Tuesday, May 5, 2020

Lessons Learned From Italy: COVID-19 and Mental Health Services

Mental health services in Italy, as in the United States, have undergone significant changes because of the COVID-19 pandemic. In an article in JAMA Psychiatry, leaders from the Departments of Mental Health and Addiction in Lombardy describe several lessons learned during the COVID-19 crisis and unknowns about the long-term mental health of the population.

Italy has a National Mental Health System divided into 134 Departments of Mental Health and Addiction, 27 of which are in Lombardy. While mental health care in Italy is available to all, changes to hospital psychiatric wards, day facilities, outpatient clinics, and home visits due to COVID-19 led to disruptions in care and considerable stress among people with mental illness, wrote Giovanni de Girolamo, M.D., of the IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, and colleagues. To be prepared for future crises, the authors recommended that mental health leaders take the following actions:

Expand e-health technologies: While some Departments of Mental Health and Addiction in Italy were able to rapidly implement e-mental health services in response to COVID-19, others were not, according to the authors. Such services are particularly critical for assisting people supporting patients living alone at home, those suddenly exposed to marked isolation, those living in households with high levels of conflict, and those who have children with attention-deficit/hyperactivity disorder or intellectual disabilities, they wrote.

Strengthen ability to offer the public psychosocial support following disasters: “[I]n Italy, very few if any [Departments of Mental Health and Addiction] are equipped in terms of skills, knowledge, and training to intervene in natural or other disasters,” the authors continued. “While a shortage of information can be detrimental, we have faced an information overload about the epidemic, and the consequences of this must be evaluated, even in terms of secondary traumatization and increase in posttraumatic stress disorder and stress reactions.” Departments of Mental Health and Addiction should be prepared to inform the public about risk, disseminate information about psychological interventions following disaster, and support distressed health care workers and those experiencing bereavement.

Develop plans for rapid reorganizations of inpatient and residential facilities in the event of emergencies: “Patients in these centers may be particularly distressed at the sudden introduction of restrictive measures,” the authors wrote. “Being able to measure [individuals’] stress levels and psychosocial adjustment is essential to both plan for the necessary psychosocial support during the recovery phase and prepare ourselves should this happen again.”

(Image: iStock/franckreporter)

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