Mental health services in Italy during the COVID‐19 pandemic

To date, very little is known about the way in which mental health systems worldwide are facing the current COVID‐19 global health emergency. ¹ , ² , ³ Italy was the first Western country to be severely affected by the COVID‐19 pandemic, and only local reports relating to Italian psychiatric services have been published so far. ⁴ , ⁵ , ⁶ , ⁷ In this short report, we present preliminary data emerging from a survey conducted by the Italian Society of Psychiatry to study the impact of the current emergency on the functioning of the Italian Departments of Mental Health (MHD), comprising community mental health centers (CMHC), residential facilities (RF), and psychiatric wards in general hospitals (GHPW).

Between 1 and 11 April 2020, all heads of the MHD received a 40‐item multiple‐choice questionnaire focused on CMHC, and a 30‐item questionnaire on GHPW. Responses were analyzed according to geographical area and to the rates of COVID‐19 cases per 1000 inhabitants in the reference area. To date, 71 questionnaires have been returned from the 134 Italian MHD (52.9%) and 107 from the 318 (33.6%) GHPW.

A total of 14% of CMHC have been closed and approximately 25% have reduced their hours of access. A decrease has been registered (approximately –78%) in the number of operational day hospitals, which are largely involved in the clinical monitoring and treatment of subacute but not severe cases, whilst an even greater reduction (–85%) has been observed in the number of operational day centers focusing on psychosocial and rehabilitation activities. Only RF, units specifically deputed to medium to long‐term rehabilitation, have remained almost fully operational. The routine mode of operation in CMHC has changed substantially. Urgent psychiatric consultations, both on‐site and at home, are continuing as usual, in the same way as interventions for compulsory treatments, psychiatric prison consultations, and on‐site and home administration of long‐acting injectable antipsychotics; however, all other activities have been affected by a significant decrease. Indeed, scheduled psychiatric consultations, both at home and on‐site, have only gone ahead for selected cases, being replaced in approximately 75% of cases by scheduled remote contact, mainly phone calls (100% of MHD), videocalls (67%), or emails (19%), with 41% of units adopting all these means of contact. All other activities have been affected by a significant decrease, including psychiatric consultations for general hospitals (approximately −25%), individual psychotherapies (approximately −60%), group psychotherapies and psychosocial interventions (approximately −90% and –95%), and monitoring of cases manifested in RF (−40%) and among offenders affected by mental disorders assigned by the Court to CMCH (−40%). COVID+ cases have been registered among both staff members (52% of CHMC) and facility users (52% of CHMC), although slightly lower rates have been reported for residents living in RF (less than 40% of RF). As expected, a significantly higher number of cases have been reported in the northern Italian regions (i.e., areas featuring the highest rates of infection). Finally, a limited number of CMHC (21%) have reported cases of increased aggressiveness or violence, either towards the self or others, among community patients, with 8.6% constituting severe cases.

Major issues in the supply of personal protective equipment for staff members have been reported, particularly for infrared thermometers, high‐protection masks, safety glasses, and disposable gloves. A certain reduction in the number of GHPW wards (−13%) has been observed, largely due to conversion into general COVID‐19 units for positive patients, as well as in the number of beds available (approximately –30%) due to a need to increase the distance between patients and to set up isolation rooms. An overall reduction of admissions has been registered (87% of GHPW), partly due to a restriction of scheduled admissions (64% of GHPW). Only 8% of GHPW have reported an increase in compulsory admissions. The vast majority of GHPW have continued to guarantee psychiatric consultations for emergency rooms and medical and surgical units, with psychiatric consultations for COVID‐19 units being performed in approximately one‐fifth of GHPW. Mood disorders, psychoses, anxiety disorders, and attempted suicides represent the most frequent reasons for consultations. Only 8% of wards have registered an increased rate of violence towards the self or others among inpatients. Fifty percent of GHPW have reported the availability of swabs for patients, although only 20% of these are able to request swabs on both admission and discharge. Approximately 60% of GHPW have reported the admission of symptomatic, COVID+ psychiatric patients to general COVID‐19 units, whilst severely ill and non‐collaborative COVID+ patients are generally admitted to specific COVID‐19 GHPW, or to purpose‐adapted isolated areas of the wards. Indeed, although the Italian MHD has effectively succeeded in facing the challenges manifested and has implemented a widespread use of telepsychiatry, numerous issues related in particular to psychosocial interventions and family support will need to be addressed in the future should the current operational restrictions continue.

Disclosure statement

The authors declare no conflict of interest. All authors contributed equally to this letter.