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| PERSPECTIVE/VIEWPOINT - COUNTRY/REGIONAL |
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| Year : 2020 | Volume
: 2
| Issue : 2 | Page : 112-114 |
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The Austrian Perspective on the COVID-19 Outbreak through a Social Psychiatric Lens
Eleonore Miller-Reiter1, Alexander Kaltenboeck2, Johannes Wancata2
1 Kuratorium Psychosozialer Dienste, Medical University of Vienna, Vienna, Austria
2 Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| Date of Submission | 17-May-2020 |
| Date of Decision | 29-May-2020 |
| Date of Acceptance | 08-Jun-2020 |
| Date of Web Publication | 14-Aug-2020 |
Correspondence Address:
Prof. Johannes Wancata
Clinical Division of Social Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna
Austria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_31_20
In Austria, rather drastic measures such as travel restrictions and shutdown were implemented earlier than in other countries to contain the coronavirus from spreading. Due to this fact, the curve of new COVID-19 cases flattened successfully. After only 7 weeks, Austria started to gradually reduce restrictions step by step. While the overall number of psychiatric hospital admissions was lower than usual, the number of severe cases among inpatients increased. In the general population, an increase of alcohol consumption and substance abuse was observed. For some weeks, there was a shortage of protective clothing for medical staff and of lithium medication. Frequently, psychiatric treatment changed from personal meetings with patients to tele- or videophone appointments. To separate people with psychiatric illness and COVID-19, some services were dedicated exclusively to this group, whereas other psychiatric services treated only those without COVID-19. Overall, psychiatric services were able to deliver treatment undisrupted throughout the whole shutdown.
Keywords: Austria, COVID-19, pandemic, psychiatry
How to cite this article:
Miller-Reiter E, Kaltenboeck A, Wancata J. The Austrian Perspective on the COVID-19 Outbreak through a Social Psychiatric Lens. World Soc Psychiatry 2020;2:112-4 |
| The General Situation in Austria | |  |
The Austrian government started travel restrictions and other measures very early when the number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was still very small. The Austrian government, as well as provincial governments, then implemented increasingly rather drastic measures in March to contain the coronavirus from spreading. Thus, Austria started a shutdown earlier than several other European countries. It seems that the curve flattened successfully – at least until now. About 2 weeks ago, Austria entered a new phase, planning to gradually reduce the restrictions step by step.
Overall, Austria has been rather lucky compared to many other countries with up to now (May 15, 2020) only 16,000 confirmed cases and 620 deaths. From the very beginning, Austrian psychiatrists implemented numerous measures to be prepared for the worst-case scenario and for the prevention of psychosocial damages. We report some of the main activities that were undertaken to confront COVID-19.
| Psychiatric Health Care during the Lockdown | | |
- Numerous psychiatric inpatient and outpatient services split their staff into small teams working together (i.e., building “cohorts”). This resulted in small groups of professionals working together at the same time on site, whereas the others provided backup from home offices. Thus, in the case of infection among staff members of one cohort, there was always another group of professionals available to take over from those who developed COVID-19 (or were exposed to SARS-CoV-2)
- Treatment in psychiatrists' private offices as well as in psychiatric community services changed from personal meetings with patients to tele- or videophone appointments, and insurances agreed to pay equally for this during the time of the crisis. Team meetings and supervision were exclusively held virtually
- Patients with very severe symptoms, and who were anxious to leave their house, were visited by psychiatric outreach teams. Even when using protective equipment, some professionals infected themselves by doing this type of work
- Similar to other medical centers, psychiatric hospital departments and community services installed “COVID-19 gatekeepers” who screened every person before they entered the building. Thus, people suffering from COVID-19 could be identified before they entered psychiatric facilities, resulting in a separation of infected patients and keeping many psychiatric facilities free of the disease
- In order to provide inpatient treatment for people with severe psychiatric illness and COVID-19, some hospital wards were dedicated to providing care, especially for these patients. These wards treated exclusively psychiatric patients' comorbid with COVID-19. In addition, other wards were dedicated to severely mentally ill people who were suspected to have a COVID-19 infection, but without a clear Polymerase Chain Reaction (PCR) test result (i.e., keeping them in quarantine). People with mild psychiatric symptoms and mild COVID-19 symptoms were obliged to stay in their private household (again isolating them from others)
- For people with COVID-19, who were unable to care for themselves (due to mental illness or any other reason), large facilities were built up to care for them and to avoid an overflow of need for hospital beds. For this purpose, congress centers or similar buildings were prepared. Fortunately, these facilities were needed only by a small number of people until now
- Psychosocial corona crisis management groups were formed on the provincial as well as on the national level to give advice to the government. Several telephone hotlines for people suffering from crisis reactions or worrying about their future had been built up. These low-threshold services were able to point help-seeking people to highly specialized services such as family support, psychiatric services, or suicide prevention centers. In addition, various psychiatric services provided advice and supervision to other health-care workers experiencing burnout or burdened by the high amount of work.
As a result of all these measures and procedures, psychiatrists and psychiatric teams were able to deliver treatment undisrupted throughout the whole shutdown.
| Problems and Challenges | | |
In general, an increase of alcohol consumption and substance abuse was observed, resulting in more contacts with emergency departments (due to intoxication or delirium). Some individuals needing outpatient treatment or hospital admission stayed at home as long as possible. This decreased the number of outpatient contacts and hospital admissions. Among those who were admitted to hospitals, frequently, psychiatric symptoms were more severe than usual. Unfortunately, we do not have exact data on this. Thus, we have to rely on clinical observations (for now).
At the beginning of the COVID-19 crisis, there was only a very small amount of protective clothing and equipment available to all medical specialties. Even after this became available for clinical (including psychiatric) services, the staff of social services such as residential homes had a clear lack of such items. It took several weeks until this protective gear was available in sufficient numbers for all services and professionals.
The shutdown and the border closures resulted, for a short time, in a shortage of lithium medication. Colleagues reported of a small number of relapses among patients with bipolar disorders. Fortunately, this problem could be resolved after a very short period.
Similar to many other countries, the shutdown caused unemployment and other economic problems for many people. Even after the gradual lift of restrictions, the unemployment rate is at its highest level since World War II. Stuckler et al.[1] showed that rapid and large increases in unemployment were associated with a significant increase in suicide rates. The effect was stronger in countries with low spending on active labor market programs and null or reversed in countries with high spending. They reported that every US$ 10 per person investment in active labor market programs reduced the effect of unemployment on suicides by 0.038%. Until now, we have no data in Austria on the number of suicides in the past few weeks. Nevertheless, we assume that this will be one of the major consequences of the pandemic and the associated lockdown in Austria.[2]
Outbreak control and prevention efforts, including lockdowns, enforced quarantine, and suspension of work in offices are targeted at the general public, and some of their psychosocial (adverse) effects have been described in previous epidemics.[3] Until now, we lack data on the effects of such interventions on people suffering from mental disorders. To us, this seems to be one of the major research challenges for academic, social psychiatry in the months to come.
| Conclusions | | |
Austria's psychiatric community has reacted very fast to the challenges and dangers associated with the pandemic. It is now time to prevent further psychosocial damages and long-term effects.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: An empirical analysis. Lancet 2009;374:315-23.  |
| 2. | |
| 3. | Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20. |
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