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Executive Summary of "Meeting the psychological needs of people recovering from severe coronavirus"

Posted 23rd July 2020

This is an executive summary of Meeting the psychological needs of people recovering from severe coronavirus (Covid-19), published by the The British Psychological Society (BPS).

The guidance considers the likely psychological needs of people who have been hospitalised with severe Covid-19 and the most effective ways to support their recovery.

The mortality rate for those critically ill, ventilated patients is still not certain but appears to be high. Long term consequences of Covid-19 may include fatigue, persistent changes in heart and lung function, depression, anxiety and post traumatic stress disorder (PTSD). Some patients experience cognitive impairment, which in the extreme could include dementia-like presentations. It should be noted that patients with milder illness following Covid-19 may also experience psychological difficulties.

Common psychological aspects of recovery include:

  • Anxiety
  • Low mood
  • Fear of further illness and hyper-vigilance of bodily symptoms
  • Nightmares or flashbacks
  • Poor slee
  • Impaired memory functioning
  • Effects on attention , mental processing speed and executive function
  • Fear of stigma or of contaminating others

In hospital risk factors for subsequent psychological difficulties include:

  • In hospital stress, fear and low mood
  • Confusion and delirium, experiences such as hallucinations and delusions with difficulty distinguishing between real and unreal phenomena
  • Prolonged ventilation
  • Prolonged use and high doses of sedatives including benzodiazepines and other psychoactive drugs commonly used in critical care
  • Inability to communicate due to being intubated and not understanding why
  • Perceived lack of control and autonomy
  • Loss of memory and early intrusive memories in hospital

During the Covid-19 pandemic, issues that could exacerbate this further may include:

  • Physical barriers to seeing and communicating with staff due to PPE
  • Social isolation – loved ones prohibited from visiting
  • Common ICU environment stressors such as noise, alarms, lack of daylight and disruption of patients circadian rhythms exacerbated by conditions in ICU during the Covid-19 crisis
  • Witnessing other patients on ventilators and/or deaths
  • Concerns about effect of lack of staffing and equipment on care
  • Psychological components of care to aid recovery

 

A stepped, needs-based approach to providing psychological care is recommended:

 

1. Provision of information/psychological care

  • Before discharge: All patients with severe Covid-19 should receive psychological care from relevant members of the healthcare team throughout their admission, to relieve fear and help them to understand symptoms they are experiencing.

  • Early follow-up appointment: All patients recovering from Covid-19 should be proactively followed up after 1 to 2 months to review their psychological, physical and functional needs. It is useful to invite relatives to take part in follow up sessions. It is recommended that all aspects of recovery should be reviewed, including a brief assessment of psychological symptoms and psychological aspects of experience of physical symptoms. It is recommended that this assessment includes brief screening for the following elements:

    • Daily routines including sleep/wake routine

    • Evidence of returning to normal activitie

    • Impact on family or other social relationships

    • Anxiety issues

    • Low mood

    • Post traumatic stress disroder (PTSD) symptoms

    • Cognitive difficulties

 

2. Structured rehabilitation/guided self-management

All patients with significant psychological, cognitive, functional or physical difficulties following hospitalisation for severe Covid-19 should be provided access to a structured, multidisciplinary rehabilitation package. This should be delivered in an interdisciplinary way by physiotherapists, occupational therapists (OTs), practitioner psychologists, nurse specialists, doctors and other MDT members such as speech and language therapists (SALTs) and dieticians where relevant.

Key psychological aspects of the rehabilitation package would include:

  • Provision of information
  • Psychological education to normalise symptoms and explain causes
  • Support for emotional distress
  • Cognitive behavioural approaches to recovery
  • Interventions to increase confidence in, and overcome fear of, resuming normal activities
  • Advice on compensating for cognitive problems
  • Peer support and integration with patient and family-led organisations such as ICU Steps
  • Involvement of relatives

These psychological aspects could be delivered remotely via the internet but should be integrated within the overall MDT support package.

 

3. Specialist psychological services

Those with clinically significant difficulties with mood, anxiety, PTSD or other psychological difficulties should be referred to local psychological therapy services or specialist psychological services in physical health, critical care or trauma, where available. Those with significant cognitive difficulties should be referred to specialist neuro-rehabilitation and/or neuropsychology services.

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