Three Population-Level Steps for Dealing With the Mental Health Consequences of COVID-19

Sandro Galea of Boston University, Raina Merchant from the Perelman School of Medicine in Philadelphia, and Nicole Lurie from the Coalition for Epidemic Preparedness Innovations outline three population health-level steps that should be taken to deal with the mental health consequences of the COVID-19 outbreak in an opinion published today in JAMA Internal Medicine.

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• Outreach and routine buffer the effects. Although social media, Zoom meetings, and old-fashioned phone calls may soften the effect of  loneliness and isolation, social distancing has cut people off from interactions at work, school, places of worship, and recreational areas. The authors say employers should have daily outreach programs either by supervisors or through a buddy system of some kind. Establishing routines and keeping to a structure can help people - especially children - with the mental health issues that may arise from isolation.

• Surveillance systems need to be adjusted. Home is not a safe place for people suffering - or at risk of suffering - from domestic violence and child abuse. The surveillance and intervention systems for those problems need to be adjusted to take social distancing into account. Agencies and government agencies that receive reports need to be creative about how they are going to follow up.

• Take a stepped approach - and telemedicine visits can be part of that. The authors recommend a stepped approach, which involves calibrating care so the most effective, “least resource-heavy treatment” is delivered and then moving on to “resource-heavy treatment” when and where it is  needed. They see a role for nontraditional groups providing “psychological first aid” and endorse telemedicine mental health visits as playing  important roles. In addition, mechanisms to refill and deliver psychiatric medicines need to be found implemented.