Pandemic brings challenge and opportunity for people with schizophrenia

A sudden shift in the usual parameters of reality; odd events such as the overnight disappearance of people from the streets; and in the media everyone talking about the same thing as if part of a giant conspiracy – these features are now part of everyday life for us all. But for some people who have schizophrenia, they may seem like radically distressing reminders of relapse.¹ 

People with schizophrenia are susceptible to the exceptional psychological stresses associated with COVID-19, but they are also more vulnerable to the effects of the virus itself since stigma and marginalization mean they are less likely than others to receive treatment if critically ill.¹ The same is true of follow-up care.

High rates of smoking, poor nutrition, comorbid disease, inadequate housing or homelessness, limited social networks, and lack of health insurance -- all compound the problem.²

Disasters disproportionately affect poor and vulnerable populations, and patients with serious mental illness may be among the hardest hit²

Means of mitigation

To try and ensure that people with serious mental health problems are not disadvantaged, several measures have been suggested. These include²

• Ensuring adequate communication between mental health care providers and other health services
• Equipping those dealing with mental health needs – who will frequently be users’ first or only point of contact with medical services -- with knowledge of signs and symptoms of COVID infection and personal protective equipment to sufficient to manage people infected or at high risk
• Provision of information on preventive measures such as social distancing and handwashing that is easy to communicate to patients; and provision of information on maintaining a healthy diet and levels of exercise
• Planning ways of maintaining core services in the face of shortages of staff and medication.

For people in treatment for a chronic mental health condition, there is also the risk that a reluctance to keep hospital appointments or visit pharmacies may result in interruption of the drug treatment that is crucial to relapse prevention and the maintenance of good long-term function.^3,4 Steps need to be taken to ensure patients continue to have access to medication.

From stigma and marginalization to the interruption of drug treatment, people with schizophrenia are especially vulnerable to the pandemic

A time of threat but also opportunity

Comprehensive care for people experiencing first episode psychosis (FEP) improves outcomes and is cost effective⁵ [see article Early detection and intervention in psychosis – where are we now?]. But its implementation is threatened in the current COVID-19 crisis.

In this context, it is helpful that the American Psychiatric Association (APA) has developed a Telepsychiatry Toolkit to aid delivery of crucial elements of care at a distance.⁶ This covers clinical considerations, technical requirements relating to software, and legal and reimbursement issues. It also has all-important information on helping patients prepare for a teleconsultation.⁷

The advice includes the need to select a location that is private and without distractions, checking the technology and log-in procedures ahead of time, and preparing notes and questions in advance.

In any telemedicine consultation, helping patients prepare is crucial

It is also helpful that several digital health companies now provide at no cost tools that allow patients quick access to professional carers using their smartphone or tablet.

New study shows the acceptability of telemedicine

Also very relevant is the publication this year of a study into how users of an FEP program in urban Canada react to the offer of telepsychiatry as an alternative to hospital visits.⁸ The authors suggest this is the first study of its kind.

The first important finding was that teleconsultation would solve problems for many service users, since 78% of respondents reported that they had experienced obstacles (including anxiety, and the availability and cost of transportation) to attending face to face appointments.

Secondly, 49% of respondents were favorable to the idea of receiving services by videoconferencing, and a further 25% were somewhat favorable. Fifty-five percent said they would be interested in having their next appointment in this way. And 84% had access to a smartphone.

Vulnerable patients’ resilience is being tested as never before – and they need professional care more than ever⁹

More personal accounts also suggest the offer of teleconsultation is well received by patients accessing mental health services.⁹ For those who do still come to hospital appointments, texting patients to notify them of a doctor’s availability while they wait in their car is a sensible alternative to a crowded waiting room.

Also helpful is the introduction of flexible working hours for staff since professionals’ practical and emotional needs must be catered for at a time when our patients -- whose resilience is being tested as never before – need us more than ever.⁹