Psychiatry during the Covid-19 Pandemic: a survey on Mental Health Departments in Italy

Abstract Background To date, very little knowledge is available with regard to the way in which mental health systems worldwide are facing the current global health emergency. The present paper reports the data emerging from a survey conducted to study the impact of the current emergency on the functioning of the Italian Departments of Mental Health (MHD).Methods Heads of MHDs received a 40-item multiple choice questionnaire relating to Community Mental Health Centres (CMHC) and related facilities, and a 30-item questionnaire focused on General Hospital Psychiatric Wards (GHPW). Statistical analysis was carried out by means of Chi Square test with Yates correction or the Fisher Exact test, as needed.Results: 71 questionnaires returned from the 134 MHDs (52.9%) and 107 of the 318 (32.6%) GHPWs. Less than 20%of CMHCs have been closed; approximately 25% have restricted access hours. The usual mode of operation in CMHCs changed substantially. Urgent psychiatric consultations are continuing as usual, in the same way as interventions for compulsory treatments, and prison consultations. All other activities have been reduced to some extent. Remote contacts with users have been set up in approx. 75% of cases. Cases of COVID positivity were reported amongst both staff members (approx. 50 % of CHMCs), and facility users (52% of CHMCs). 20% of CMHCs reported cases of increased aggressiveness or violence, among community patients, although only 8.6% regarding severe cases. Major issues in the supply of personal protective equipment (PPE) for staff members were reported. A reduced number of GHPWs (-12%), beds (approx.-30%) and of admissions was registered (87% of GHPWs). 8% of GHPWs reported an increase in compulsory admissions, and an increased rate of violence toward self or others among inpatients. Patient swabs were carried out in 50% of GHPWs. 60% of GHPWs have reported the admission of symptomatic, COVID+ psychiatric patients to General COVID-19 Units; severely ill and non-collaborative COVID+ patients are generally admitted to specific “COVID-19” GHPWs, or to purpose-adapted isolated areas of the wards. Conclusions The COVID-19 pandemic has heralded a radical change in the mental health system of Italy, and a consequent series of challenging issues.