Adaptations and Innovations to Minimize Service Disruption for Patients with Severe Mental Illness during COVID-19: Pers
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Adaptations and Innovations to Minimize Service Disruption for Patients with Severe Mental Illness during COVID‑19: Perspectives and Reflections from an Assertive Community Psychiatry Program Iline Guan1 · Nicole Kirwan2 · Michaela Beder3 · Matthew Levy1 · Samuel Law1,3,4 Received: 29 June 2020 / Accepted: 2 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Changes to community psychiatry during COVID-19 are unprecedented and without clear guidelines. Minimizing disruption, ensuring quality care to the already vulnerable people with serious mental illness is crucial. We describe and reflect our adaptations and innovations at one community psychiatry program, based on three key principles. In (i) Defining and maintaining essential services while limiting risk of contagion, we discuss such strategies and ways to assess risks, implement infection control, and other creative solutions. In (ii) Promoting health and mitigating physical and mental health impacts, we reflect on prioritizing vulnerable patients, dealing with loss of community resources, adapting group programs, and providing psychoeducation, among others. In (iii) Promoting staff resilience and wellness, we describe building on strength of the staff early, addressing staff morale and avoiding moral injury, and valuing responsive leadership. We also identify limitations and potential further improvements, mindful that COVID-19 and similar crises are likely recurring realities. Keywords Assertive community treatment team · COVID-19 pandemic · Pandemic preparedness · Disaster preparedness · Severe mental illness
Background * Samuel Law [email protected] Iline Guan [email protected] Nicole Kirwan [email protected] Michaela Beder [email protected] Matthew Levy [email protected] 1
Department of Psychiatry, University of Toronto, Toronto, Canada
2
Clinical Nurse Specialist, and Administrative Lead, Community Psychiatry Program, St. Michael’s Hospital, Toronto, Canada
3
Department of Psychiatry, St. Michael’s Hospital, University of Toronto, Toronto, Canada
4
Li Ka Shing Knowledge Institute, St. Michael’s Hospital Cardinal Carter Wing #17029, 30 Bond Street, Toronto, ON M5B 1W8, Canada
In the months following the outbreak of the COVID-19 pandemic, efforts to curb the spread of the virus have led to far-reaching socioeconomic upheavals and disruptions in the delivery of healthcare (World Health Organization 2020), with unprecedented impact on the practice of community psychiatry. Recent outbreaks such as the Severe Acute Respiratory Syndrome (SARS) in 2003, and the H1N1 influenza in 2009 had significantly disrupted health systems and prompted more planning for pandemic preparedness (Fineberg 2014; Yen et al. 2014; Reidy et al. 2015). However, few specific guidelines existed to help community mental health respond to disruptions at the scale of those generated by the COVID-19 pandemic. Additionally, very little has been written on actual res
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