How much has the COVID-19 pandemic changed us? The experience of the Clinic for Mental Disorders "Dr Laza Lazarević"

In order to preserve and improve public health, guided by the recommendations of the World Health Organization (WHO), the Clinic for Mental Disorders Dr Laza Lazarević, in cooperation with the Ministry of Health of the Republic of Serbia, developed a strategy for mental healthcare during the COVID-19 pandemic. This paper briefly presents some specific activities that the Clinic for Mental Disorders Dr Laza Lazarević has carried out during the current COVID-19 pandemic.

INTRODUCTION

At present, all countries in the world are stricken by the pandemic caused by the new corona virus named SARS-CoV-2 [1]. The first cases of infection with the SARS-CoV-2 virus were registered at the end of 2019, in the Hubei province of the People’s Republic of China and were initially described as atypical pneumonias of unknown etiology [2]. Since then, more than 187 million people have been infected worldwide and over 4 million have died from this disease [3].

As yet, there are no studies clearly indicating the increase of the frequency in mental disorders during the ongoing pandemic. However, epidemics are linked to higher exposure of people to risk factors for mental disease, which is why it is necessary that the impact of the pandemic on mental health should be further monitored. Repeated, well designed studies are important for monitoring the needs of the population, in order to direct available resources to those parts of the mental healthcare system which are under the greatest pressure [4],[5],[6],[7],[8],[9].

For the purpose of preserving and improving public health, guided by the recommendations of the World Health Organization (WHO), the Clinic for Mental Disorders Dr Laza Lazarević has, in cooperation with the Ministry of Health of the Republic of Serbia, designed a strategy for population mental healthcare during the COVID-19 pandemic [10]. Since the very beginning of the epidemic, the Clinic has been carrying out numerous activities related to the improvement of the mental health of the Republic of Serbia population, such as the application of telemedicine, COVID-19 immunization, counselling activities for citizens, the implementation of public health campaigns, training, workshops, etc. This study will briefly present some of the specific activities that the Clinic for Mental Disorders Dr Laza Lazarević has carried out during the ongoing COVID-19 pandemic.

TELEMEDICINE

Telemedicine is the provision of health services by means of information and telecommunications technologies, regardless of the geographic location of the health service provider, the patient, medical information, or medical equipment [11].

During the COVID-19 pandemic, mass application of telemedicine began in almost all branches of medicine, with the aim of providing medical services to patients and support to vulnerable groups, while at the same time enabling the enforcement of epidemiological protective measures [12]. The Clinic for Mental Disorders Dr Laza Lazarević, in cooperation with the Ministry of Health of the Republic of Serbia, started introducing telemedicine into mental healthcare in early 2019, when the free National Helpline for Preventing Suicide was established at the Clinic. When the first cases of COVID-19 were registered in the Republic of Serbia, the Ministry of Health of the Republic of Serbia also opened the free National Helpline for Psychosocial Support during the COVID-19 Pandemic. The helpline was opened at the Clinic on March 16, 2020. In keeping with WHO recommendations, the helpline How are you doing? was also opened for adolescents, their parents, but also other individuals who are directly or indirectly facing mental health issues in this particularly sensitive period of life. For the purpose of centralization, the abovementioned helplines were joined, on May 15, 2021, into a unified free service for mental healthcare of the Ministry of Health of the Republic of Serbia and the Clinic for Mental Disorders Dr Laza Lazarević. By calling the number: 0800/309-309, users can choose one of three options, i.e., one of the three types of psychological support offered. The helpline is available to citizens 24 hours a day, every day, during the entire year. In this way, more than 30.000 interventions have been carried out so far.

Support, counseling, short psychotherapy (crisis) interventions, as well as recommendations related to already prescribed medication, are offered by qualified health workers and consultants of the Clinic, whose work is continuously monitored by trained psychotherapists.

IMMUNIZATION AGAINST COVID-19

Persons with mental health problems are a population at high risk of increased morbidity, but also mortality form the COVID-19 disease [13], which fact has been linked to a higher rate of obesity, as well as metabolic and cardiovascular disorders in this vulnerable group [14]. It has been proven that persons with mental disorders, primarily those suffering from schizophrenia, have a 15 to 20 years lower life expectancy than the general population [15]. This is especially important for inpatients, who find themselves in conditions carrying a higher risk of SARS-CoV-2 infection, due to unavoidable contact with other patients, but also with medical staff [16]. Therefore, numerous authors believe that persons with mental health problems should be provided early access to immunization against COVID-19 [13],[17],[18],[19].

In cooperation with the Belgrade City Institute for Public Health, the Clinic for Mental Disorders Dr Laza Lazarević started immunizing its patients as early as the beginning of March 2020, on the hospital wards for continued treatment and psychosocial rehabilitation. Subsequently, all other interested inpatients were also immunized, however, only after signing an informed consent form. Upon receiving the approval of the Health Inspection of the Ministry of Health of the Republic of Serbia, the Clinic, in cooperation with the Institute of Public Health of Serbia Dr Milan Jovanović Batut, opened a vaccination point within its premises for persons with mental disorders and their family members, healthcare workers, and other citizens. The following vaccines are available at the Clinic: Astra-Zeneca, Pfizer, and Sinopharm. In the following period, the Clinic will continue with active immunization against COVID-19, thereby contributing to the achievement of herd immunity, which the Government of the Republic of Serbia has identified as a priority in the fight against the ongoing pandemic.

SUPPORT TO EMPLOYEES OF THE HEALTHCARE SYSTEM

Burnout syndrome in healthcare workers is not new. Everyday care for the life and wellbeing of others, a high level of responsibility, as well as the need for constant professional development, represent some of the factors which place healthcare workers in the high-risk group for the development of this syndrome. Risk of infection, social isolation, financial ramifications, the burden of increased workload, as well as the lack of job satisfaction stemming from numerous adverse outcomes of the disease, are additional pandemic related factors which have led to an even higher risk of the development of this syndrome amongst healthcare workers [20]. The following categories of health care workers have proven to be particularly vulnerable: medical technicians, women, the staff in intensive care units, as they have most commonly developed depression, anxiety and insomnia. The negative effects of this syndrome are not limited only to the healthcare workers themselves, rather, they affect patients and the healthcare system as a whole. These effects are connected to higher rates of medical errors, decreased productivity, and the decrease in the quality of healthcare services, which additionally encumbers the already overburdened healthcare system [21].

For the purpose of early and timely intervention aimed at prevention and other forms of care for the mental health of healthcare workers, psychosocial support in the context of the COVID-19 epidemic has been organized via phone lines and digital platforms (Skype and Zoom).

Also, in cooperation with the Institute for Mental Health in Belgrade and the World Health Organization, in late 2020 and early 2021, workshops and training sessions for primary healthcare workers were organized in five cities in Serbia. These events were dedicated to the prevention of burnout syndrome in the workplace and to the improvement of mental health in healthcare workers, but also in health service users.

CENTER FOR MENTAL HEALTH

In February 2018, The Ministry of Health, the Clinic, and the City of Belgrade opened the first Center for Mental Health in the territory of the City of Belgrade. So far, more than 15,000 citizens have used this form of outpatient mental healthcare. During the ongoing pandemic, the Center for Mental Health has reorganized the way it operates, in the sense of offering preventive program services to all interested persons via telephone and digital platforms (Skype, Viber and WhatsApp). In addition to the basic activities, partnership and cooperation with the nongovernmental sector has been established, for the purpose of providing assistance and support to socially vulnerable groups susceptible to discrimination and stigmatization resulting from their sexual orientation or gender identity. Also, under the auspices of the Ministry of Health and in cooperation with the A Chance for Parenthood Association, the implementation of the project of psychosocial support to couples undergoing the process of in vitro fertilization has been continued.

PUBLIC HEALTH ACTIVITIES AIMED AT PRESERVING AND IMPROVING MENTAL HEALTH IN THE POPULATION DURING THE COVID-19 PANDEMIC

During the pandemic, as every year, the World Suicide Prevention Day (September 10) and the World Mental Health Day (October 10) were celebrated on the Trg Republike square in Belgrade, with the observance of all mandated epidemiological protective measures. Interested citizens had the chance to get tested for the most common mental disorders (anxiety, depression, dementia, etc.), to do a consultative interview with mental health professionals, as well as to get additional information from educational brochures issued by the Clinic on different mental conditions and illnesses (Dementia, Depression, Anxiety, Suicide is Not the Answer, etc.) Also, at the Trg Republike square in Belgrade, on May 15, 2021, International Day of Families was celebrated for the first time, with a special focus on adolescents and the problems which they and their families have been facing during the COVID-19 pandemic. Citizens could also find additional information on the ways of adapting to the ongoing epidemiological situation through the following brochures: Adolescents and COVID-19 and The Family at the Time of the COVID-19 Pandemic.

IN-HOSPITAL TREATMENT

The primary activity of the Clinic did not cease at any time during the epidemic. The Clinic for Mental Disorders Dr Laza Lazarević continued to operate with full capacity dealing with emergency psychiatricconditions and admitting patients for in-hospital treatment throughout its regular working hours and during 24-hour stand-by shifts, covering the needs of patients from the entire territory of the City of Belgrade.

Additionally, keeping in touch with the needs of the healthcare system and the pace of the epidemic, in December 2020, the Clinic became a part of the covid system of hospitals,. In cooperation with the Clinic for Infectious and Tropical Diseases of the University Clinical Center of Serbia and the Institute of Public Health of Serbia Dr Milan Jovanović Batut, ten percent of the hospital bed capacity was designated for persons with mental disease suffering from the COVID-19 infection, from the entire territory of Serbia. Through interdisciplinary work, parallel psychiatric treatment and the full protocol for treating mild and moderate clinical forms of the COVID-19 disease, with oxygen therapy needs of up to 15 l O₂ /min, are carried out in this part of the hospital.

LESSONS LEARNED

In addition to placing before us numerous and considerable challenges, the COVID-19 pandemic has taught us many other lessons, namely:

• Healthcare systems are dynamic and living entities. Their components can indeed interact and behave in unexpected ways. Therefore, constant vigilance, flexibility, readiness to accept change and to make short-term projections, represent factors which have been proven to enable positive shifts.
• After all, organizations are made up of people. Highly organized management, motivated staff, and quality standards represent the golden trinity favoring efficiency.
• Public health is the most valuable national resource. The pandemic has reminded us of how much more we could have and should have done in the domain of prevention, health promotion, and health awareness and education, even before the coming of this storm that has claimed lives, damaged economies, and politically shaken the entire world.
• Mental health is an integral part of health, and the ability of individuals to adapt and their maturity represent the most valuable resources of a society.
• A crisis is an opportunity for us to see what real values are and to gain clarity. Let us admit that hypocrisy of personal comfort, of egocentric and materialistic culture, has become exposed in the clash between man and nature. Thankfully, we have changed – to the benefit of and primarily owing to medicine.