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:
In hospital risk factors for subsequent psychological difficulties include:
During the Covid-19 pandemic, issues that could exacerbate this further may include:
A stepped, needs-based approach to providing psychological care is recommended:
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
Post traumatic stress disroder (PTSD) symptoms
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:
These psychological aspects could be delivered remotely via the internet but should be integrated within the overall MDT support package.
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.