COVID ‐19 and psychiatrists' responsibilities: a WPA position paper

The SARS­CoV­2 virus has changed our world, endangering health, lives, social connections and economies, with the like­ lihood and consequences of future waves of infection still unknown. In this context, the WPA Standing Committee on Ethics and Review has produced a position paper to provide ethical guidance to the profes­ sion on the issues raised by the pandemic. This essay summarizes and builds on this position paper, adding more recent infor­ mation. During the COVID­19 pandemic, psy­ chiatrists must continue to care for their patients by all possible means, including telepsychiatry and other forms of virtual care. Their role, however, goes well be­ yond primary duties to prevent, diagnose, treat and keep safe individuals with mental disorders. To be effective, psychiatrists must have accurate information about COVID­19 and act accordingly. This includes appropriate knowledge of and adherence to physical distancing, frequent hand washing with soap and water or disinfectant, and proper protocols for masking, face shields and other protective equipment, which may vary over time and jurisdiction. Psychia­ trists should also be prepared to debunk myths about the origin of the virus, un­ proven treatments, potential harms of vac­ cines, and protective measures. Of course, psychiatrists should safeguard their own health with proper nutrition, sleep, rest and exercise, and promptly seek professional help if they become physically or mentally unwell. Some health care professionals, work­ ing long hours in life­threatening condi­ tions, often without appropriate protective equipment, may develop anxiety, depres­ sion, post­traumatic stress disorder (PTSD), insomnia, and excessive irritability and an­ ger. Psychiatrists should assist in devel­ oping self­help, group or individual sup­ ports or treatments for distressed colleagues and their families. However, they should also support the resilience and pride in their roles experienced by many health care workers during the pandemic. As psychiatrists are physicians, they may volunteer or be redeployed to as­ sume other duties in their institutions or communities, such as working in emer­ gency departments, primary care, inter­ nal medicine, critical care or long­term care homes. They may also be called on to support medically ill patients or their families during illness or following be­ reavement. This is especially critical as isolation often prevents the usual social supports. As leaders in their hospitals, health care agencies and communities, psychiatrists may also participate in COVID­19 decision­ making committees (including triage), where they should safeguard the rights of persons with mental disorders. They may participate in educational and media ac­ tivities for patients, health care workers, the public or policy makers about the mental health distress caused by physical distanc­ ing, home quarantine, shelter­in­place, iso­ lation, and loss of social support, work and income. Psychiatrists should also advo­ cate for interventions by governments and others to reduce distress and suicide in the general population. Social disadvantage and inability to fol­ low public health advice places individu­ als with mental disorders at higher risk for COVID­19. In addition to older people, it is now clear that ethnic minorities, mal­ nourished individuals and long­term care home residents, recent migrants and in­ digenous peoples also face higher risks of COVID­19 and adverse outcomes. Mortality/morbidity data are missing for people with mental illness, who may not only share the above risk factors, but also be unable or unwilling to protect them­ selves against COVID­19 due to apathy, Psychiatry M. Maj has had a prominent role in preparing the report, which is due for publication in early 2021. The WPA will be invited to have a continuing role in the life of the Commission. • As president of WPA, I co­chair the World Economic Forum Global Future Council 2019­2020 on Technology for Mental Health, that aims to promote the ethical adoption of technologies and has acted to facilitate positive working relationships in the field.