1
|
Davies T, Daniels I, Roelofse M, Dean C, Parker J, Hanlon C, Thornicroft G, Sorsdahl K. Impacts of Covid-19 on mental health service provision in the Western Cape, South Africa: The MASC study. PLoS One 2023; 18:e0290712. [PMID: 37639441 PMCID: PMC10461815 DOI: 10.1371/journal.pone.0290712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
In the context of an already large treatment gap in South Africa, this study aimed to examine how Covid-19 and the related lockdown measures affected the availability, accessibility, quality, and continuity of mental health services in the Western Cape province in South Africa. A mixed-methods design was employed, using narrative surveys, quantitative surveys, and qualitative semi-structured interviews, with 17 public mental health providers, and secondary data from the District Health Information System. We analysed and combined the data using descriptive statistics, template analysis and methodological triangulation. Results showed that Covid-19 and the lockdowns had negative impacts on mental health service provision at all levels of care, such as reduced access to services, increased stigma and discrimination, disrupted medication supply, increased workload and stress for providers, and the closure of psychosocial and therapeutic services. Innovations used by providers to mitigate these impacts included telehealth, online training, peer support groups, and community outreach. The study concludes that Covid-19 and the lockdowns exposed and exacerbated the existing gaps and challenges in mental health service provision in South Africa. Key recommendations for policy formation and response to future pandemics in the public mental health sector include: classifying psychological treatments as essential services, establishing an intersectoral mental health emergency response plan, involving mental health care users in the development of pandemic responses, creating policies for managing health emergencies in psychiatric facilities, and increasing resources for the mental health sector in South Africa. These recommendations are relevant for South Africa and other LMICs in ensuring adequate mental health care during public health emergencies.
Collapse
Affiliation(s)
- Thandi Davies
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Ingrid Daniels
- Cape Mental Health, Observatory, Cape Town, South Africa
| | - Marinda Roelofse
- Western Cape Department of Health, Western Cape Province, South Africa
| | - Carol Dean
- Western Cape Department of Health, Western Cape Province, South Africa
| | - John Parker
- Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, and WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| |
Collapse
|
2
|
Wullschleger A, Gonçalves L, Royston M, Sentissi O, Ambrosetti J, Kaiser S, Baggio S. Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric department: An interrupted time-series analysis. PLoS One 2023; 18:e0289310. [PMID: 37498908 PMCID: PMC10374153 DOI: 10.1371/journal.pone.0289310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The CoVID pandemic and the associated lockdown had a significant impact on mental health services. Inpatient services faced the challenge of offering acute psychiatric while implementing strict infection control measures. There is, however, a lack of studies investigating the use of coercive measures during the pandemic and their relation to hospitalizations and symptom severity. AIMS To investigate the effects of the CoVID outbreak on psychiatric admissions, use of seclusion and symptom severity. METHOD Using routine data from 2019 and 2020 gathered in the Department of Psychiatry at the Geneva University Hospitals, we performed an interrupted time series analysis. This included the number of psychiatric hospitalizations, the proportion of people who experienced seclusion and the average severity of symptoms as measured by the Health of Nations Outcome Scale (HoNOS). Dependent variables were regressed on the time variable using regression model with bootstrapped standard errors. RESULTS Hospitalizations decreased over time (b = -0.57, 95% CI: -0.67; -0.48, p < .001). A structural break in the data (supremum Wald test: p < .001) was observed in the 12th week of 2020. There was an inverse relationship between the number of admissions and the proportions of people subject to seclusion (b = 0.21, 95% CI: -0.32; -0.09, p < .001). There was a statistically marginally significant inverse relationship between HoNOS scores at admission and the number of psychiatric hospitalizations (b = -1.28, 95% CI: -2.59, 0.02, p = .054). CONCLUSION Our results show that the CoVID pandemic in 2020 was associated with a significant decrease in the number of hospital admissions. This decrease was correlated with a greater use of seclusion. The higher burden of symptoms and the difficult implementation of infection control measures might explain this higher use of coercion.
Collapse
Affiliation(s)
| | - Leonel Gonçalves
- Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Maya Royston
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Othman Sentissi
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Julia Ambrosetti
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
3
|
Pinto da Costa M, Stewart R. Investigating time-dependent COVID-19 pandemic mental health data: Challenges and opportunities of using panel data analysis. PLoS Med 2023; 20:e1004219. [PMID: 37071617 PMCID: PMC10112801 DOI: 10.1371/journal.pmed.1004219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Mariana Pinto da Costa and Robert Stewart provide commentary on a large prospective panel survey of mental health during the pandemic and consider the implications of such data science initiatives.
Collapse
Affiliation(s)
- Mariana Pinto da Costa
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
4
|
Aziz AM. COVID-19 outbreak management in a mental healthcare setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:470-476. [PMID: 35559690 DOI: 10.12968/bjon.2022.31.9.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Since the beginning of the novel coronavirus disease pandemic (COVID-19), inadvertent exposure of hospitalised patients and healthcare workers has been a major concern. Patients in inpatient settings with mental illnesses have also been impacted by the restrictions the pandemic has caused, with many having experienced the confines and loss of liberties that COVID-19 has brought. This article identifies the infection prevention and control measures required in a mental health setting during an outbreak of COVID-19. The focus is on the challenges of working in a mental health setting and identifies the difficulties in containing the infection within this ill-designed built environment and includes the additional pressures of managing this complex and diverse group of patients. Current guidance on outbreak measures is given with particular attention applied to the patients, the practices and the environment.
Collapse
Affiliation(s)
- Ann-Marie Aziz
- Clinical Lead: Infection Prevention and Control, Pennine Care NHS Foundation Trust, Greater Manchester
| |
Collapse
|
5
|
Abstract
This review covers the thematic series of 22 papers selected from among manuscripts published by BJPsych Open concerning coronavirus disease 2019 (COVID-19) and healthcare. We report nine papers that cover concepts and epidemiology relating to the public and patients. We review 11 papers about the impact of COVID-19 on healthcare services and their staff in 15 countries. Two papers consider the psychosocial impact on staff working in mental health services in the UK. Most papers report cross-sectional analyses of data collected from convenience samples by self-reported surveys conducted at single times. They have limitations of generalisability, do not enable conclusions about diagnosis or causality, and many are likely to have attendant bias and noise. BJPsych Open published these papers to meet requirements for early indications of the mental health impact of COVID-19 on the public and on healthcare staff. They claim high prevalence of symptoms of anxiety, depression and post-traumatic stress. We contrast these findings with selected reports of studies with different methodologies published elsewhere. We emphasise the need for longitudinal clinical studies with refined sampling and methodological rigour. We identify several longitudinal research programmes; two in this series. We advocate tuning advice offered about caring for the public and healthcare staff to the realities of their circumstances and their perceptions of need in the context of findings from further longitudinal studies. We draw attention to the importance of the social, relationship and environmental circumstances of the public and healthcare staff in order to understand their distress and their risks of developing mental health disorders.
Collapse
Affiliation(s)
- Richard Williams
- Professor Emeritus of Mental Health Strategy, Welsh Institute for Health and Social Care, University of South Wales, UK; Presidential Lead for COVID-19, Emergency Preparedness and Mental Health to the Royal College of Psychiatrists, UK; and Director of the Psychosocial and Mental Health Programme for the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh, UK
| | - Kenneth R Kaufman
- Professor of Psychiatry, Neurology and Anesthesiology, Rutgers Robert Wood Johnson Medical School, USA; and Visiting Professor, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| |
Collapse
|
6
|
Del Casale A, Lai C, Iannuccelli A, Ciacchella C, Veneziani G, Ali M, Zocchi C, Bilotta I, Pompili M. Pandemic experiences and psychopathological aspects in individuals with mood disorders and other mental disorders. Front Psychiatry 2022; 13:1039072. [PMID: 36311495 PMCID: PMC9614274 DOI: 10.3389/fpsyt.2022.1039072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
Individuals with different personality traits, temperaments, and psychological symptoms have different attitudes toward the pandemic experiences and restrictive measures. The aim of the present study was to evaluate the associations between the psychological factors and the attitudes toward COVID-19, experienced during the third pandemic wave in Italy, in a sample of individuals with psychiatric disorders. Between March and September 2021, 53 patients with mood disorders and other mental disorders completed a survey composed of self-report questionnaires that assessed sleep quality, depressive and hypomanic symptoms, and temperament and personality traits. Positive and negative attitudes toward the pandemic experience were assessed using an ad hoc questionnaire. The results showed that individuals with more severe depressive symptoms were less prone to adhere to government guidelines, and were more convinced that the pandemic was not a real problem. Reduced sleep quality was associated with increased skepticism toward official explanations concerning the causes of COVID-19. Lastly, negative affect and cyclothymic temperament predicted the disposition toward COVID-19 vaccines. In conclusion, these findings highlighted that some psychological aspects and psychiatric symptoms could influence the beliefs about COVID-19 and compliance with government recommendations. Further research is needed to provide indications on how to improve the current healthcare policies.
Collapse
Affiliation(s)
- Antonio Del Casale
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Alessia Iannuccelli
- Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy.,Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Chiara Ciacchella
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giorgio Veneziani
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Mohamed Ali
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Clarissa Zocchi
- Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy.,Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Irene Bilotta
- Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy.,Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy.,Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
7
|
Williams R, Cranshaw J, Pinto da Costa M. COVID-19 triage in general adult in-patient psychiatry: perspectives from clinicians on a novel triage ward during the pandemic. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Intra-hospital transmission of COVID-19 is a major concern. To mitigate this risk, ‘COVID-triage’ psychiatric wards were implemented by some in-patient service providers in the UK. Although the effectiveness of this model has not been investigated, there are questions about the benefits and detriments of this model of care for patients and staff. This reflection draws from the experiences of clinicians who were redeployed from their planned clinical posts (and training rotations, in the case of trainees) to staff a newly established COVID-triage ward at a large urban mental healthcare provider, between August 2020 and March 2021.
Collapse
|