Mental Health and Addiction Response: Supporting Nursing Resilience in a Pandemic.

In their paper, Stelnicki and Carleton (2021) highlight both the findings of their 2019 survey of nurses' mental health (Stelnicki et al. 2020) and more recent literature published during the COVID-19 pandemic. This response outlines the role of nursing leaders in enabling the mental health of nurses in a mental health and addiction setting, particularly during the COVID-19 pandemic.

Effects of COVID-19 on Healthcare Providers: Opportunities for Education and Support (ECHOES).

Healthcare providers (HCPs) working at point of care with patients have experienced health-, home- and work-related stressors from the COVID-19 pandemic. The magnitude and duration of the pandemic pose particular challenges for nursing leadership, and there is little research to guide them during this unprecedented time. This study was designed to explore how the pandemic influences HCP well-being, professional practice, inter-professional collaboration and the education and supports that would assist them during the pandemic recovery period. The article reports on the qualitative portion of a mixed-methods study, which included 56 HCPs who work in a large mental healthcare facility in Ontario. Witnessing the impact of the pandemic restrictions on patients was a significant source of stress for HCPs. HCPs recommended strategies, such as learning new therapeutic modalities and participating in the redesign of health services as key strategies to support them during the pandemic as these would promote patient well-being. Lastly, the pandemic provided opportunities for HCPs to deepen their understanding of other professions. This awareness was viewed as a strength that could support interprofessional collaboration and enhance health services redesign. The findings and recommendations can assist leaders to address the mental health challenges arising from the pandemic.

Virtual family town hall: An innovative multi-family telehealth intervention during COVID-19.

The COVID-19 pandemic has posed unprecedented challenges to the U.S. mental healthcare system. Immediate action has been required to transform existing social work practice models to ensure uninterrupted delivery of essential mental health services. This paper describes how clinicians in a residential program, who offered an in-person multi-family education workshop, rapidly pivoted in the context of the pandemic to develop and implement an alternative and unique multi-family intervention model - a virtual family town hall. This innovative telehealth practice model serves as an exemplar of best practices amidst the COVID-19 pandemic as it prioritized health and safety, increased accessibility, and allowed clinicians to effectively respond to family members' heightened informational needs.

Lessons Learned From a Mental Health Hospital: Managing COVID-19.

Congregate settings such as psychiatric units have an increased risk of disease transmission because of the milieu setting and the inability to isolate patients. Interventions to prevent infection and cross-contamination are discussed including monitoring of patient temperatures, personal protective equipment, remote care, monitoring of human resources, and reinforcement of infection prevention strategies. We discuss the effectiveness of those interventions and the lessons learned, including implications for psychiatric clinical care, during future pandemics or a next wave of COVID-19.

[Responsiveness and sustainability of psychiatric care in France during COVID-19 epidemic]. / Réactivité et pérennité des soins psychiatriques en France à l'épreuve du COVID-19.

OBJECTIVES: The sudden changes of healthcare system due to COVID-19 particularly affect the organization of psychiatry. The objective of this review is to examine the adaptations of psychiatric care in France during this pandemic. METHOD: This narrative review is based on the observation of changes made in French psychiatric hospitals and on an analysis of the literature. RESULTS: Regarding psychiatric hospitalization, the COVID-19 epidemic required rapid measures that profoundly modified the conditions of patients' reception, forcing the medical staffs to adapt their methods of care. The authors noted the creation of at least 89 wards specifically dedicated to patients with COVID-19 needing psychiatric hospitalization, allowing dual care of general medicine and psychiatry. Regarding ambulatory care, maintaining patients with long-term follow-up was a priority. Patients recalling and teleconsultation have been precious resources but cannot entirely replace face-to-face consultations. DISCUSSION: COVID-19 epidemic created unprecedented situation of large-scale upheavals in the healthcare system and in society. Despite the absence of previous recommendations on the subject, French psychiatry has shown great adaptability. Some changes could inspire post-COVID-19 care.

[Evolution of electro-convulsive therapy activity in France since the beginning of the COVID-19 pandemic]. / Évolution de l'activité d'électro-convulsivo-thérapie en France depuis le début de la pandémie COVID-19.

The recent COVID-19 pandemic has led to major organisational changes in health care settings, especially in psychiatric hospitals. We conducted a national online survey to assess the evolution of electroconvulsive therapy (ECT) in the different centres practicing this treatment. 65 responses from all over France were analysed. More than 90 % of the centres practising ECT experienced a decrease in their activity. Half of the centres experienced a total cessation of activity and 25 % of the centres experienced a decrease of more than half of their usual activity. Post-pandemic COVID-19 psychiatric care is expected to be difficult. It is essential not to add to this difficulty the complications, often serious, that will be associated with delaying or stopping the practice of ECT. It will also be necessary to remain vigilant with regard to the specific neuropsychiatric consequences that will follow the pandemic.

[Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review]. / Assurer les soins aux patients souffrant de troubles psychiques en France pendant l'épidémie à SARS-CoV-2.

OBJECTIVE: The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. METHODS: Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. RESULTS: We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.

Transformation and operation of a uniform psychiatric ward dedicated to COVID-19 patients during the pandemic. / Transformacja i zasady dzialania psychiatrycznego oddzialu jednoimiennego w trakcie pandemii COVID-19.

This article aims to describe the experience of transforming the Clinical Department of Adult, Child and Adolescent Psychiatry of the University Hospital in Krakow (CDACAP) into award designated by the Malopolska Voivod to provide the treatment for mentally ill adults from Malopolska Voivodship and adolescents from the south of Poland during the COVID-19 pandemic. We discuss sequent stages of transformation, practical solutions and difficulties encountered in the process. 9 patients with confirmed SARS-CoV-2 infection were hospitalized in the CDACAP between 09.04 and 29.05.2020, and 97 were tended to by consulting psychiatrists in the main building of the University Hospital in Krakow between 23.03 and 23.05.2020. In our experience, the Polish healthcare facilities, especially psychiatric and long-term care ones, were ill-equipped to operate during the pandemic crisis. This situation has brought out the nationwide lack of systemic solutions, particularly in the areas of child and adolescent psychiatry as well as forensic psychiatry. Functioning during the epidemic and confronting the risk of rapid deterioration in patients'condition clearly pointed out the necessity of creating psychiatric wards within the multispecialty hospitals. The requirement for ensuring separate spaces for patients with SARS-CoV-2 infection or with exclusion thereof should be considered in the psychiatric reform which assumes the regional responsibility of stationary wards.

Staying Connected: Reaching Out to Psychiatric Patients During the Covid-19 Lockdown Using an Online Blog.

Health systems worldwide are challenged by the coronavirus pandemic and all medical specialties have struggle to meet the conflicting requirements for virus containment on the one hand and treatment of other medical conditions on the other. This holds true also for psychiatry. Per se, psychiatric patients are highly vulnerable to suffer from social isolation and loneliness. As a result of the Covid-19 pandemic and lockdown measures, unfortunately, this vulnerability is even further increased. As a part of its pandemic risk management, the outpatient clinic of the Psychiatric District Hospital Regensburg launched an online blog as a means of assisting patients who were required to stay home. Aim of the blog was to stay by patients' side in those uncertain times by offering an online connection to their therapists, by providing important information about the pandemic situation, by offering some ideas on how to build a daily routine and how to meaningfully spend their time at home during the lockdown. We also aimed at involving patients as experts in their own affairs by inviting them to contribute to the blog's shape and content. As a result of coordinated team effort, it was possible to launch a blog within few days, and this was perceived helpful by many patients. Overall, however, patient involvement turned out to be a challenge requiring more attention in future work.

Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review.

OBJECTIVE: The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. METHODS: The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. RESULTS: We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units". These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.

The enclosed ward management strategies in psychiatric hospitals during COVID-19 outbreak.

During the COVID-19 pandemic, as a large city located in Southwest China, Chengdu was mainly affected by imported cases. For a psychiatric hospital, the enclosed management model, the crowded wards and the uncooperative patients are the risk factors of nosocomial infection. Admitting new patients while preventing the COVID-19 outbreak within the institutions was a crucial challenge. The Mental Health Centre of Chengdu proposed a series of effective management strategies to deal with the rapidly evolving situation during the COVID-19 pandemic which included regulation for the inpatients, their families and staff, and achieved Zero infection in our hospital.

Management of COVID-19 Response in a Secure Forensic Mental Health Setting: Réponse à la gestion de la COVID-19 dans un établissement sécurisé de santé mentale et de psychiatrie légale.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic presents major challenges to places of detention, including secure forensic hospitals. International guidance presents a range of approaches to assist in decreasing the risk of COVID-19 outbreaks as well as responses to manage outbreaks of infection should they occur. METHODS: We conducted a literature search on pandemic or outbreak management in forensic mental health settings, including gray literature sources, from 2000 to April 2020. We describe the evolution of a COVID-19 outbreak in our own facility, and the design, and staffing of a forensic isolation unit. RESULTS: We found a range of useful guidance but no published experience of implementing these approaches. We experienced outbreaks of COVID-19 on two secure forensic units with 13 patients and 10 staff becoming positive. One patient died. The outbreaks lasted for 41 days on each unit from declaration to resolution. We describe the approaches taken to reduction of infection risk, social distancing and changes to the care delivery model. CONCLUSIONS: Forensic secure settings present major challenges as some proposals for pandemic management such as decarceration or early release are not possible, and facilities may present challenges to achieve sustained social distancing. Assertive testing, cohorting, and isolation units are appropriate responses to these challenges.

Opening up while locking down: how an Irish independent sector mental health service is responding to the COVID-19 crisis.

The COVID-19 pandemic poses a particular set of challenges for health services. Some of these are common across all services (e.g. strategies to minimise infections; timely testing for patients and staff; and sourcing appropriate personal protective equipment (PPE)) and some are specific to mental health services (e.g. how to access general medical services quickly; how to safely deliver a service that traditionally depends on intensive face to face contact; how to isolate someone who does not wish to do so; and how to source sufficient PPE in the face of competing demands for such equipment). This paper describes how St Patrick's Mental Health Services (SPMHS) chose to address this unfolding and ever-changing crisis, how it developed its strategy early based on a clear set of objectives and how it adapted (and continues to adapt) to the constantly evolving COVID-19 landscape.