What’s the psychiatrist’s role in the COVID-19 outbreak?

As the COVID-19 pandemic rapidly escalates, individual and community-wide stress levels have increased. Psychiatrists’ unique blend of medical and mental health expertise uniquely places them to shape and support individual and community responses.

Pandemic concerns are a significant stressor, particularly for those susceptible to mental illness. Those vulnerable to anxiety and depression may have elevated risk of relapse. Factual, consistent, emotionally balanced and sensitively delivered information will help inform patients without undue or inadequate alarm. Advising people to screen information sources and not excessively monitor the news is prudent. Undue hypervigilance adds to stress and may affect the sleep cycle – adversely affecting the immune system (Haspel et al., 2020). Patients and the community should be made aware of the link between stress, sleep and immunity.

Rarely, catastrophic emotional reactions may arise from news of being infected or being at high risk of exposure. In the extreme this can lead to suicidal ideations and behaviours (Liu et al., 2017). Contingency planning for appropriate emotional support and risk containment is needed prior to health system overload. Patients with a history of suicidal ideations appear to be at higher risk (Liu et al., 2017), and it may be appropriate to target emotion support to this group when informing them of viral exposure. Importantly, front-line medical staff such as anaesthetists and intensivists will need access to mental health supports given the huge strain upon them. There is a special role for psychiatrists offering such support to them through telemedicine. Reducing ‘burnout’ in front-line intensive care staff will likely make a material impact on service sustainability.

Existing patients with paranoid disorders or germ phobias may be particularly at risk from the stressor of pandemics. Such patients may require more frequent review and supportive psychotherapy. For patients with paranoid illnesses, exploring for impacts of the pandemic on any delusional belief systems is prudent. Subclinical cases may ‘tip over’ into clinical problems. Anxiety and hypervigilance can mimic paranoid states, so detailed assessment is needed. Delineating normal spectrum reactions from those merging into psychotic processes needs expert assessment. Many people will have an adjustment disorder overlay during the pandemic – with health, economic and civil unrest stressors all potentially involved. Support until the underpinning stressors are resolve is needed.

At a population health level, psychiatrists can help inform public health approaches. Somewhere between denial and panic is a reasonable adaptive level of concern – facilitating active coping and reasonable measures. As social distancing and quarantine measures expand, the impact of social isolation on depression risk also needs to be considered (Leigh-Hunt et al., 2017). In tandem with the roll out of social distance measures, there is need to mitigate adverse impacts of social isolation. While social media can spread panic, the opportunity is it can help spread support and reasonable measures. Crowding out low-quality channels with quality ones is a public mental health opportunity. Wide access to telemedicine also offers opportunity to remotely deliver supportive psychotherapy.

By late-2020 the full extent of the COVID-19 pandemic will be clearer. There is value to the community by psychiatrists being proactive in this pandemic, engaging patients, colleagues and the wider community.