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Mental/behavioural healthcare / Quality improvement

Mental health unit design flawed in COVID-19 containment, warns College

By Andrew Sansom 22 Apr 2020 0

The COVID-19 crisis sweeping across UK care homes could be replicated in mental healthcare unless access to testing kits and PPE dramatically improves, the Royal College of Psychiatrists (RCPsych) has warned, with one faculty chair highlighting how the design of mental health units is not conducive to containment of the disease.

Thousands of psychiatrists and frontline staff are still treating people with mental illness face-to-face, either in the community or in inpatient settings – such as specialist eating disorder units and liaison services – and are at increased risk of contracting or passing on COVID-19. 

The College’s warning comes as its national survey found only half of psychiatrists were able to access testing kits for themselves (51 per cent) or their patients (54 per cent), while less than one in three (30 per cent) confirmed they can obtain tests for family members.

Dr Agnes Ayton, chair of the eating disorders faculty at the College, said the way that many mental health facilities are designed creates added risks of the disease spreading.

“Mental health units were ill-prepared to cope with this pandemic as they’re not designed to contain a highly contagious disease,” she said. “Our buildings are often crammed with shared computers and offices. Waiting rooms and shared facilities in inpatient settings also makes it difficult to reduce the risk of transmission. 

“New patients are arriving for life-saving treatment and we don’t know if they’re carrying coronavirus as we’re unable to test them. We need to be able to access tests if we’re to try to mitigate against COVID-19 among our workforce.”

Professor Wendy Burn, president of the Royal College of Psychiatrists, added: “The findings of our survey are deeply worrying, with many psychiatrists unable to test their patients or themselves in line with official advice. Without access to testing kits and the right protective equipment, I fear we could see a care home-style crisis sweeping through mental health units, with many patients and staff contracting the virus.

“Care homes have been left behind during the pandemic. The Government must ensure the same does not happen to mental health services.”

Despite official guidance that psychiatrists and frontline mental health workers should have access to protective equipment, the results of the survey also show: 

  • nearly one in four (23 per cent) psychiatrists in the UK don’t have access to the correct PPE;
  • Scotland (29 per cent), Wales (28 per cent) and Northern Ireland (26 per cent) are worse than the overall UK figure on PPE access; and
  • more than one in five (22 per cent) psychiatrists in England are working without correct PPE.

“A patient with or at risk of contracting COVID-19 is the same in all healthcare settings and they should be treated the same,” said Dr Adrian James, registrar of RCPsych. “Not all our buildings are set up to withstand infection control and we’re hearing some real fear from our frontline psychiatrists, who are putting themselves and their families in danger every time they go to work. 

“Government must urgently address the need in mental health services to ensure staff and patients have the protection they need from the virus.”

Several written responses to the survey from psychiatrists working on the frontline testify to the critical situation in which they find themselves. 

One wrote: “Last week we did CPR on a patient who had hung themselves with no fit-tested PPE”; another commented: “There are extreme shortages of PPE and most of us are at risk. Only very limited supply is obtained and most of the time frontline staff are refused, risking their lives. Staff are terrified and afraid.” 

And in another instance, a respondent wrote: “Spitting [among] COVID positive patients is a real issue, and not able to get the appropriate PPE; social distancing impossible in inpatient settings.”

Nearly 1700 members responded to the survey, which was circulated over three days last week. Questions were asked on access to PPE, testing kits, duties undertaken at work, time-off during the pandemic, and delays in implementing the Mental Health Act.

Organisations involved