseases. In early 2020, a psychiatric hospital and a psychiatric unit were reported to have nosocomial coronavirus disease 2019 (COVID-19) infection. A large number of patients and staff were severely impacted. This type of nosocomial infection threatens patient safety and quality of care. By learning from previous experiences of severe acute respiratory syndrome (SARS) and previous studies, psychiatric hospitals can provide safeguards to prevent nosocomial infection among patients and staff during an epidemic or biological disaster. These strategies include a series of actions such as following national guidelines for infection control, reserving adequate support for disinfection equipment, providing relevant and sufficient pro-service and in-service education and training, establishing regular surveillance of hand hygiene habits, proper communication and health education, and providing opportunities for vaccination if possible. Based on the harm reduction concept, staff division of office breaks and ward classification and shunting are recommended and should be further implemented.