People with severe mental illness are often at a disadvantage, in terms of access to general medical services, under ordinary circumstances. Additionally, they are further neglected during pandemics. They might also have difficulties complying with hygiene rules and general public instructions, which make them vulnerable to infections (Huremović, 2019; Xiang et al., 2020). During pandemics, people with severe mental illness are exposed to an increased risk of relapse or exacerbation of the disorder (Huremović, 2019).
In Istanbul, most of the inpatient units were converted to clinics for the treatment of COVID‐19 inpatients, and all physicians were assigned to treat them, regardless of their expertise. Patients who required hospitalization due to a mental illness related problem and tested positive for SARS‐CoV‐2, were ignored during this process—although the risk of infection was higher for them. No later than a month, a need arose for a unique unit for patients who required hospitalization because of a mental disorder and also tested positive for COVID‐19, according to computed tomography and/or polymerase chain reaction (PCR) tests.
We have structured an inpatient unit for patients with the comorbidity of COVID‐19 and severe mental illness, in a very short time. The following actions were taken accordingly:
Telephone networks and cables in patient rooms were removed due to the possible risks of strangulation they posed, for patients with mental illness. Cameras were constructed in patient rooms for observation of patients, by doctors and nurses.
We used all necessary, personal, protective equipment, since most of the patients with severe mental illness were likely not to use self‐protective equipment themselves.
For cases possible and necessary, we offered hospitalization with a companion. Written informed consent was obtained from both the patient and their companion (with regard to camera surveillance and risk of contamination).
Smoking was prohibited in the COVID‐19 Positive Psychiatric Inpatient Unit. Nicotine cravings of the patients were relieved by nicotine replacement treatments like the nicotine transdermal patch.
Daily visits and medical treatments for COVID‐19 patients were conducted after daily consultations with the Department of Infectious Diseases. All vital signs and electrocardiogram of the patients were recorded regularly, in terms of drug interactions (Roden, Harrington, Poppas, & Russo, 2020).
Considering that all interventions for patients with mental illness take longer than patients without such illness, healthcare workers were allowed to stay alternately and no longer than 15 minutes in the patient rooms. Despite undertaking all precautionary measures, a few psychiatrists and nurses in the unit were infected with SARS‐CoV‐2. (Among 23 psychiatrists and 32 nurses, 4 psychiatrists and 5 nurses exhibited COVID‐19 symptoms, while 1 nurse tested positive for SARS‐CoV‐2 through the PCR test.)
Due to the risk of transmission and harmful behaviors of mentally ill patients toward themselves and others, 14 such patients were hospitalized in single rooms with attached restrooms.
Since the number of male patients awaiting hospitalization was higher than that of female patients, COVID‐19 Positive Psychiatry Inpatient Units were not segregated in terms of gender, in order to accommodate the male patients.
Since patients with severe mental illness are vulnerable to infection, and are negatively impacted by the pandemic, they may experience frequent exacerbations during this period; thus, the need for inpatient units for mentally ill, comorbid patients should not be ignored (Druss, 2020; Fagiolini, Cuomo, & Frank, 2020). We have organized the “COVID‐19 Positive Psychiatry Inpatient Unit” which is the first of its kind in Turkey and one of the firsts in the world, to the best of our knowledge. We believe that sharing the process of creating such unique experiences may contribute to the field during the course of the pandemic.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
The manuscript has not been published, accepted, or submitted elsewhere.
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