World Social Psychiatry

INVITED COMMENTARY
Year
: 2020  |  Volume : 2  |  Issue : 2  |  Page : 74--75

World Association of Social Psychiatry Position Statement on Coronavirus Disease 2019 Pandemic: A Commentary from Lockdown in London


Thomas KJ Craig 
 Emeritus Professor, Social Psychiatry, King's College London, Past President of the World Association of Social Psychiatry (2013–2016)

Correspondence Address:
Prof. Thomas KJ Craig
Social Psychiatry, King's College London




How to cite this article:
Craig T. World Association of Social Psychiatry Position Statement on Coronavirus Disease 2019 Pandemic: A Commentary from Lockdown in London.World Soc Psychiatry 2020;2:74-75


How to cite this URL:
Craig T. World Association of Social Psychiatry Position Statement on Coronavirus Disease 2019 Pandemic: A Commentary from Lockdown in London. World Soc Psychiatry [serial online] 2020 [cited 2020 Nov 30 ];2:74-75
Available from: https://www.worldsocpsychiatry.org/text.asp?2020/2/2/74/292114


Full Text



The World Association of Social Psychiatry position statement on the coronavirus disease 2019 pandemic is an important call for collaboration and sharing of information and advice across all member societies and social psychiatry colleagues worldwide.

Many countries, including the one I write from, are slowly emerging from lockdown and with that, perhaps about to uncover the greatest psychosocial impact of the pandemic. To this point, the major burdens have been the fear of contagion, nowhere more acute than among front-line medical and nursing colleagues who have had the closest contact with the most ill patients with no recourse to therapies of proven efficacy and intermittent shortages of protective equipment. On top of this traumatising exposure, some health-care workers, including ambulance drivers have also been identified as “disease carriers,” facing stigma and onslaughts from terrified members of the public. The redirection of health service effort toward dealing with the pandemic has taken attention and resources away from all the other health conditions to the extent that, for example, representatives of our professional bodies, National Health Service England, and government ministers have joined in public campaigns to remind people to seek help for urgent medical and psychiatric conditions as numbers of strokes and heart attacks presenting in emergency departments have decreased as people avoid contact with a hospital for fear of the virus. No-one really doubts that the lockdown, with a curtailment of social contact, will have been bad for mental health. However equally, no-one really doubts that what is to follow may be worse. The economic hit has been staggering, estimated at trillions of dollars dwarfing anything seen in the economic crisis of 2008/9. The impact is almost certain to be the worst in low-income countries.

Horrible as this phase of “lockdown” has been, it has also led to some positive changes that might be built on going forward. It has shown, for example, the potential of digital communication both for business and pleasure. Anyone with reasonably fast broadband can meet in ways far exceeding what was possible just 5 years ago. Businesses, public sector organizations, university and teaching establishments lead the way, but small charities and groups of friends worldwide also regularly talk, sing in virtual choirs and play games together. As we move into postlockdown, many people are speculating on how the office/home life may change with work from home becoming the norm. In the UK, there has been a proliferation of webinars aimed at clinicians. One of these, of 8 h in the evening and spread over 4 days, was set up by a local psychiatrist and attracted attendees from around the country. The content was a mixture of physical and mental health updates given freely by leading physicians and psychiatrists and pharmacists covering topics from the presentations of the disease through adjustments to prescribing, administering, and monitoring psychotropic medication. From the University perspective, similar use of videoconferencing has been extended to seminars and teaching at undergraduate and postgraduate level with a massive effort to prepare material that is suitable for distance learning – something that has long been talked about but with a surge in production in recent weeks. However, above all these has been the opportunity to share practical knowledge – how do you manage a manic patient with the virus on a ward with other noninfected patients and staff? Is everyone forced to remain as inpatients in lockdown even when they are well enough to have periods of leave from the hospital? What are the legal consequences? As it turns out, no one really knows for certain so we discuss and document our solutions.

Another digital development that has been necessitated by lockdown, is increased use of telephone and videoconference delivery of psychiatric care and treatment. Previous meta-analyses of delivering psychotherapy remotely in this way already established that patients are generally satisfied with this approach and that therapy outcomes are comparable to face-to-face contact. The stumbling block to widespread use has been largely skepticism on the part of clinicians but who, now forced by circumstance, are open to including these measures in routine care and may continue to use this technology even after lockdown. Interesting experiments to test the approach for posttraumatic stress disorder are ongoing. Of course, there will be patient groups who are unable or unwilling to adopt this technology, particularly the elderly, those with a learning disability and some with psychotic disorders, but for the most common disorders, these and guided self-help may offer new ways forward.

Whether or not the expected flood of referrals for mental health care will emerge is to be seen. However, in anticipation, we can also build on what has been another positive feature of the lockdown. Paradoxically, here in London, local confinement has resulted in an expansion of neighborliness with offers of emotional and practical support from friends, neighbors and families, and volunteer organizations collecting supermarket shopping for vulnerable elderly or contributing to local food banks.

The pandemic experience has given many of us the opportunity to reflect on a slower pace of life, to appreciate the improvement in air quality and reduction in road traffic that has brought some impetus toward future management of the environmental problems that are so clearly ahead if we continue to ignore the warnings of environmental scientists and so sleepwalk to the next crisis much as we all did to the threat of viral pandemics, equally well predicted and ill-prepared for.

To conclude, we live in a world that is better connected than at any time in our history-making it far easier to support one another and share experience and knowledge of this new virus and its impact on our patients and society. Regional webinars that bring together psychiatrists and colleagues in physical medicine is an excellent way to share experience and expertise that could go a long way toward improving the standing of our specialty and build important links for future collaborations in training and research.