Timely psychological care for patients with severe mental illness during COVID-19 epidemic

The epidemic outbreak of novel coronavirus (COVID-19) pneumonia originating from the Wuhan, Hubei province, China, and spreading worldwide over the past four months; has gained significant attention globally (Wang et al., 2020). With the stringent administrative system as well as rigorous policy implementation, the situation of COVID-19 infection has been brought under control in China (National Health Commission, 2020).The negative impact of the emerging infectious disease has brought mental health sequalae: including distress, insomnia, anxiety, depression, and Posttraumatic Stress Disorder (PTSD) (National Health Commission, 2020). Therefore, the structured and comprehensive mental health services are urgent to implement for the populations in the countries affected by COVID-19 pandemic (Seidi et al., 2020), The National Health Commission has put in place guideline principles for addressing emergency psychological crises in those affected (Liu et al., 2020). The psychological care for patients with severe mental illness (SMI) during the COVID-19 epidemic was limited initially, although psychological services for the highest need groups has been increasingly established (Kang et al., 2020). The increased life-time prevalence of SMI (Schizophrenia and other psychotic disorders 0.9%, Bipolar disorder 0.5%, Major depressive disorder 3.9%) was reported in China last year (Huang et al., 2019). The majority of the patients with SMI are functionally disabled and overall less able to utilize/access mental health services (Li et al., 2013). Patients with SMI appear to have been more vulnerable to the emerging infectious disease consistent with overall trends in risk for medical comorbidity; along with barriers to appropriate nutrition and exercise, polypharmacy, and sustained hospitalizations (Chiang et al., 2019; Zhu et al., 2020). Moreover, the patients with SMI could be a potential source of infection for the emerging infectious viruses, such as COVID-19, because he/she was difficulty to be screened and quarantined (Sujita et al., 2020). Stress related to stringent quarantines could increase the likelihood of the onset of SMI as well as lead to exacerbation of existing mental disorders in susceptible individuals. Furthermore, the ability of patients and their guardians to seek care at outpatient psychiatric clinics has been impeded with the suspension of public transportation. Unfortunately those with poor economic conditions and lower education level are also less likely to be able to access online psychological intervention and services though they have been established nationwide.

The COVID-19 epidemic has created great challenges for providing effective psychological service to individuals with SMI and their families. It is important that attention be brought to the unmet mental health service needs of these vulnerable subpopulations. Early identification and effective interventions for high-risk individuals will be helpful to address psychological emergencies; such as suicide and aggressive behavior. A toll-free, 7*24hrs hot-line for psychological crisis intervention was available for the public to help those with stress responses and psychological distress; including patients with SMI and their caregivers in Zhongshan, Guangdong province. It would be important that optimized, affordable, and easily accessible care be provided to mitigate the psychological impact on patients in a timely manner. This would include programs for individualized health insurance, multidiscipline-orientated interventions, and community service initiatives (Ma et al., 2020). Telemedicine style follow up (such as phone interviewing) was set up to provide care for stable patients with SMI. Care for SMI patients with high risk behavior and more urgent needs was put in place through a multidisciplinary team approach with input from community committees, public security, and psychiatric providers/facilities. Finally, effective works from the policymakers the health authority, and the researchers will facilitate efficient psychological services for patients with SMI and their families during this time of increased hardship as the impact of the epidemic is felt (Tandon, 2020).

Financial Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the reported in this correspondence

Declaration of Competing Interest

The authors declare that they have no conflict of interesting to this correspondence.