Dear Victorian Branch Members,
At this time our thoughts and best wishes are with you, your families, your colleagues and your patients. It is a particularly challenging time, with marked physical and existential challenges for us all. We need to rapidly change how we work with people, in various contexts, that frequently seem to lag what we feel is necessary or timely.
There was a recent email from College President Associate Professor John Allan, regarding the bi-national arm of the RANZCP response to COVID-19. This covered a range of key updates on the bi-national response, training issues, CPD, and private practice. We would also like to direct to you the RANZCP information page on COVID-19 – which is frequently updated.
This eBlast is aimed at local issues and resources, and is an opportunity for us to draw particular attention to the key issues we are all facing in our day-to day-work.
Severe mental illness, risk factors for severe illness with COVID-19, and how these intersect in our most vulnerable patients.
We are all aware that with the current undercurrents of anxiety, and stress within our community we are seeing increased anxiety throughout the population. In people with pre-existing mental health problems this may lead to an increase in pre-existing symptoms, or a relapse of treated disorders. We are already seeing increases in COVID-19 related sleep disturbance, anxiety and psychotic symptoms.
Many people we see are likely to be at increased risk from the emotional challenges facing us as we become increasingly separate at a time of enormous existential threat. Alongside the general increase in physical, social and emotional stressors we will see, there is a well recognised association between stress-response acute adjustment disorders and suicide, and we are likely to see the precipitation of new suicidality or worsening of pre-existing suicidality. Completed suicide rates are likely to rise in our community as a result of this. The economic impact of COVID-19 further threatens the mental health and well-being of our entire community.
While the evidence is still preliminary, an analysis of risk factors for severe illness with COVID-19 indicate a large number of factors that we know are already far more prevalent in people with severe mental illness (SMI), and are already some of the key contributors to the large life expectancy gap seen between people with SMI and the general population. This list includes:
- age ≥ 65
- cardiovascular diseases
- diabetes mellitus
- chronic lung disease
- chronic kidney disease
- being a heavy smoker.
Based on this list of risk factors, and its intersection with the physical health issues we know are more prevalent in the people we treat, one would have to think that we will see far greater deaths in people with SMI than in the general population from COVID-19. This risk is likely to be compounded in people with poor ADLs secondary to their illness, and people with poor executive functioning. For example, many people with schizophrenia, intellectual disabilities, substance use, etc. At the same time, as these risks exist, their usual supports have been drastically decreased due to being seen as non-essential services, or to decrease risk to the providers of these services.
We are currently advocating around this issue within the public health system, but we know there are more people with SMI in Victoria being seen outside of the public mental health system than within it.
On an individual level each of us can keep this in mind, and as many of us have already been doing, provide basic public health services to our patients on each review (be it remotely or in person as is necessary). This includes education on basic hand hygiene and social distancing, helping people to identify their own risk factors for severe disease, providing advice to self-isolate in a person identified as high risk, and providing support to problem solve self-isolation where required. It also may include education about smoking as a risk factor and providing information, or linkages to a GP to help quit or cut down as the individual desires.
Finally, there is evidence of likely increased rates of domestic violence and substance abuse at these times. Please keep this in mind when reviewing and assessing people.
The aim has to be to maintain good psychiatric treatment, ensure continuity of treatment, even if that focuses on pharmacotherapy and maintenance of prescriptions, and to support physical distancing while we identify opportunities for social supports and connectedness for our patients.
As we rapidly move to telehealth for all appropriate consultations, this leads to a number of new challenges for us. There are currently some resources available on the college website, but these are now dated, and are in the process of being reviewed and updated. There will be a new webinar on tele-psychiatry, that is currently in the planning and preparation stages. In the interim we would suggest this free guide. The Department of Health’s temporary telehealth bulk-billed items for COVID-19 can be accessed here.
We are currently scoping further measures which would be useful to support Victorian members. This may include the development of tools and resources to support your clinical practice, for example, a tele-psychiatry readiness audit tool. It is our intention, pending approval, that if this was completed prior to implementing practice changes/training/learning it could then be completed again at a later date as a means of reviewing improvements in the delivery of telehealth, and potentially claimed as a practice improvement activity. This may be one way in which we can potentially support people to complete CPD requirements at this difficult time, and in a manner that is relevant and helpful to your clinical practice.
Please let us know via firstname.lastname@example.org if this would be a helpful measure to support your clinical practice at this time. Further suggestions as to how the Victorian Branch can support members to implement telehealth are also welcomed.
Support for members
This is a rapidly evolving situation that is presenting personal and professional challenges and difficulties in a rapidly evolving manner. It remains paramount that we continue to support each other and our colleagues. If there are things you feel that the Branch should be aware of, or act on, please feel free to contact us. This can be done via email@example.com or for Policy and Advocacy matters you can contact our Policy and Advocacy Advisor, Lily Edwards on firstname.lastname@example.org.