-  reducing the number of outpatient appointments,
- the adoption of triage protocols that recommend treating urgent issues only,
- restructuring caseloads to minimise contact among patients
- reducing size, cancelling, or moving online group psychotherapy and peer support
- isolation rooms, 
- decreasing the total number of beds available

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- Admission
- Physical distancing
- telehealth and home-based treatment
- Adjustments of policies
- Possible barriers

Infection-control measures in mental health-care settings

Moreno, C., Wykes, T., Galderisi, S., Nordentoft, M., Crossley, N., Jones, N., Cannon, M., Correll, C., Byrne, L., Carr, S., Chen, E., Gorwood, P., Johnson, S., Kärkkäinen, H., Krystal, J., Lee, J., Lieberman, J., López-Jaramillo, C., Männikkö, M., Phillips, M., Uchida, H., Vieta, E., Vita, A. and Arango, C., 2020. How mental health care should change as a consequence of the COVID-19 pandemic. The Lancet Psychiatry. DOI:https://doi.org/10.1016/S2215-0366(20)30307-2

How mental health care should change as a consequence of the COVID-19 pandemic

Infection-control measures through physical distancing

There has been widespread use of telehealth and virtual meetings for medication management, nursing, case management, vocational interventions, and peer support due to pandemic. Home-based treatment has also become an essential part of the mental health services for COVID-19 and will be key to prevent the spread of infection and providing a more acceptable alternative to inpatient treatment.

Telehealth and home-based treatment for mental health

Many low-income countries had even insufficient bed numbers before the pandemic, making implementations such as pre-admission periods and physical distancing difficult as they may further reduce the capacity to treat patients. Ethical and practical questions are raised to the rapid discharge to minimise the risk of hospital-acquired infection

Possible barriers for infection-control measures in mental health-care settings

Policy changes have included adjustments to access policies, insurance coverage, privacy laws, and access to controlled drugs such as allowing pharmacies to accept expired prescriptions and loosening monitoring requirements for drugs with potential side-effects (consequences still unknown). To accommodate the expansion of telehealth and virtual activities, changes to laws and legislation concerning confidentiality and privacy are needed.

Adjustment of policies for infection-control measures in mental health-care settings

Inpatient admission decisions are complex, require continuous adaptation, and should be informed by the availability of community support. Access to appropriate psychiatric and medical treatment needs to be guaranteed for SARS-CoV-2-positive patients with mental disorders. Screening patients for SARS-CoV-2 in the emergency department before admission, allocating them to wards on the basis of their infection status, pre-admission quarantine periods are all ways that can help control infection in mental health institutions. Placing greater constraints on admission and reducing admission duration have been used to guarantee more space for physcial distancing as well.

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