COVID-19 ADDS PRESSURE TO PERSISTENTLY WEAK MENTAL HEALTH SERVICES IN
South Africa’s already strained mental healthcare services now face increased numbers of patients relapsing on treatment along with rising new cases due to the stresses of the COVID-19 pandemic, while many psychiatric patients are at higher risk for COVID-19 due to co-morbid diseases and difficulties in following preventative measures such as mask wearing and physical distancing.
In a statement released today, the South African Society of Psychiatrists (SASOP) urged public and private healthcare providers to maintain the availability of beds for psychiatric patients as they work to build a large hospital bed network to cope with the disease outbreak.
Dr Kagisho Maaroganye, SASOP board member and public sector national convenor, says that against a background of a chronic psychiatric bed shortage and lack of psychiatric medication in the district health system to treat, manage or contain relapsed or new patients, there is no adequate plan in place to support mental health patients during the pandemic.
“The twin peaks of an increased rate of COVID-19 amongst psychiatric patients and increased incidence of relapses and new psychiatric cases, is bound to have these two distinct groups of patients arriving at psychiatric facilities at the same time, and possibly in large numbers,” he said.
Dr Maaroganye warned that accommodating COVID-19-positive psychiatric patients in the same ward as psychiatric patients not suspected of having COVID-19 would be “unacceptable, for both ethical and humanitarian reasons”.
This would be contrary to the National Department of Health’s COVID-19 Infection Prevention and Control Guidelines (Version 2 issued 21 May 2020), which state that ‘Confirmed or suspected patients with COVID-19 not requiring ICU care should be accommodated either in a single room or in cohort isolation.’
“The correct assumption that anyone could have COVID-19 even without symptoms, should not negate or diminish the sound ethical and legal basis for this stance by the National Department of Health.”
He argues that the long-standing critical situation in state mental health hospitals is exacerbating the crisis, while psychiatric patients are far more at risk of contracting COVID-19 than the general population due to their high levels of co-morbidities.
“The lifestyle of those suffering from mental illness increases their risk and the most frequent co-morbidities include diabetes, hypertension, obesity, smoking, and addiction. These medical conditions not only escalate the risk of contracting COVID-19 but also the risk of mortality once infected.”
“Psychiatric patients have for many years suffered from a minimal allocation of national healthcare resources to meet their needs and now, at a time that they are most vulnerable, they cannot once again be denied the rights afforded to medical and surgical patients for whom such mixing of patients would hardly be considered.”
Dr Maaroganye said mental healthcare services were already burdened by crowded living conditions in psychiatric hospitals with shared dining and bathroom spaces, and are poorly-equipped especially when it comes to protective equipment.
He said that ongoing delays in implementation of sound policies such as the National Mental Health Policy Framework and strategic plan (2013-2020) as well the findings of the SA Human Rights Commission following the Life Esidimeni tragedy have created a “further misfortune in that government has not taken the time to address widely-known shortcomings that would have assisted in building resilience of the mental health care system before COVID-19 landed on our shores”.
SASOP urges the National Department of Health, provincial departments of health and private hospital groups not to use psychiatric beds for non-psychiatric COVID-19 patients in their drive to build a stronger hospital bed network, due to an already acute shortage of psychiatric beds.
In light of the current situation SASOP recommends a number of steps that should be taken by health authorities and mental health care providers during this pandemic:
1) Heads of health establishments, healthcare providers, multidisciplinary mental health specialists and informal caregivers should continue to render mental health care services throughout the pandemic, as is their duty.
2) Psychiatric patients infected with or suspected of having COVID-19 and needing high care or intensive care (eg, ventilation) should be transferred to a medical facility without delay.
3) In anticipation of more psychiatric patients acquiring COVID-19 and/or relapsing from pandemic-associated stress, the capacity to accommodate psychiatric patients during this pandemic should be attended to with urgency and immediately.
4) The opening up of more psychiatric beds could be facilitated through a number of means including:
Fast-track the licensing applications of NGOs that can accommodate users with profound and severe intellectual disability in order to free up acute or specialist psychiatric beds.
Re-procurement of contracted beds at larger long-term facilities that can house users with complex mental illnesses with risk factors that cannot be contained in the community.
Immediate inspection of all hospital facilities to search for underutilised wards (eg, TB wards that are no longer needed as more and more patients respond favourably to ARVs).
Along with infrastructure improvement, more psychiatric staff should be pre-emptively hired to help current staff cope with the expected influx.
Any decision to close an acute psychiatric ward should not be haphazard as this may lead to creation of a COVID-19 ward which lies unused. Rather, one hospital within a region should become a near-complete COVID-19 hospital, accepting COVID-19 patients from nearby hospitals so that other non-COVID-19 conditions can continue to be treated.
Government must engage the private sector to assist in addressing any shortfalls in hospital bed capacity.