Mental Health during COVID-19
Module created May 2020
The COVID-19 outbreak has been affecting everyone differently. The way the health service operates has been overturned with most primary care consultations being held remotely via telephone or video link. There have been concerns from health care professionals about the decrease in patient contacts regarding non-covid related illness and the knock on effect this outbreak may have on the general health of the population with chronic disease and acute presentations (eg myocardial ischaemia or stroke).
There is furthermore a reluctance amongst a large section of the patient population to be admitted to hospitals with emergency or acute conditions. Emergency departments are reporting a 50% drop in presentations and acute services for cardiovascular disease are reporting a similar drop in acute presentations. Hospital beds have a 50% occupancy and there is currently a physical overcapacity in the system. That said, modelling for a second spike of covid cases predicted for November and December has highlighted a possible capacity issue coinciding with the winter flu season.
During October we had Mental Health Awareness week. This provided GPs with a reminder about the importance of mental health and emphasises the need to reflect on how we are supporting all of our patients’ mental health during these troubled times. Practices will have a register of patients with significant mental health conditions and there should be regular follow up of these patients as well as medication reviews. In the chaos of reconfiguring regular practice life, it is inevitable that some things will be postponed and some practices are relying on patient contact or adopting a more opportunistic response to reviewing such patients.
Anecdotal evidence from discussion with colleagues across South Wales reveals a reported decrease in contact of new patients with mild to moderate depressive symptoms. There have been a number of previously stable patients asking to increase or restart antidepressants due to worsening symptoms. Many report the number of contacts with patients with severe mental health problems such as psychosis and bipolar effective disorder have decreased. A recent report on the BBC highlighted an old age psychiatrist who said ‘our patients appear to have evaporated’ blaming patients being too fearful to seek help at this time. The survey of 1300 mental health doctors reported a 45% decrease in routine appointments. Full data is not yet known. Voluntary services have also been affected with all face-to-face support such as counselling and group meetings being cancelled as a result of the lockdown. Despite this, Cardiff and Vale out of hours service saw their percentage of mental health related calls double this April compared to the same month in 2019 and this percentage is already higher for May.
In primary care many new mental health problems present with another symptom, such as palpitations, headache, poor sleep etc. The underlying psychiatric diagnosis must be skilfully unpicked from the presenting complaint by the practitioner. Often patients may see if they trust the doctor enough with their handling of a minor physical complaint before opening up about their mental health concerns. These opportunities are now not available as the public is being reminded constantly to only seek medical help if it truly cannot wait, many putting things off for fear of exposure to covid-19. There is currently a publicity campaign asking patients to present despite the crisis.
This module has been written by Dr Mary Robathan, a GP Appraiser within RSU.