Experiences of Persons With Serious Mental Illness During the COVID-19 Pandemic

'I am proud of how I handled it'. Exploring the impact of the COVID-19 pandemic and related restrictions on well-being of adults with severe mental illness using qualitative methods

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic and related restrictions globally impacted mental health, particularly for those with pre-existing severe mental illness (SMI). This qualitative study examined how adults with SMI perceived the effects of the COVID-19 pandemic and related restrictions in the Netherlands, focusing on their personal recovery, well-being and daily life, including an exploration of factors influencing these effects.

METHODS

Semi-structured interviews were conducted, audio-recorded and transcribed verbatim. Reflexive thematic analysis was applied. Purposive sampling was used to ensure diversity of individuals with SMI (i.e., age, gender, diagnosis, cultural background and mental healthcare institution).

RESULTS

Twenty participants (median age: 45 years [SD: 12, 8]; 11 females) were interviewed between May and July 2023. Findings revealed a wide range of experiences: while some individuals reported a negative impact on their existing psychiatric symptoms, others described adaptability, resilience and even positive effects of COVID-19 restrictions on their mental health and well-being. Factors influencing the heterogeneic perceptions of the COVID-19 pandemic and related restrictions include the availability of trusted social relationships and enduring interactions with health professionals.

CONCLUSION

Personalised support, both socially and professionally, is crucial for addressing fears, building resilience, reducing isolation and encouraging positive coping strategies for individuals with SMI during external crises. In this project, a participatory research approach that integrated the lived experience perspective helped uncover the unique perceptions of people with SMI with regard to the pandemic and related restrictions.

PATIENT OR PUBLIC CONTRIBUTION

The study used a participatory action research approach, with experts-by-experience involved in every stage of the project as part of the research team. This included engagement with the funding application process, recruitment strategies for interviews, developing the interview guide, piloting the interview, interpreting findings, and knowledge dissemination activities.

Impact of COVID-19 on the lives of people with severe mental illness-front-line community psychiatry workers observation from a provincial survey of assertive community treatment teams in Ontario, Canada

Using an online survey distributed to members of the provincial organization that represents the 88 Assertive Community Treatment (ACT) and Flexible ACT teams in Ontario, Canada, this descriptive study relied on the unique vantage points and observations of the front-line community psychiatry workers who maintained contact with patients through outreach and telecommunication during the height of COVID-19. The patients who suffer from serious mental illness (SMI) were uniquely affected by COVID-19 due to the changes, reduction or shut down of many essential clinical and community support services. Thematic and quantitative analyses of the workers' observations highlighted 6 main areas of note, including significant social isolation and loneliness, clinical course deterioration and life disruption, increased hospital and ER use, police and legal contacts, and substance abuse and related deaths. There were also encouraging signs of positive adaptations in terms of independence and resilience. Reflections of these impacts and potential ameliorating approaches are further discussed.

Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic

Objective

This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic.

Methods

Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test.

Results

In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777).

Conclusion

Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.

Impact of Digital Literacy Training on Outcomes for People With Serious Mental Illness in Community and Inpatient Settings

OBJECTIVE

The authors explored whether a digital literacy program, Digital Outreach for Obtaining Resources and Skills (DOORS), could improve self-reported functional skills and clinical outcomes among people with serious mental illness.

METHODS

The 8-week program was offered to participants receiving treatment in community mental health centers (N=113) and an inpatient psychiatric unit (N=74). Pre- and postintervention self-report surveys were collected. Descriptive statistics and two-tailed t tests were used for analysis.

RESULTS

For patients treated in a community center, improvements were observed in 27 of the 29 self-reported functional skills that measured digital literacy. Changes in seven of these skills were statistically significant. Although these participants reported larger improvements in clinical outcomes than did inpatient participants, no statistically significant changes in symptoms were seen in either setting.

CONCLUSIONS

Digital skills training is necessary to increase access to care through technology. DOORS can improve self-reported digital literacy, but further research is necessary to determine its immediate impact on symptoms.

Stuck Inside: How Social Functioning in Schizophrenia Changed During the COVID-19 Pandemic

Social distancing policies enacted during the COVID-19 pandemic altered our social interactions. People with schizophrenia, who already exhibit social deficits, may have been disproportionally impacted. In this pilot study, we a) compared prepandemic social functioning to functioning during the pandemic in people with schizophrenia ( n = 21) who had data at both time points; and b) examined if patterns of decline in schizophrenia differed from healthy controls ( n = 21) across a series of repeated-measures analyses of variance. We observed larger declines in social functioning in schizophrenia (η 2 = 0.07, medium effect size) during the pandemic compared with the control group. Between-group declines did not extend to other domains, suggesting that declines are specific to social functioning. Our findings signal that treatments focusing on reconnecting people with schizophrenia to their social networks should be prioritized. Future studies should continue tracking social functioning after the pandemic to illustrate patterns of recovery.

Socially Distanced Emergencies: Clinicians' Experience with Tele-behavioral Health Safety Planning

Psychiatry has experienced a rapid expansion in providing behavioral health services using virtual means; however, little is known regarding clinicians' experience in managing patient emergencies during virtual encounters. We present survey data from a large academic psychiatry department designed to better understand safety planning while delivering ambulatory tele-behavioral health services during the COVID-19 pandemic. Clinical faculty in the department were sent an anonymous electronic survey developed and distributed using the Qualtrics™ software. Departmental leadership provided a list of clinicians who performed ambulatory care. SAS 9.4 was used to conduct statistical analysis for associations between variables. Approximately one quarter (23.3%) of respondents engaged in proactive safety planning for most of their outpatient virtual visits, while a little over half (53.2%) of clinicians implemented emergent safety planning between just one to five visits. Clinicians who more frequently implemented emergency protocols were more likely to engage in proactive safety planning prior to emergencies (p = 0.0115). 10.8% of participants petitioned for civil commitment, though those that did identified numerous challenges. Our results reinforce the importance in appropriate training regarding best practices while providing tele-behavioral health care, with increased awareness for conducting safety planning and implementing emergent protocols. Furthermore, while petitioning for civil commitment is a relatively low base rate event in a large outpatient practice, these data and narrative feedback help to outline challenges and potential measures to improve this process for all parties. Increased attention to protocols and procedures are key as the utilization of virtual care within psychiatry continues.

The impact of COVID-19 on benzodiazepine usage in psychiatric inpatient units

OBJECTIVE

This study aims to investigate whether COVID-19 has led to increased usage of benzodiazepines in acute psychiatric settings.

METHOD

We evaluated the rates of benzodiazepine usage in two acute psychiatric inpatient units over a period of two years, 2019 and 2020 (the year of the pandemic). Rates of oral atorvastatin usage over the same period were used as a comparator.

RESULTS

We saw a significant increase in the usage of benzodiazepines in the period between April and December 2020 compared to the same period in 2019 despite a decline in the total number of admissions in 2020. Usage peaked further at the time of eased pandemic restrictions which coincided with higher rates of emergency department mental health (MH) presentations and acute MH hospital admissions. We also noticed higher rates of substance use disorder recorded on admission. Hospital leave restrictions due to COVID-19 also led to further restrictions on smoking.

CONCLUSION

Benzodiazepine usage increased in the context of the COVID-19 pandemic. The study encourages more research to better understand the impact of the pandemic on acute psychiatric settings.