By Professor Rael Strous, Medical Director, Mayanei Hayeshua’s Mental Health Centre
According to a recent article in the British Journal of Psychiatry, Covid-19 has highlighted technical and ethical challenges for psychiatry. The co-author, Professor Rael Strous, Medical Director of Mayanei Hayeshua’s Mental Health Centre, poses several critical questions: How should the psychiatrist protect the needs and rights of the mentally ill while maximizing population health? In the new uncertain world of Coronavirus, how do we balance the challenges facing epidemiologists, public health and infectious disease specialists, with the needs of the psychiatric field?
At the public health level, priority is rightly being given to slowing or halting the progress of Covid-19. However, there is also a ripple effect from a mental health perspective. There are identifiable consequences resulting from the sudden marked change in routine, fear of loss of life, generalized anxiety and economic effects.
We need to find a trade-off between raising awareness of Covid-19, versus the increased stress that this awareness inevitably causes. The media constantly streams updates of international statistics from the novel virus but who is measuring the numbers of morbidity from anxiety and enhanced obsessive behavior? Professor Strous suggests including a mental health professional at the national decision-making level to ensure that media minimizes anxiety, while maintaining hope and maximizing compliance with regulations.
Should individuals with mental illness be coerced into psychiatric hospitalization, when the only danger that they pose is their refusal to respect isolation or maintain quarantine? Professor Strous suggests that the extreme measure of involuntary hospitalization should be restricted solely to patients who pose an immediate and serious Covid-19-related threat.
The Covid-19 outbreak poses several challenges for psychiatric administrators. What should be done with patients residing in hostels and other non-hospital settings? Ideally facilities should arrange a way to logistically enable patients to remain in their familiar environment. If this is not feasible, suggests Professor Strous, it is desirable that some of these patients be provided with temporary alternative living solutions. Furthermore, there is a case for setting up specialised psychiatric wards for the management of patients requiring psychiatric hospitalization who also require quarantine.
Psychiatry can contribute much to the discourse and community management surrounding the virus onslaught. There is no doubt that the pandemic has brought the conflict regarding the individual’s rights versus the communal good in “protecting the many” into sharper focus. The psychiatrist needs to contribute to this discourse while ensuring solidarity, reciprocity and community health for all.