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This article briefly reports the experience of mental health services and the lessons learned during the coronavirus disease 2019 (COVID-19) crisis. In particular, this report offers opportunities to build on experience gained in managing the COVID-19 emergency in the Departments of Mental Health and Addiction (DMHAs) in Lombardy, the wealthiest Italian region, which has approximately 10 million inhabitants.
Italy has a National Mental Health System divided into 134 DMHAs, 27 of which are in Lombardy. In the 4 weeks after the epidemic started, important changes occurred in the management of DMHAs in Lombardy. Many challenges have occurred in the management of health services. In many hospitals, entire wards, including some psychiatric wards, have been reorganized to admit patients with COVID-19, and many physicians and nurses have been diverted to wards managing patients with COVID-19. Most day facilities for patients with psychiatric needs have been temporarily closed, whereas in residential facilities, patients who usually are free to come and go during the day have had to be confined in the facilities with very limited or no leave. These changes have produced considerable stresses on people with severe mental disorders. Many outpatient clinics have limited appointments to those with the most urgent cases, and home visits, a common practice in most DMHAs, have been drastically reduced with potentially detrimental consequences for patients’ well-being. Another potential detrimental consequence of being forced to stay at home has been an increase in the hours spent face to face with families with high amounts of conflict.
Conclusions and Relevance
Departments of Mental Health need to be equipped with appropriate e-health technologies and procedures to cope with situations such as the COVID-19 pandemic. Additionally, interventions are needed to mitigate the potentially harmful consequences of quarantine. Departments of Mental Health should be able to assume a leadership position in the psychosocial management of disasterlike situations, and this requires the acquisition of new skills, notably how to correctly inform the population about risk, train and disseminate effective preventive and management procedures for disasters, support health personnel and rescuers, and support those experiencing bereavement.
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Acceptance Date: April 1, 2020.
Corresponding Author: Giovanni de Girolamo, MD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125 Brescia, Italy (firstname.lastname@example.org).
Published Online: April 30, 2020. doi:10.1001/jamapsychiatry.2020.1276
Author Contributions: Drs Girolamo and Clerici had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: de Girolamo, Clerici, Starace, Tura.
Drafting of the manuscript: de Girolamo, Cerveri, Clerici, Spinogatti, Starace, Tura.
Critical revision of the manuscript for important intellectual content: Cerveri, Clerici, Monzani, Tura, Vita.
Statistical analysis: Tura.
Obtained funding: Tura.
Administrative, technical, or material support: de Girolamo, Starace, Tura.
Supervision: de Girolamo, Clerici, Tura, Vita.
Conflict of Interest Disclosures: None reported.
Additional Contributions: Matthew Large, MBBS, DMedSci, School of Psychiatry, University of New South Wales, and Prince of Wales Hospital Sydney, and Olav Nielssen, MBBS, MCrim, PhD, Faculty of Medicine and Health Sciences, Macquarie University, St Vincents Mental Health, provided valuable comments on the manuscript, uncompensated.
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