Emeritus Professor of Psychiatry, University of Ioannina, Ioannina, Greece.
Professor of Social Psychiatry, Panteion University, Athens, Greece.
Psychiatriki. 2022 Jun 10;33(2):101-104. doi: 10.22365/jpsych.2022.081. Epub 2022 May 18.
The psychological impact of pandemics, which historically appear in the human species, is described in detail in Steven Taylor's excellent book "The Psychology of Pandemics",1 which was published in 2019, a few months before the outbreak of the Covid-19 pandemic. This pandemic shows similar characteristics in terms of mental health problems to the previous ones described in the book, according to the findings of epidemiological research, both internationally and in Greece.2-5 The results of these studies show a significant increase of the prevalence of common mental disorders, especially in vulnerable groups, particularly in persons with preexisting mental disorders. The necessary restrictive measures applied, especially in the first stages of the pandemic, had an impact in the accessibility of psychiatric patients to the mental health services, both in- and outpatient ones.6 This led to decreased outpatient appointments and admissions in inpatient wards, depriving a large number of these patients from necessary treatments and interventions, often resulting in worsening their mental state or relapse of acute episodes. The lack of accessibility to mental health services, had a greater impact on persons with social and financial problems, which deteriorated during the pandemic, leading to mental health problems.3 An additional problem is that persons suffering from severe mental disorders, such as chronic psychoses, face a greater risk of infection and death by Covid-19.7 These problems, arising during the pandemic (increased prevalence of mental disorders, increase of relapses of serious mental disorders, increased risk of infection and death by Covid-19, increased prevalence in those infected, especially those in the ICUs, problems of accessibility) underline the chronic insufficiencies of the mental health care system, which in many countries, especially in Greece, is fragmented and is not covering adequately the mental health needs of the population. A series of articles in prestigious mental health journals point out the problem and propose solutions, in order to correct insufficiencies and create a new strong mental health system through a series of activities.8-10 These articles underline the problems known for decades and propose the following solutions for enhancing the existing mental health system, not only to cover additional needs created by the pandemic, but leading to a new mental health system covering adequately the needs of the population: (1) Strengthening leadership and governance, with interventions to politicians and administrators, in order to understand mental health issues, and provide services in terms of inclusivity, equity and accountability. (2) Supporting financially evidence-based services, adopting policies to counteract the social determinants of mental health, as well as the additional needs created by the pandemic. (3) Promoting programmes targeting vulnerable groups, especially those related to social determinants, with the active participation of stakeholders, with emphasis in combating stigma and enhancing mental health literacy. (4) Strengthen mental health services in all three levels, with emphasis in community mental health services, treatment at home, special services for vulnerable groups, services for the Covid-infected and the relatives of the deceased from the infection, the staff of health services dealing with Covid-19, using "telehealth" services, adopting information systems to assist services and close collaboration with the services dealing with Covid-19. (5) Training the staff of primary health care in mental health by using the mhGAP programme of the World Health Organization (WHO) and linking them to the special mental health services. (6) Implementing programmes for mental health promotion and prevention of mental disorders, with the participation of stakeholders, NGOs and the civil society. (7) Improving mental health information systems and connecting them with parallel systems dealing with Covid-19. (8) Strengthen and finance research in mental health, from epidemiology and services research, to neurobiology, as well as research aiming to provide innovative solutions for improving the system of mental health services and the provision of services and interventions through the social media. (9) Protecting rights of mental patients aiming to provide high quality services by use of evaluation instruments such as WHOQualityRights of WHO.
大流行对人类的心理影响在 Steven Taylor 的优秀著作《大流行心理学》中有详细描述,该书于 2019 年出版,就在新冠疫情爆发前几个月。根据国际和希腊的流行病学研究结果,这场大流行在心理健康问题方面与书中描述的前几次大流行具有相似的特征。2-5 这些研究结果表明,常见精神障碍的患病率显著增加,尤其是在弱势群体中,特别是在有先前精神障碍的人群中。在大流行的最初阶段,采取的必要限制措施对精神科患者获得精神卫生服务的机会产生了影响,包括门诊和住院服务。6 这导致门诊预约和住院病房入院减少,使许多这些患者无法接受必要的治疗和干预,往往导致他们的精神状态恶化或急性发作复发。由于缺乏精神卫生服务,社会和经济问题严重的人受到的影响更大,这些问题在大流行期间恶化,导致了心理健康问题。3 另一个问题是,患有慢性精神病等严重精神障碍的人感染和死于新冠病毒的风险更大。7 这些问题(精神障碍患病率增加、严重精神障碍复发增加、感染和死于新冠病毒的风险增加、感染人群中患病率增加,尤其是 ICU 中的人群、服务可及性问题)突显了精神卫生保健系统的长期不足,在许多国家,尤其是在希腊,该系统分散且不能充分满足人口的精神卫生需求。一些著名的精神卫生期刊上的一系列文章指出了这个问题,并提出了一些解决方案,以纠正不足,并通过一系列活动创建一个新的强大的精神卫生系统。8-10 这些文章强调了几十年来已知的问题,并提出了以下解决方案,以加强现有的精神卫生系统,不仅要满足大流行所带来的额外需求,还要建立一个新的精神卫生系统,充分满足人口的需求:(1)加强领导力和治理,对政治家和管理者进行干预,以了解精神卫生问题,并提供包容性、公平性和问责制方面的服务。(2)支持基于证据的服务,采取政策来应对精神卫生的社会决定因素,以及大流行带来的额外需求。(3)推广针对弱势群体的方案,特别是与社会决定因素相关的方案,利益相关者积极参与,重点是消除耻辱感和提高精神卫生素养。(4)加强所有三个层面的精神卫生服务,重点是社区精神卫生服务、居家治疗、弱势群体特别服务、新冠感染者服务和感染者亲属服务、处理新冠病毒的卫生服务人员服务,使用“远程医疗”服务,采用信息系统协助服务,并与处理新冠病毒的服务密切合作。(5)通过世界卫生组织(WHO)的 mhGAP 计划培训初级保健人员的精神卫生知识,并将他们与特殊的精神卫生服务联系起来。(6)实施精神卫生促进和预防精神障碍的方案,利益相关者、非政府组织和民间社会参与其中。(7)改善精神卫生信息系统,并将其与处理新冠病毒的平行系统连接起来。(8)加强和资助精神卫生研究,从流行病学和服务研究到神经生物学,以及旨在通过社交媒体为改善精神卫生服务系统和提供服务和干预措施提供创新解决方案的研究。(9)通过使用世卫组织的 WHOQualityRights 等评估工具,保护精神病人的权利,以提供高质量的服务。
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