While the United Kingdom has the highest registered numbers of deaths from COVID-19, the early warning signals came from Italy. What lessons can we take from this pandemic to ensure we learn and be ready for the next one? What fragility in healthcare systems has the virus exposed? Many countries have been overwhelmed by the health and economic impacts of COVID-19 and our responsibility moving forward is to learn from these hard lessons.
A new viewpoint in JAMA Psychiatry authored by Giovanni de Girolamo and colleagues from the Unità Operativa di Psichiatria Epidemiologica e Valutativa details the Italian response to COVID-19. Italy’s National Mental Health System (DMHAs) is divided into 134 areas, 27 of them are located in Lombardy, one of the hardest-hit areas. In any given year, of the 60 million people living in Italy, DMHAs provide care to upwards of 850,000 people. Italy had to pivot quickly to address growing healthcare needs, including mental health in the first month of the pandemic. Hospital beds and wards were converted to care for those with COVID-19 solely; these often including patients with psychiatric needs. Many of the day facilities caring for people with mental illness had to be closed to support the social distancing measures deployed in Italy. These closures were particularly challenging as people had built the routine of going to their facility for ongoing care and now faced the prospect of being at home alone all day.
Additionally, the number of health professionals impacted by COVID-19 was twice the rate experienced in China, further straining the health system. Layering on to this complex picture was the reality that all Italians had to go into lockdown. As we have written about before, mental health needs expressed from China suggest that stress, anxiety, and insomnia were prevalent as a result of these dramatic changes in everyday life. Prison riots in twenty Italian jails over this period also added to the complexities of keeping people safe in the pandemic. Living in such proximity in prisons puts those incarcerated at higher risk of exposure.Services to support addiction medicine services were also severely impacted- doses, for example, for methadone would ordinarily be given one at the time was no longer viable, so the risk of overdose rose.
Lessons learned from these early days in Italy point to the importance of building and leveraging systems to avail of digital mental health tools. Italy also sees the need for building more robust telehealth services so patient care can continue via video visits and telephone consultations. DMHAs also have the potential to support the broader population to address the negative impacts of quarantine by making self-care tools available to people. As such, the traditional role of DMHAs needs to expand to better prepare support systems for the broader population. Mental Health leaders also recognize the next wave of need will come from their peers, doctors, nurses, first responders, and allied professionals caring for many patients in hospitals throughout the pandemic. The after-effects of that will be seen in the coming months.
The authors outline seven populations for the focus of future efforts; these include the general population impacted by quarantine, people who were quarantined due to being exposed to someone with the virus. People with the infection who could manage symptoms at home, people who were hospitalized but thankfully recovered, health care professional caring for patients, families of those who died from the virus, and those who have ongoing mental health needs. The work ahead of us is to take these hard lessons learned and translate them into strategies so future pandemics won’t be as destructive to the care systems for all citizens.
Thanks for reading – Trina
(Opinions are my own)
Mental Health in the Coronavirus Disease 2019 Emergency— The Italian Response