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1/15 A thread on our @MentalHealthPRU synthesis of international perspectives and experiences of COVID-19 impact on people already living with mental health problems and on mental health services
Pre-print, not yet accepted for a peer-reviewed journal.
https://www.medrxiv.org/content/10.1101/2020.06.15.20129411v1.full.pdf
Pre-print, not yet accepted for a peer-reviewed journal.
https://www.medrxiv.org/content/10.1101/2020.06.15.20129411v1.full.pdf
2/15 Many general population mental health studies launched during pandemic, but not so much focus yet on what's happening to people already living with mental health conditions, to services they use
This work: initial overview of range of relevant experiences & perspectives
This work: initial overview of range of relevant experiences & perspectives
3/15 We searched for relevant accounts published before 30 April 2020 - papers in journals and professional press, in newspapers, videos & podcasts, on charity and professional organisation websites, in English, French, German, Spanish, Italian & Mandarin Chinese.
4/15 Method was rapid framework-based synthesis. We found 872 relevant sources from 29 countries. A huge researcher team - thanks all!! - used an initial framework to chart the content, adding themes when needed, then experienced qualitative researchers summarised each theme.
5/15 Our pre-print paper gives an overview, but there is a lot more detail in the accompanying Supplementary Report, which gives a detailed summary of each theme.
https://www.medrxiv.org/content/10.1101/2020.06.15.20129411v1.supplementary-material
The rest of this thread summarises selected themes.
https://www.medrxiv.org/content/10.1101/2020.06.15.20129411v1.supplementary-material
The rest of this thread summarises selected themes.
6/15 Individual responses: Not surprisingly, many reports of deterioration in mental health in pandemic period, often attributed to fears of illness and death, loneliness & isolation from usual supports, withdrawal or reduction in services, societal & economic impacts of pandemic
7/15 Accounts of deteriorations in certain conditions were especially detailed and numerous: depression & anxiety, OCD, eating disorders. The pandemic has disrupted the routines, activities and relationships that allow people to manage their mental health day-to-day.
8/15 Frequently described impacts include loneliness & isolation, increased domestic violence and family conflict, difficulty in accessing essential services, especially if no internet.
Isolation in hospital a major concern - cut off from visits, interactions on wards, leave
Isolation in hospital a major concern - cut off from visits, interactions on wards, leave
9/15 Exacerbation of existing inequalities and social adversities is an important overall theme. People with pre-existing mh conditions are potentially at greater risk both from COVID-19 infection and its societal and economic consequences
10/15 Most accounts of pandemic impact are negative - but there are positive experiences: some feel better connected, that stresses have reduced, that they have become aware of reserves of resilience. New self-management strategies & effective peer support are described.
11/15 At service level: most reports on mental health service activity suggested reductions in admissions and referrals early in the pandemic, accompanied by large increases in activity of many voluntary sector mental health and suicide prevention hotlines
12/15 Big challenges in hospitals: practical difficulties implementing infection control & high risk of outbreaks; boredom, isolation & lack of therapeutic programmes or advocacy; potentially inequitable pressures to treat COVID-19 infections as far as poss in psych hospitals
13/15 Adaptations & innovations in hospital: COVID-19 specific units with physical health input; enhanced use of technology to reduce isolation, maintain therapies; home treatment initiatives to prevent admission/facilitate discharge
14/15 In the community: significant themes are large variations in how far services maintained, within and across countries, and very rapid & widespread implementation of tele-health. Tele-health allows services to keep going, but can exacerbate inequalities too.
15/15 The paper concludes with a commentary from co-authors with relevant lived experience, higlighting some of the important ethical challenges in the current situation.
