Table 2.

A summary of the potential impact of COVID-19 on specific mental disorders requiring input from secondary mental health services

Mental Illness	Impact of COVID-19	Mental Health Consequences
Anxiety disorders	Increased anticipatory anxiety, avoidance and anxiety symptoms. Difficulty switching off, feeling overwhelmed, feeling out of control. Insomnia, altered appetite, reduced exercise, disrupted routine. Less able to engage in adaptive behaviours that reduce anxiety, for example, social connection, exercise	Increased risk of relapse of anxiety disorder symptoms including panic attacks, agoraphobia, health-related anxiety symptoms Obsessive–compulsive disorder – fear of contamination and increased compulsive behaviours, for example, handwashing, checking, routines. Increased risk of trauma relating to the experience of COVID-19 illness or witnessing impact of illness on service user, friend and family.
Affective disorders	Increased social isolation and loneliness Insomnia, altered appetite, reduced exercise, disrupted routine. Personal experience of COVID-19 in self/family or friends.	Relapse of depression Relapse of mania
Psychosis	Rates of isolation and loneliness are higher in this population at baseline. Increased difficulty accessing care due to altered pathways and increased isolation from family/friends. Those with negative symptoms will be particularly affected by the change in routines, reduced interaction and social distancing measures. Viral infection appears to be a general risk factor for psychotic disorders, and coronavirus infection may also be a specific risk factor, conferring acute and long-term risk for psychosis (Cowan, 2020). Trauma and social marginalisation are risk factors associated with longer term increased risk of psychosis (Radua et al. 2018).	Relapse of psychotic symptoms, for example, hallucinations, delusions. Increased duration of untreated psychosis resulting in poorer prognosis. Further impairment of social and occupational functioning, which will be difficult to re-establish after COVID-19. Difficulty/fear of accessing evidence-based interventions, for example, psychological interventions, family interventions, individual placement support, physical health interventions. Impact of telephone versus face-to-face assessments, therapeutic interventions. Potentially increased longer-term risk of psychosis in the population. Further delays in implementing the National Early Intervention for Psychosis Model of Care.
Eating Disorders	Disruption of usual routines. Fear of loss of control. Potential for increased familial stress and conflict	Relapse or exacerbation of eating disorder Difficulty accessing evidence-based interventions, for example, psychological interventions, family interventions, physical health interventions. Impact of telephone versus face-to-face assessments, therapeutic interventions Further delays in implementing the National Eating Disorders Model of Care.
Attention deficit hyperactivity disorder	Disruption to routine, reduced capacity to be active, difficulty accessing a work/school environment at home.	Reduced capacity to relax, increased restlessness and impulsivity. Increased anxiety and depression Increased self-harm Further delays in implementing the National ADHD in Adults Model of Care.
Personality disorder	Increased social isolation and loneliness Impaired sleep, altered appetite, reduced exercise	Emotional dysregulation Increased self-harm to assist managing emotions Increased substance use to assist managing emotions Increased suicide risk
Dual diagnosis	Reduced social support which is central to most addiction programmes. Reduced access to treatment groups and programmes. Societal tendency to utilise alcohol/illicit drugs to cope with stress	Risk of relapse to alcohol or substance abuse. Increased suicide risk

Note: The contents of this Table were developed by the authors as part of an expert working group in consultation with relevant stakeholders