COVID-19 guidance on mental health care delivery

The COVID-19 pandemic presents health care services with unique dilemmas. These are unprecedented times for which there is no clear rulebook.

Our guidance, therefore, can only offer general principles to support you in your ongoing care delivery. They need to be as flexible as possible as the situation will change and may change rapidly. 

There is a danger in trying to co-ordinate the challenges front line staff will face from national position. Services are different up and down the country with variations in bed base, local resources, the condition of the estate, variation in patient needs and workforce configuration. Many, if not all services, will have special Clinical Committees or other organisational groups to coordinate local management. Such committees will be better placed to manage the specificity of local situation as it unfolds.

Connecting with carers

We know that COVID-19 and lockdown are having an impact on the mental health and wellbeing of people of all ages. This is an issue not only for individuals but also for families and carers.

This series of three free webinars has been developed jointly by people with lived experience of family caring, the British Association of Social Workers, the Royal College of Nursing and the Royal College of Psychiatrists.

They are aimed at: 

• carers, families and friends affected by the mental health needs of people close to them during COVID-19 and ‘lockdown’
• health, social work and wider social care staff supporting carers and families, and individuals in mental health need
• students of health, social work and care professions.

• Connecting with Carers in Covid: Listening to carers and family members, identifying what helps
• Connecting with Carers in Covid: the principles of good professional practice webinar 

Inpatient

This guidance offers general principles to support patient care on in-patient wards. Developed with Starwards and Safewards expertise they are designed to be as flexible as situations will change rapidly. 

See: Guidance for inpatient mental health staff

Psychiatric intensive care

The current national situation arising from COVID-19 will present challenges for the care and engagement of mental health patients presenting with acute disturbance and who are also a possible infection risk.

The National Association of Psychiatric Intensive Care and Low Secure Units (NAPICU) has published guidance for managing acute disturbance in the context of COVID-19. 

Supporting high-risk physical health needs in the community amid COVID-19

This is an extremely challenging time for the NHS and the UK population. National guidance is evolving daily. Restrictions around face-to-face visits continue to increase. This is having an impact on the way our mental health nurses work and support service users in the community. Those at higher risk from COVID-19 must be adequately supported through this time of crisis. The following algorithm should be used by to assist clinical decision-making in conjunction with national and local guidance. If physical health needs cannot be met through local provision, clinicians must escalate the case to their trust’s ethical considerations committee.

Physical Health Assessment and Monitoring for COVID-19

The Coronavirus pandemic presents health care services with unique dilemmas. These are unprecedented times for which there is no clear rulebook. This community based physical health guidance offers general principles to support you in your ongoing care delivery. See: Physical health assessment and monitoring for COVID-19. A guide for nurses in community mental health

Please note: since the publication of this document new guidance has been provided, see: Medication section of the Specialised Pharmacy Service on blood monitoring advice for clozapine and lithium etc in relation to COVID-19

Community clinical decision framework 

With the Royal College of Psychiatrists, RCN members have worked up a clinical decision framework to enable the allocation of care and treatment for community mental health patients during the COVID-19 outbreak.    

See: Clinical decision framework to enable the allocation of care and treatment for community mental health patients based on need 

Community and inpatient services

The RCN is now working with NHS England and Improvement (NHSE/I), the Royal College of Psychiatrists and Unite the Union to provide guidance for healthcare professionals working in Community and inpatient services. See: Community and inpatient services - COVID-19 guidance for clinicians.

• inpatient services
• liaison psychiatry
• medication
• older people
• people with intellectual disabilities
• pregnant women and those in the perinatal period
• psychiatric Intensive Care Units (PICUs)
• secure hospital and criminal justice settings.

For more information, see: Clinical guidance for managing COVID-19 (see section on mental health)

Infection Prevention and Control

Public Health England has published guidance (2021) on COVID-19 and infection prevention and control for mental health and learning disability settings. This document is an appendix to the ‘COVID-19: Guidance for the maintaining of services within health and care settings’ and covers the specific mental health and learning disabilities requirements in terms of applying the main guidance document in these specific settings. This should therefore be read in conjunction with this guidance.

Checklist and monitoring tool for the management of COVID-19 in Mental Health settings
Assessing the management of suspected/known COVID-19 cases from triage to assessment to admission and/or discharge to help prevent the spread of infection and to provide assurance to the organisation that the 'COVID-19 Guidance for the remobilisation of services within health and care settings: IPC recommendations' has been implemented.

IPC COVID-19 Outbreak Management Toolkit for Mental Health settings
This Checklist tool is designed to be used as a tool to assist in the management of suspected and confirmed COVID-19 outbreaks or increased incidences.

Personal Protective Equipment

This information is based on revised government guidance and aims to clarify what is required for staff working specifically across mental health settings.

Recommended PPE for primary, outpatient and community care by setting, NHS and independent sector

For healthcare professionals working in primary, outpatient and community care, the following PPE guidelines apply. This might be relevant to those working in the following services:

• all community mental health teams, including children & young people, adults, older adults, perinatal, rehab and forensic mental health teams
• crisis resolution and home treatment teams and other similar models
• assertive outreach and othr similar models
• single point of access services
• primary mental health care
• IAPT services for children, adults and older adults, and other psychological therapies
• all mental health outpatient services and specialist clinics
• residential settings, supported housing and care homes.

Recommended PPE for healthcare workers by secondary care inpatient clinical setting, NHS and independent sector

For healthcare professional working in secondary care inpatient clinical settings, the following PPE guidelines apply. This might be relevant to those working in the following services:

• liaison mental health services
• all adult acute inpatient wards
• all older adult inpatient wards
• all inpatient wards for children and young people
• all inpatient facilities for those with intellectual disabilities
• specialist eating disorder units
• mother and baby units
• ECT suites
• PICU
• all secure inpatient wards
• prison healthcare

PPE videos for mental health and learning disability staff

PPE videos from Public Health England have been updated for mental health and learning disability staff. The first video is for non-aerosol generating procedures (AGPs) and the final two are for AGPs. 

This video should be used in conjunction with PHE's guidance on the use of personal protective equipment (PPE) for non-aerosol generating procedures (APGs).

• COVID-19: Donning and doffing of PPE for mental health and disabilities staff (non-AGP)

These two videos should be used alongside PHE's guidance on the use of personal protective equipment (PPE) for aerosol generating procedures (AGPs).

• COVID-19: Donning of PPE for mental health and learning disabilities staff
• Removal and disposal of enhanced PPE for mental health and learning disabilities staff