COVID-19 challenges call for mental health service reform

Challenges in managing patients hospitalized for major psychiatric disorders during the coronavirus disease 2019 (COVID-19) outbreak have led researchers to call for reform of mental health care in China.

In February 2020, a larger number of COVID-19 cases were reported among inpatients with psychiatric disorders and patients with severe psychiatry disorders in China. While emergency measures had been put in place to manage the potential increase in mental health problems among patients and their close contacts diagnosed with or suspected of having COVID-19, these measures had resulted in increased pressure on the limited inpatient mental health services that were available in China. Authors of a recently published review have therefore suggested a few strategies to ensure adequate mental health service provision in psychiatric hospitals, including reducing outpatient (OP) visits at psychiatric hospitals, tightening admission criteria, shortening length of hospitalization, as well as restricting hospital access for newly admitted patients. [Int J Biol Sci 2020;16:1741-1744]

The risk of spread of COVID-19 infection is higher in psychiatric hospitals than in general hospitals, because of the environmental setting and group activities adopted at psychiatry wards as well as psychiatric inpatients’ disordered mental state, which may render them less capable of practicing infection control measures. Therefore, strategies should be in place to equip hospital staff with an adequate supply of protective equipment and infection control system (eg, setting up of isolation wards and infectious disease alarm and control system), educate staff and all members of the public about infection control (eg, handwashing technique), and ensure regular body temperature monitoring of all staff and patients to limit the spread of the infection in psychiatric hospitals. Measures to limit family members’ visits and avoid group activities during the COVID-19 outbreak are also advocated by the authors.

Although millions of community-dwelling patients with severe psychiatric disorders have benefitted from China’s existing mental health care model, initially developed as part of the national effort to rebuild the mental health system following the 2003 severe acute respiratory syndrome (SARS) outbreak, the authors noted that suspension of public transportation as a result of mass quarantine had led to limitations in access to regular maintenance treatment from hospital OP clinics, which were often located far from patients’ homes. This had resulted in widening treatment gaps among clinically stable patients with major psychiatric disorders living in the communities.

Reform of health insurance service and further development of community mental health care system in China are needed, according to the authors. These include the establishment of community psychiatric outreach service teams, who would attend to clinically stable patients with psychiatric disorders at home, as well as the use of designated vehicles for service delivery, they suggested.