New Delhi: The Ministry of Health and Family Welfare, in collaboration with the National Institute of Mental Health and Neurosciences (NIMHANS), Monday released guidelines on how hospitals can take care of patients with mental health illnesses amid the ongoing Covid-19 pandemic.
“The pandemic has put inordinate strain on health facilities, and posed unique challenges to mental health care delivery, both in the community and institutional/hospital settings,” reads the document, titled Guidelines on Managing Mental Health Illness in Hospital Settings during COVD-19.
The guidelines tackle how to protect patients in mental health establishments from contracting Covid as well as the clinical management of patients with mental health illnesses who test positive for the virus.
It suggests that a nodal officer from each mental health establishment (MHE) review and update the guidelines as and when needed. “Also, a hotline can be established between an MHE and a nearby Covid designated hospital to facilitate easy transfer across facilities,” the guidelines read.
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Regular screening of flu-like symptoms, restrictions on OPD visits
The guidelines state that MHEs should constitute a Hospital Infection Committee that ensures proper handwashing, regular screening of Influenza-Like Illness (ILI) symptoms, waste disposal, and physical distancing is maintained by both staff and patients.
They also recommend OPD visits be restricted to appointments-only to reduce footfalls. All patients presenting ILI symptoms after screening should be taken to a separate area for consultation. Covid-positive patients may be referred to a nearby hospital along with teleconsultations with a psychiatrist.
For patients living in a facility, the guidelines recommend, they remain in their rooms. “Though this is contrary to the normal running of the ward, staff should find ways to monitor the patients inside the ward. Rules and restrictions can be revised appropriately, viz., eating while watching television,” reads the document.
Electroconvulsive Therapy (ECT) is to be given “only as emergency treatment and with adequate safety precautions”.
“Patient with COVID-19 positive status may not be administered ECT. However, a repeat RT-PCR testing can be done after 14 days and if negative, can be considered for ECTs,” say the guidelines.
Clinical management
The guidelines also state that at “no point should any psychotropic medication be stopped abruptly without a psychiatrist’s advice, unless in case of a life-threatening emergency”.
They go on to outline treatment options for elderly patients and perinatal women with mental illnesses, those with substance abuse problems as well as children and adolescents with mental health issues.
“A collaborative approach is strongly recommended for making specific decision/s on a case-to-case basis (both formulating and implementation). These can be made by a team involving a physician and a psychiatrist,” it says.
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