Patients with psychiatric illness are a high-risk population during the COVID-19 pandemic because they frequently:

• Have impaired judgment and poor adherence to infection-prevention measures

• Live in shared environments (wards, rehabilitation homes)

• Require close physical interaction with staff

• Possess higher rates of medical comorbidities

• Experience medication-related metabolic or respiratory vulnerability

Mental health facilities therefore require specialized infection-prevention systems that balance patient autonomy, therapeutic engagement, and infection control.

2. OVERARCHING PRINCIPLES

1. Protect patients, staff and caregivers

2. Maintain continuity of psychiatric care

3. Avoid unnecessary admissions

4. Reduce ward density

5. Substitute physical contact with remote interaction where possible

6. Prevent psychiatric relapse due to service disruption

14.5 A — INPATIENT HANDLING

3. PRE-ADMISSION SCREENING AND TRANSFER

3.1 Screening before Psychiatry Referral

All patients from:

• Emergency Department

• Casualty

• Medical OPD

must undergo medical triage before entering psychiatry services.

Mandatory Screening Components

Only cleared patients enter psychiatric ward.

Suspected cases → isolation medical unit.

4. ADMISSION PROCEDURES

4.1 On Arrival

• Mask immediately applied to patient

• Hand hygiene supervised

• Minimum staff contact

• Maintain ≥2 meters distance when possible

4.2 Consent Process

Prior to admission:

• Screen for fever or respiratory symptoms

• Conduct rapid physical assessment

• Obtain collateral history via phone when possible

5. WARD ENVIRONMENT CONTROL

5.1 Ward Decongestion Measures

• Reduce number of admitted patients

• Shorten hospitalization duration

• Suspend non-essential activities

• Stagger meal and medication times

5.2 Staff Interaction Rules

• Only one doctor + one nurse review acute patient

• Avoid team crowding during rounds

• Limit ward discussions to remote meetings

6. DAILY INPATIENT CARE PRACTICES

Infection Control

• Daily surface disinfection (beds, handles, tables)

• Supervised hand hygiene for patients

• Mask use encouraged whenever tolerated

• Physical distancing during therapy

Observation Modifications

7. VISITOR POLICY

• Maximum one visitor at a time

• Limited duration

• Screening required

• Remote communication preferred

8. LIAISON PSYCHIATRY CONSULTATIONS

Before attending medical wards:

1. Confirm screening completed

2. Review vitals remotely if possible

3. Obtain collateral history via phone

4. Use PPE for suspected cases

If patient suspected → follow isolation protocol.

9. REHABILITATION UNIT MANAGEMENT

Patients in occupational or rehabilitation centers who develop symptoms:

• Immediately transferred to hospital

• Medically evaluated

• Returned only after clearance

10. OUTPATIENT DEPARTMENT (OPD) MANAGEMENT

Entry Protocol

• Mandatory hand sanitization

• Temperature screening

• Mask requirement

Waiting Area Control

• Reduce congestion at records & pharmacy

• Appointment spacing

• Seating distance ≥2 meters

Consultation Room Rules

• Only patient allowed

• One caregiver only if essential

• Maintain distance ≥2 meters

• Short focused interview

11. PSYCHOPHARMACOLOGY CONSIDERATIONS

Benzodiazepines and Respiratory Risk

Sedatives may worsen respiratory depression in COVID-19 patients.

Preferred agents (if necessary):

• Lorazepam

• Alprazolam

Avoid heavy sedation in suspected/confirmed infection.

14.5 B — OCCUPATIONAL THERAPY SERVICES

12. GENERAL SAFETY MEASURES

Occupational therapists must:

• Wear full PPE when indicated

• Follow infection-prevention protocols

• Avoid crowded therapy environments

13. PATIENT SELECTION BEFORE THERAPY

Patients must be assessed for:

• Ability to maintain distancing

• Ability to wear mask

• Behavioral cooperation

Uncooperative patients → defer therapy

14. THERAPY ROOM PROTOCOLS

Environmental Controls

• Ventilated room

• Disinfect equipment before and after use

• No shared materials without cleaning

15. INDIVIDUAL THERAPY SESSIONS

16. GROUP THERAPY

Allowed with strict limits:

• Maximum 5 patients

• Masks mandatory

• Hand hygiene before and after

• Distanced seating

17. HOME-BASED REHABILITATION

Encouraged whenever possible.

Patients capable of independent activities:

• Assigned graded home tasks

• Monthly remote review

18. HOME VISITS

Not recommended during outbreak due to transmission risk.

19. PATIENT EDUCATION

All psychiatric patients should receive repeated instruction on:

• Hand hygiene

• Mask use

• Distancing

• Symptom reporting

Education must be simplified and repeated due to cognitive limitations.

20. CORE CLINICAL MESSAGE

21. KEY SAFETY PRIORITIES

1. Screen before entry

2. Reduce contact time

3. Maintain therapeutic alliance

4. Prevent relapse and infection simultaneously

5. Protect staff mental health as well