Rehabilitation During a Pandemic: Psychiatrists as First Responders?

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Rehabilitation During a Pandemic: Psychiatrists as First Responders? Jeremy Cave

. Matthieu Crews

Received: 25 September 2020 / Accepted: 1 October 2020 Ó Springer Nature India Private Limited 2020

Abstract The South London and Maudsley Community Rehabilitation Psychiatry team aims to provide long-term and holistic care to patients with enduring mental illness. This letter concisely outlines our response to the coronavirus pandemic, including the standard operating procedure we introduced and, at a trust level, the changes made to clozapine monitoring. We were surprised by the expectations of our patients during the pandemic: we found that unwell patients or their carers would contact our service first, ahead of 111, primary care or emergency services for advice and treatment. In response, we took on a deliberative first-responder role. Perhaps this is to be expected for a specialty that provides holistic long-term care to its patients. We think this is of interest to other mental health teams, primary care, community psychiatry teams and the lay reader. Keywords Psychiatry  Rehabilitation  Clozapine  Primary care  Covid-19  Holistic care

Community Rehabilitation Psychiatry aims to provide long-term, holistic, recovery focused care to patients

J. Cave (&)  M. Crews South London and Maudsley NHS Foundation Trust, London, UK e-mail: [email protected]

with chronic mental-health conditions struggling with their social and personal functioning [3]. The South London and Maudsley High Support Rehabilitation Team serves 120 patients within the densely populated London borough of Southwark and responded to the challenges posed by Covid-19 at a team and trust level. Generally our patients live in supported or residential placements, require higher-risk medication such as clozapine or augmented antipsychotic strategies and suffer poor physical health. Self-neglect and isolation are significant risks and a key part of our work is encouraging patients to attend primary care appointments and bringing together services in support of their recovery and inclusion. For these reasons, Covid-19 poses a particular challenge to our cohort. Living in communal settings they are more likely to contract the virus and with multiple co-morbidities they are more likely to die if they become unwell. They require support to seek help, follow national guidelines and organise their medication and meals during isolation. For those on clozapine Covid-19 poses a diagnostic challenge with symptoms mimicking complications such as agranulocytosis and myocarditis. Routine white cell count monitoring and urgent blood counts for those unwell pose a transmission risk between staff and other patients. Notably, we have found during the current pandemic that unwell patients or their carers would

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J. Psychosoc. Rehabil. Ment. Health

contact our service for advice ahead of 111, primary care or emergency services, perhaps reflecting the close trust they place in our team to support them through difficulty. Anticipating the