Supporting mental health in a time of crisis

The COVID-19 pandemic is having a major impact on our lives. A recent survey in the UK shows 79% of people feel their quality of life has reduced due to COVID-19 and that on average, the UK population is suffering with high levels of psychological stress.¹

Furthermore, a survey of 1210 Chinese citizens from 194 cities conducted in January 2020, showed that 16.5% were experiencing moderate to severe symptoms of depression, and 28.8% symptoms of moderate to severe anxiety.²

Given such data, psychiatrists are almost as much key workers as the physicians who are dealing at a population level with the physical consequences of COVID-19 infection. Psychiatrists also have a more specific role – that of supporting their existing patients who are particularly susceptible to depression and anxiety.

The pandemic’s short and long-term effects on mental health will be profound

Patients are especially vulnerable

People with mental health problems are a large and vulnerable section of society. This vulnerability arises from a number of factors.³

The risk of infection is high for people living in institutions. More generally, the chance of complications is increased by comorbidities, stigma and barriers to quickly accessing healthcare.³ There may also be individual factors such as cognitive impairment, reduced awareness of risk and the need for personal protection.³

A recent position paper published in the Lancet emphasises the need for vulnerable groups, as well as front line medical staff, to be a priority for mental health support. They urge for action now to limit the impact the pandemic has long-term on mental health and wellbeing. Immediate priorities are to monitor and report rates of anxiety, depression, self-harm and suicide along with other mental health issues to inform interventions.⁴  

Healthcare professionals faced with life or death decisions

In terms of preventing distress, Wang et al² noted from their survey that the adverse impact of the pandemic was felt less severely by people who had up-to-date and accurate health information and by those who had adopted precautions such as handwashing and wearing masks.

Unparalleled challenge to the wellbeing of HCPs

Given the correct equipment, healthcare professionals working with the critically ill can be protected against infection. But the psychological consequences of having to make daily life and death decisions are more difficult to deal with. The rationing of ventilators is described in the New England Journal as “the toughest triage” doctors are ever likely to face.⁵ When such decisions violate a physician’s moral or ethical code, the “moral injury” can be profound.⁶

Suggestions for how the mental health consequences can be mitigated include preparing staff honestly for decisions they will have to make, providing forums in which the emotional challenges can safely be discussed, and supportive supervision.⁶