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For psychiatric inpatient facilities, the coronavirus (COVID-19) pandemic presents unique challenges related to space constraints, close contact between staff and patients, and structural barriers in care delivery, according to an article in press in Psychiatric Services.
“Beyond the direct challenges in physical space and exposure risks to staff and patients, there are additional indirect challenges that can impact services delivery in inpatient psychiatric settings during a pandemic,” wrote Luming Li, M.D., of the Yale School of Medicine.
Li outlined five strategies for responding to COVID-19 in inpatient psychiatric facilities:
Manage COVID-19 precautions: Inpatient psychiatric facilities should consider screening patients for respiratory symptoms and fever prior to admission, as well as throughout the patient’s hospitalization. Staff should use personal protective equipment (PPE) when patients develop fever and respiratory symptoms, and surfaces should be cleaned and disinfected often, especially those that are frequently used.
Restrict visitors and minimize nonessential contacts: To protect essential staff and patients from potential COVID-19 exposure, inpatient psychiatric facilities should restrict visitations by family members, nonessential employees, and trainees. Preventing visitors, however, may impact patients’ treatment course, affect how patients reconnect with family members, and cause significant anxiety for family members.
Develop contingency staff plan: Li noted that a national shortage of psychiatrists will likely worsen during the COVID-19 pandemic, as they are exposed and become ill. Li encouraged administrators and clinical leaders to consider back-up plans for staffing. These plans might include reducing team sizes so that an alternate team is available should frontline workers be unable to continue to provide care and incorporating telepsychiatry to deliver services to minimize staff exposure.
Plan for patients suspected of COVID-19: Patients who develop symptoms of COVID-19 should immediately be given a mask and gown and isolated to minimize spread. Due to the difficulty of isolating patients on psychiatric units, which often have open layouts, steps should be taken to transfer patients to inpatient medicine for COVID-19 testing. Patients who develop COVID-19 symptoms should be monitored closely for worsening of psychiatric symptoms and the emergence of new psychiatric symptoms.
Modify group therapy: Though group therapy can be an important aspect of treatment, facilities may need to change the way group meetings take place, including limiting the number of individuals who can participate at one time and enhancing social distancing.
“With increasing volumes of individuals seeking care, it is important to strategically plan and advocate for services and resources to support high-quality, safe psychiatric care delivery,” she advised. “Otherwise, psychiatric patients will be vulnerable … not only from their mental illness but also from the repercussions of COVID-19.”
This Open Forum article is in press at Psychiatric Services and can be cited as follows: Li L: Challenges and priorities in responding to COVID-19 in inpatient psychiatry. Psychiatric Services.
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