Challenges of facing coronavirus disease 2019: Psychiatric services for patients with mental disorders

Abstract

As a public health emergency of international concern as declared by the World Health Organization (WHO), the current outbreak of coronavirus disease (COVID-19) in China has captured the world's attention.1 The global COVID-19 outbreak can now be characterized as a pandemic, and the number of confirmed cases all over the world has increased to 416 686 as of 04:34 hours, 26 March 2020, according to data released by the WHO.1 International journals for general medical and specialty fields are working closely with experts across the globe to raise comment and provide advice on measures to protect mental health in this epidemic.2, 3 We have enormous respect for those who have most recently published the latest content on this new virus; however, it is time for a change in focus. In addition to the challenges faced by medical professionals and the general public, the mental health services for patients suffering from mental disorders have several challenges to face. To this end, a guideline document was recently issued by the government of the People's Republic of China with respect to strengthening the management of treatment for patients with severe mental disorders during the outbreak of COVID-19.4 Afterwards, an expert consensus on the managing pathway and coping strategies for patients with mental disorders during prevention and control of the outbreak of a serious infectious disease (novel coronavirus pneumonia) was published by the Chinese Society of Psychiatry together with other psychiatry-related academic organizations.5 However, we are under challenging conditions to effectively deal with the realistic problems in the psychiatric domain caused by the COVID-19 outbreak. A nationwide epidemiological survey reported that the lifetime prevalence of any psychiatric disorder is 16.6% in China.6 Many patients need ongoing support in outpatient clinics, and many require repeated readmissions to inpatient wards, and vice versa. Psychiatrists assess patients, advise them and their guardian, and provide long-term treatments at hospitals. The difficulty in maintenance treatment of individual patients with mental disorders is currently increased for several reasons. First, under strict control due to the epidemic, most of the general hospitals in Hubei province and elsewhere are temporarily unable to care for psychiatric patients to lower the possibility of COVID-19 transmission. Second, because of the need to establish special wards for patients who have a fever, specialized hospitals have had to reduce the number of ordinary hospitalizations. Third, patients undergoing hospitalization and outpatients seeking help or undertaking follow up have had to discontinue their treatment due to suspended public transport in a number of areas. At present, there are few measures as to how long maintenance treatment in mental disorders should last after an episode. Failure to directly resolve these problems prevents us from achieving our goal, despite its importance in the clinical management of mental disorders. Given that many more medical comorbid factors occur in patients with mental disorders, another challenge is addressing the effects of medical comorbidity in patients; for instance, respiratory diseases are more common in schizophrenia patients than in the general population, and patients with schizophrenia and concomitant influenza or pneumonia have higher mortality rates (see Wang et al.7 for a review). There so far appears to be no attention paid to these vulnerable individuals, that is, psychiatric patients with comorbid COVID-19. Here, we would like to share response suggestions. The World Health Assembly in 2013 endorsed an action plan, the WHO's ‘Comprehensive Mental Health Action Plan 2013–2020.’8 A key recommendation is to shift services from institutions to the community, highlighting the steps required to provide appropriate psychiatric services for patients in the current COVID-19 epidemic. In addition to this, the development of artificial intelligence techniques in clinical settings, attempts to speed up constructing the framework of online consultation and Internet hospitals, and the provision of telemedicine are all valuable. As a fundamental component of mental health services, psychiatric health-care professionals based in large top-class tertiary hospitals play critical roles in the comprehensive health of the population with mental disorders. This can be leveraged through large data analyses and harnessed via updated clinical practice guidelines and algorithms to improve policy-making. The COVID-19 epidemic has now spread across China and affected the world for almost 3 months. It poses many problems not only with the provision of psychiatry care, but also public health, prevention and control, preclinical and clinical research, health policy, and even health law. We are writing to draw attention to the challenges regarding maintenance treatment and concomitant COVID-19 in patients with mental disorders. The positive response is increasingly expected to explore and address the issues that affect patients with mental disorders on the basis of available evidence. The authors declare no conflicts of interest.