Locked out during COVID-19 lockdown—an online survey of relatives of people with psychotic and bipolar disorders in Norway

The TIPS family psychoeducational group work approach in first episode psychosis and related disorders: 25 years of experiences

AIM

The aim of this paper is to present 25 years of clinical experience with family psychoeducation (FPE) work at Stavanger University Hospital in Norway, highlighting the lessons learned in overcoming implementation barriers in publicly funded specialized mental health care.

METHODS

This retrospective analysis reviews the integration and sustainability of FPE work within the hospital's standard treatment protocols for psychosis, tracing its origins from the Early Treatment and Intervention in Psychosis (TIPS) study (1997-2000) to its current application. The paper examines key strategies for successful implementation, including staff training and resource allocation, as emphasized by international research.

RESULTS

Stavanger University Hospital has successfully implemented and maintained both multi- and single-family FPE approaches over the past 25 years. Initially part of the TIPS study, FPE has been integrated into routine clinical practice for treating psychosis and has recently been extended to families of patients with other severe mental disorders. The sustained success at Stavanger University Hospital is attributed to consistent staff training and the prioritization of sufficient resource allocation.

DISCUSSION

The successful and sustainable integration of FPE at Stavanger University Hospital is relatively unique. International guidelines recommend FPE for psychosis, but its implementation remains inconsistent globally, despite over 50 years of supporting evidence. The hospital's experience underscores the critical role of continuous training and dedicated resources in embedding FPE into regular clinical practice. These findings suggest that addressing these areas can significantly enhance the uptake of FPE in other clinical settings.

CONCLUSION

The 25-year experience at Stavanger University Hospital demonstrates that with appropriate training and resources, FPE can be successfully integrated and sustained within standard mental health care practices. This case study provides valuable insights for other institutions aiming to implement FPE and improve treatment outcomes for patients with severe mental disorders.

Knowledge Families Hold: Co-Production and Co-Research With Mental Health Family Carers in Understanding Experiences During the COVID-19 Pandemic

BACKGROUND

Through an in-depth exploration of mental health family carers' experiences during the COVID-19 pandemic in Australia, this co-produced study identified recommendations for advocacy, practice and policy implications to uphold family carer wellbeing. Government-enforced restrictions, changed service availability and difficulties accessing hospitals, led to additional anxiety, depression and elevated distress, especially for people experiencing mental health challenges before the pandemic. The National Mental Health Consumer and Carer Forum alongside two academic researchers aimed to discern the impact of care provision, levels of distress, unmet needs, challenges and benefits of providing support, across geographic locations and diverse communities.

METHODS

This article reports on the survey component of a co-designed mixed-methods exploratory study of family carer experiences. A project steering group worked with two academic researchers, members of SWITCH Research Group, Monash University, to develop the 71-question online survey across 9-domains.

RESULTS

Family carers were relied upon to provide support and care when mental health services changed or closed. Carers support more than one person and typically people with daily and high-level needs. Caring levels increased from 26-h to an average of 40-h a week of support provision, with changed roles and increased complexity. Heightened demands became stress-inducing to the point of mental ill health and suicidality for some family carers.

CONCLUSION

Government policy and pandemic responses failed to address the financial, practical or emotional resources needed to fulfil the role of care provision and support to unwell and extremely distressed people with new or ongoing mental and psychological ill-health.

PATIENT OR PUBLIC CONTRIBUTION

From its inception, this project was co-produced and co-designed with mental health family carers and service users based on their expertise in understanding their experiences and ways to best explore these to the benefit and wellbeing of families in distress. The academic research partners both have active experience of supporting people with mental health challenges. Through each of the identified phases, lived experience expertise (family carers and service users) co-designed and co-facilitated the process. At times leading the process, such as in recruitment strategies, and at other times acting as guides. Guidance was provided by lived experience expertise in reflecting upon the literature review to understand what had been researched internationally and what would be important to understand in Australia. The academic partners advised on the possible processes for data collection, and the lived experience experts decided on the methodology based on that advice. Both the focus group and survey questions were developed and scrutinised from the perspective of the service users and carers in the project team. Difficult conversations were handled with respect, service users within the project team gently addressed areas of enquiry that may suggest stigma or feed into societal stereotypes of people with mental health challenges. Carers were able to consider the wording of questions to still be able to address areas of concern including domestic violence within the family unit and suicide. Dissemination strategies were planned together with the carer and service user representatives being co-presenters at conferences. The report for submission to the National Mental Health Commission (Australia) was written and reviewed with all partners. A committee of service users and carers, alongside the academic partners, planned the launch of the report in August 2023. The co-authorship of peer-reviewed articles has included family carers and service users from the National Mental Health Consumer and Carer Forum.

Sleep Patterns, Social Media Usage, and Dietary Habits during COVID-19 Lockdown in Mexico: A Cross-Sectional Study

During the COVID-19 lockdown, a high prevalence of disruption in lifestyle habits was reported, especially concerning sleep habits. The present study aimed to explore the relationship between lifestyles and the COVID-19 lockdown on subjects living in Mexico. A cross-sectional survey was conducted. An online questionnaire was administered to survey participants. A clustering procedure was performed to identify groups of survey respondents with similar characteristics. There were 155 survey respondents. Most of them were women (83%) of young age. The clustering identified two distinct groups of subjects, i.e., Cluster 1 and 2. The subjects in Cluster 2 were younger, more likely to use social media, and spent much more time watching TV/surfing the internet than subjects in Cluster 1. Furthermore, the prevalence of problems with falling and staying asleep during the lockdown was higher in Cluster 2 than in Cluster 1 (14% in Cluster 2 vs. 4% in Cluster 1) even though nobody from Cluster 2 had sleep problems before the lockdown. The study showed that younger respondents were those more affected by lockdown measures.

Implementation of guidelines on Family Involvement for persons with Psychotic disorders: a pragmatic cluster randomized trial. Effect on relatives' outcomes and family interventions received

Background

Family interventions (FI) are recommended as part of the treatment for psychotic disorders, but the implementation in mental health services is generally poor. Recently, The Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, demonstrated significant improvements in implementation outcomes at cluster-level. This sub-study aims to examine the effectiveness of the IFIP intervention on relatives' outcomes and received FI.

Methods

A cluster randomized controlled trial, was conducted in 15 Norwegian Community Mental Health Center (CMHC) units that were randomized to either the IFIP intervention, including implementation interventions and clinical interventions, or treatment as usual (TAU). The clinical interventions consisted of FI: basic family involvement and support (BFIS) to all patients and family psychoeducation (FPE) to as many as possible. Patients with psychotic disorders and their closest relative were invited to fill in questionnaires at inclusion and 6 months and 12 months follow-up. Received FI was reported by both relatives and clinicians. The relatives' primary outcome was satisfaction with health service support, measured by the Carer well-being and support questionnaire part B (CWS-B). The relatives' secondary outcomes were caregiver experiences, expressed emotions and quality of life. Patients' outcomes will be reported elsewhere.

Results

In total 231 patient/relative pairs from the CMHC units were included (135 intervention; 96 control).The relatives in the intervention arm received an increased level of BFIS (p=.007) and FPE (p < 0.05) compared to the relatives in the control arm, including involvement in crisis planning. The primary outcome for relatives' satisfaction with health service support, showed a non-significant improvement (Cohen's d = 0.22, p = 0.08). Relatives experienced a significant reduced level of patient dependency (Cohen's d = -0.23, p = 0.03).

Conclusion

The increased support from clinicians throughout FI reduced the relatives' perceived level of patient dependency, and may have relieved the experience of responsibility and caregiver burden. The COVID-19 pandemic and the complex and pioneering study design have weakened the effectiveness of the IFIP intervention, underscoring possible potentials for further improvement in relatives' outcomes.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT03869177.

Lockdown during the early phase of Covid-19 - effects on specialized mental health services and vocational activities for patients with psychotic disorders

PURPOSE

People with psychotic disorders may be particularly vulnerable to adverse effects from restrictions implemented to limit the COVID-19 pandemic. Mental health professionals may also be at risk of adverse effects. The aim of this study was to investigate the impact of potential changes in accessibility, quality of care and vocational activity on people with psychotic disorders and the impact on clinicians working in these conditions.

MATERIALS AND METHODS

Patients and clinicians in specialized mental health services for psychotic disorders answered questionnaires regarding changes in treatment, quality of treatment, vocational activity, and well-being. Data was analyzed with nonparametric tests.

RESULTS

Inpatients appeared more influenced by the restrictions than outpatients, however, quality of treatment was regarded relatively unaffected. Clinicians seemed satisfied working under these conditions, though a larger portion of clinicians reported changes in treatment compared to patients. The patients who reported being affected by changes in vocational activity tended to report negative effects, but the majority reported being unaffected.

CONCLUSION

Overall, patients and clinicians appeared to cope well with the changes they experienced in accessibility, quality of care and vocational activity during the early phases of the pandemic.

COPSYC-19: The impact of early phase lockdown on mental health among people with psychotic disorders

PURPOSE

On March 12th 2020 extensive measures were implemented to prevent spread of the coronavirus disease-19 (COVID-19). These measures were commonly referred to as "lockdown". In this study we investigate the psychological impact associated with living under these circumstances among patients with psychotic disorders receiving care from specialized mental health services in Norway.

METHOD

During early phases of lockdown, patients and clinicians receiving and providing mental health care for psychotic disorders in specialized health services at Oslo University Hospital were asked to fill out questionnaires developed for the study. 129 participants from outpatient clinics (91 patients and 38 clinicians) and 89 from inpatient wards (15 patients and 74 clinicians) were recruited. Data regarding mental health and related symptoms were analysed using Wilcoxon signed rank tests and standard multiple regression.

RESULTS

Outpatients reported significantly less extensive worrying, loneliness and hallucinatory experiences during early phase lockdown compared to the two weeks prior. Reductions in loneliness were predictive of experienced improvement in subjective mental health. However, the majority of clinicians from outpatient clinics believed their patients were experiencing more worrying and loneliness.

CONCLUSION

The result of this study suggests that many patients with psychosis experienced less loneliness, excessive worrying and hallucinations during the first phase of lockdown. This contrasts the clinicians' perceptions, as the patients show signs of resilience during times of uncertainty. The limitation in the study timeframe should be noted.

How does the COVID-19 pandemic affect the personal lives and care realities of people with a schizophrenia spectrum disorder? A qualitative interview study

BACKGROUND

The COVID-19 pandemic constitutes one of the greatest recent public crises. This study explored its influence on the lives and care realities of people with a schizophrenia spectrum disorder (SSD).

METHODS

Between October 2020 and April 2021, semi-structured in-depth interviews were conducted with 30 volunteers with SSDs receiving inpatient or outpatient treatment in Vienna (Austria). Interviews were audio-recorded, transcribed verbatim and analysed thematically.

RESULTS

Three main themes were identified. First, 'Pandemic life is deprived, lonely and surreal - though certain aspects can be perceived as positive'. Second, 'Bio-psycho-social support systems were struck at their core by the pandemic and were left severely compromised'. Last, 'There is a complex interplay between one's prior experience of psychosis and the experience of the COVID-19 pandemic'. The pandemic situation affected interviewees in various ways. For many, it led to a drastic reduction in day-to-day and social activities and contributed to an atmosphere of strangeness and threat. Bio-psycho-social support providers frequently suspended their services and offered alternatives were not always helpful. Participants indicated that whilst having an SSD might render them vulnerable to the pandemic situation, prior experience with psychotic crises can also provide knowledge, skills and self-confidence which enable better coping. Some interviewees also perceived aspects of the pandemic situation as helpful for recovering from psychosis.

CONCLUSION

Healthcare providers must acknowledge the perspectives and needs of people with SSDs in present and future public health crises to ensure proper clinical support.

Lessons from the coronavirus disease 2019 pandemic in schizophrenia: a review

PURPOSE OF REVIEW

Multiple countries have reported increased COVID-19 mortality in patients with schizophrenia. The purpose of this review was to synthetize the consequences of the pandemic on patients with schizophrenia including vaccination data.

RECENT FINDINGS

We have synthetized data on the increased risk of infection and increased mortality, the impact of the pandemic and lockdowns on psychiatric care, vaccination policies, unwillingness to vaccine in patients and the rates of vaccination.

SUMMARY

Schizophrenia has been confirmed at increased risk of both COVID-19 infection and developing a severe/lethal form of the infection. Patients with schizophrenia should, therefore, be prioritized for vaccination whenever possible and should be prioritized for psychiatric and somatic care access. Psychotic symptomatology may be a barrier to vaccination in some patients, and heterogenous vaccination rates were identified in national databases. The COVID-19 pandemic has been also a unique opportunity to develop telehealth. A mixed face-to-face and distance model should be encouraged, whenever possible, to improve the experience of patients, relatives and healthcare professionals. No major change of long-acting antipsychotics has been reported in most countries, and there was no consistent evidence for clozapine prescription to increase the risk of COVID-19 infection or severe outcomes.

[Psychological Burden in Relatives of People with Mental Illness During the COVID-19 Pandemic]

CONCERN

 The COVID-19 pandemic is a burden for most people - particular for those with mental illness and their families. The aim of the present study was to investigate specific burdens as well as coping strategies among relatives of people with mental illness.

METHODS

 A questionnaire to assess Corona pandemic-related influences on burdens of relatives of people with mental illness was developed. A total of 228 relatives participated in the survey between March and June 2021.

RESULTS

 More than 87% of the relatives surveyed reported that they were burdened by the mental illness of their ill relatives. Many of the respondents subjectively described helpful coping strategies such as appreciation of healthy parts.

CONCLUSION

 In times of crisis, such as the COVID-19 pandemic, care structures and support services should also be sensitively aligned and continuously provided for relatives of people with mental illness.

Challenges Experienced by Family Caregivers of Individuals With Severe Mental Illness During the COVID-19 Pandemic: An Integrative Review

Family caregivers of individuals with severe mental illness (SMI) faced increasing challenges during the coronavirus disease 2019 (COVID-19) pandemic; however, empirical evidence on the general challenges they experienced is lacking. Thus, the purpose of the current integrative review was to explore family caregivers' challenges during the COVID-19 pandemic. A total of nine relevant studies were included. Family caregivers experienced greater care burdens, physical and mental health problems, and limited access to health care services due to the pandemic. It is necessary to develop mental health policies and appropriate interventions to help individuals with mental illness and their family caregivers in the event of future crises. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Utilization of Norwegian crisis shelters before and during the COVID-19 pandemic

BACKGROUND

The measures introduced to control the COVID-19 pandemic, including lockdowns and physical distancing, exerted considerable influence on society.

OBJECTIVES

The aims of this study were to examine (1) the prevalence of people seeking Norwegian crisis shelters for domestic violence during the first period of the COVID-19 pandemic (2020) compared to the year before, (2) the demography and type of violence among first-time visitors and (3) to compare the utilization of the crisis shelters and characteristics of the users between shelters in the capital and the other shelters throughout Norway.

DESIGN

Observational study.

METHOD

The study was based on data from each crisis shelter in 2019 and 2020. Comparison between the 2 years were based on corresponding periods (12 March until 31 December) and analysed with t-test and chi-square tests.

RESULTS

Total use of crises centres, residential stays and daytime visits were lower during the pandemic (n = 7102) compared to the pre-pandemic period (n = 11 814). There was a shift from daytime visits to phone contacts when the restrictions were established. There was a higher proportion of residential stays versus daytime visits during the pandemic (21.5%) compared to the pre-pandemic period (15.4%) (p ⩽ 0.001). The proportion of first-time users was higher during the pandemic compared to pre-pandemic period both for residents (52.4% vs 47.1%) and daytime visitors (10.9% vs 9.0%). Among first-time crisis shelter residents during the pandemic period, fewer reported having children at home compared to the pre-pandemic period. The background of the crisis-shelter users did not differ between the capital and rest of Norway, but the capital had relatively more residents with psychological violence and threats during the pandemic.

CONCLUSION

The utilization of Norwegian crisis shelters, especially daytime visits was lower during the pandemic. There was a shift in daytime contacts from visits to phone contact at the pandemic outbreak. To ensure that information about available crisis shelters reaches the total population, these shelters should be prepared for a higher volume of phone contacts in a future pandemic situation.

COVID-19 lockdown - who cares? The first lockdown from the perspective of relatives of people with severe mental illness

BACKGROUND

Informal care is vital to many people with severe mental illness under normal circumstances. Little is known about how extraordinary circumstances affect relatives with a family member with mental illness. This study investigated the consequences of the first COVID-19 lockdown in Norway from the perspective of relatives of persons with psychotic- and/or bipolar disorders: What were the challenges and for whom?

METHOD

Relatives were invited to complete an online survey shortly after the first lockdown was initiated. Both quantitative and qualitative data were collected concerning experiences of relatives' own and their affected family members' health and situation. Two hundred and seventy-nine relatives completed the survey, mostly mothers and partners.

RESULTS

One-third of the relatives reported considerable deterioration in their family members' mental health, and a substantial minority worried about severe self-harm or suicide. Main themes in the qualitative analyses were "Isolation and its effects on mental health", "Worrying about the pandemic and its consequences", "Increased symptomatology" and "Suicide". Being a relative during the lockdown put heavy strain on the relatives' own health, in particular disturbance of sleep, concentration, and the ability to take care of others in the family. Relatives of family members with psychotic bipolar disorder, not currently in treatment, or living with their family experienced the situation especially challenging.

CONCLUSIONS

Many relatives found the first lockdown hard for their family. Efforts to integrate relatives' perspectives in health care and contingency plans under normal circumstances could potentially alleviate some of the extra burden experienced by families during extraordinary circumstances.