The first cases of covid-19 were reported in the city of Wuhan, Hubei province, China, in December 2019 and the city was quarantined on 23 January 2020. After almost three months in lockdown, restrictions in the city were eased. While the outbreak was at its peak, more than 42,000 medical workers and tons of medical resources were dispatched to Wuhan from other regions of China, and sixteen makeshift hospitals built to support the infected patients. [1,2]
Infections have been stemmed during the lockdown, and the focus is moving to addressing the psychological distress brought about by the pandemic.
In February, China’s National Health Commission (NHC) published emergency plans to deploy psychological crisis intervention teams involving more than 300 mental health professionals from other provinces to Wuhan.
There are 46 designated hospitals for patients with moderate and severe covid-19 symptoms in Wuhan and 16 sheltered hospitals for patients with mild symptoms, each with 200 to 1600 beds. Every medical unit within these hospitals has been allocated a designated crisis intervention team of five mental health professionals to assess and address the psychological needs of patients and staff.
As one of the psychological crisis intervention teams based in Wuhan 7th hospital and Wuchang sheltered hospital, we would like to share our clinical observation and our proposed enhanced strategies, based on our experience in Changsha, Hunan Province, to improve access to local mental health care for the large numbers of patients and healthcare workers in need.
First, online mental health self-assessment can be utilised in wards, and those patients scoring above the cut-off point offered online consultation advice and support. Some patients (e.g. older people and those in poor health) may not able to complete the online self-assessment, so brief mental health training should be provided to equip front line healthcare workers with the skills to identify patients with major mental health issues. Front line healthcare workers also experience much distress when caring for critical patients with respiratory failure so this mental health training should incorporate skills on self-care to enhance their own mental health resilience.
Second, mental health professionals should work with the ward staff as an integrated team, participating in their regular meetings, morning rounds and other daily clinical routines. This allows patients who need mental health assessment or intervention to be referred promptly and the development of more holistic patient care plans taking into account both physical and mental health needs with input from different medical disciplines. At the same time close collegial collaboration can enhance the mental wellbeing of ward staff and any of their mental health needs addressed in a safe and trusting environment.
Third, patients should be stratified and provided with flexible and efficient mental health support.
For a large number of patients with mild covid-19 symptoms in sheltered hospitals, group interventions could be used to alleviate psychological distress. For example, in the sheltered hospital under care of the traditional Chinese medical team, Tai Chi and Eight Section Brocade (an ancient Chinese fitness practice) have been integrated into the daily ward routine for most patients. Such mindful-movement training helps patients to increase their awareness of their own negative emotions and reduce panic and unwarranted anxiety. [3]
Exercise as a type of psychological intervention may not be suitable for patients with moderate to severe symptoms isolated in cubicles in designated hospitals. Psycho-education on enhancing mental health resilience can be provided to these patients via online apps, televisions or media broadcast inside wards. Practical tips to alleviate their sense of isolation should be offered, such as connecting with families and friends by telephone and online, and use of cognitive-behavioural techniques to maintain a positive outlook.
Practical accounts of psychiatric consultation and psychological intervention related to covid-2019 focusing on the management of common mental health issues (eg, depression, anxiety, adjustment disorder), psychotic symptoms and abnormal grief responses among patients have been shared informally online, but a formal online sharing and evaluation system would be useful to help address mental health issues at different stages of the epidemic more effectively. [4,5]
We hope these reflections from our team could provide some practical tips for mental health professionals from both within and outside China on combatting mental health sequelae of the covid-19 infectious outbreak.
Yumeng Ju, doctoral student, department of psychiatry, the Second Xiangya Hospital, Central South University, Changsha，Hunan, China
Roger MK Ng, Chief of Service and Consultant Psychiatrists, department of psychiatry, Kowloon Hospital, Hong Kong SAR, China
Yan Zhang, professor of psychiatry, department of psychiatry, the Second Xiangya Hospital, Central South University, Changsha，Hunan, China
Lingjiang Li, Professor of Psychiatry, department of psychiatry, the Second Xiangya Hospital, Central South University, Changsha，Hunan, China, and Mental Health Institute of Central South University, China
- Daily picture of the patients in the shelter hospitals in Wuhan. https://culchinanewscom/gn/2020/02-25/9103882shtml (assessed Feb 26, 2020).
- Press conference of joint prevention and control mechanism of the State Council on February 29, 2020. Introduction of treatment and rehabilitation in patients with COVID-2019. http://wwwnhcgovcn/xwzb/webcontrollerdo?titleSeq=11248&gecstype=1 (assessed Feb 29, 2020).
- Diagnosis and Treatment plan for the novel coronavirus disease (COVID-2019). http://wwwnhcgovcn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989shtml (assessed Mar 04, 2020).
- Si T, Wang G, Chen J, Chen Y, Li Y, Li L, Li W, Li X, Liu Q, Liu L, Liu Z, Ma H, Shi C, Su Y, Tian C, Jun T, Wang C, Wang G, Wang H, Xi Y, Xie B, Yang C, Yu X, Zhao X. Treatment of Mental Disorders Related to Coronavirus Disease 2019. People’s Medical Publishing House Press, Feb, 2020.
- Hu S, He B, shi C, Liu Z, Chen J, Hu J. Practical Handbook of Psychological Intervention Related to Coronavirus Disease 2019. Zhejiang University Press, Feb, 2020.