Dr. Susan Finnerty: The negative effects of the COVID-19 pandemic on residents and patients of mental health services10 June 2021
A new review paper examining the impacts of and response to COVID-19 in residential mental health services was published by the Mental Health Commission today. The paper – titled ‘COVID Paper II: Examining the Impacts and Response in Residential Mental Health Services’ – highlights some of the many ways residential mental health services adapted and innovated in response to the pandemic. Services across the country worked tirelessly to protect residents and staff, and this not only ensured that service delivery has been sustained but has also prevented the spread of illness and saved lives.
Unfortunately, it hasn’t all been good news for services and service users over the past year. The majority of residents and patients of mental health services in Ireland have been in some way adversely affected by the COVID-19 pandemic and the associated restrictions and lockdowns. Here I have set out some of the negative effects of the pandemic - some revealed by the findings of the COVID paper, some observed during inspections and others communicated to us by service users and their friends and families.
Illness and death
Outbreaks of the virus in residential mental health services were inevitable, particularly as many of these centres were initially unable to isolate residents or patients while they awaited test results. Many residents and patients who contracted COVID-19 became seriously ill; between March and July 2020, 69 residents were transferred to general hospitals for treatment and of, these, 16 sadly died. In addition to the impact physical illness can have on mental health, this was likely stressful for residents who witnessed many of those around them becoming unwell.
Due to restrictions around indoor gatherings, visitors were not permitted in any centres during lockdown. Family connections are important in aiding recovery and maintaining family contact is essential for support when residents and inpatients leave hospitals. These restrictions may have caused increased feelings of loneliness and isolation among residents and in-patients, in particular those in centres which could not facilitate access to communication tools such as Zoom and WhatsApp.
Decreased admissions and pressures on community services
Many approved centres were forced to reduce their admissions to be able to isolate residents and in-patients when necessary. This increased pressure on day hospitals, outpatient facilities and other community services which were already heavily curtailed due to restrictions. As quarantine and lockdown had an especially negative effect on people with pre-existing mental health problems, this means that many people were may have been unable to access the support they needed at this time.
Those who were admitted during this period were also required to spend time in isolation, either until a negative COVID test result was received, or for a 14-day period if the resident or patient tested positive. This was doubtless a very difficult experience for someone already in a state of distress who may have been entering an unfamiliar environment.
Effect on therapeutic programmes
Adaptations made for infection-control reasons have been detrimental to the therapeutic programmes of many service users. Although some therapies could and did move online, many group and in-person therapies could not continue and therapists were restricted from face-to-face meetings with their patients. Outings for elderly and long-term residents, which are so important for introducing variety and for building and maintaining relationships with the wider community, also ceased.
Throughout the pandemic, both service users and staff showed resilience and adaptability to the situation. Over time, various innovations were made that allowed service users to access increased contact with their therapists and partake in more therapies. The provision of PPE, improved infection control, more single en-suite sleeping accommodation and the introduction of vaccines has helped services move forward to provide service users with safe and effective mental health care.
As we start to open again as a society, the most pressing matters for mental health services are:
- That we continue to actively monitor and treat physical illness in people with mental health problems
- That we continue to provide single en-suite sleeping accommodation, not only for the dignity and privacy of residents but also to aid infection prevention and control
- That we build on the flexibility and responsiveness of our mental health services to provide accessible safe care, both in the community and in hospitals and residential units
- That we acknowledge the importance of family and other contacts in promoting recovery.
The COVID-19 pandemic can be seen as an opportunity to improve our mental health services. The interconnectedness of our society made it vulnerable to infection, but it also provides the means to share best practices and to learn from the experiences of others. We hope that these learnings will ultimately lead to a more efficient and equitable mental healthcare system.
Dr.Susan Finnerty is the Inspector of Mental Health Services.