BACKGROUND: The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations. METHODS: The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the "EPA Ambassadors", on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19. RESULTS: While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients and for inpatient admission, assessments and treatment for people with mental disorders. Compared to previous months, the mean number of patients treated by psychiatrists in outpatient settings halved in April 2020. In the same period, the number of mentally ill patients tested for, or developing, COVID-19 was low. In most of countries, traditional face-to-face visits were replaced by online remote consultations. CONCLUSIONS: Based on our findings we recommend: 1) to implement professional guidelines into practice and harmonize psychiatric clinical practice across Europe; 2) to monitor the treatment outcomes of patients with COVID-19 and pre-existing mental disorders; 3) to keep psychiatric services active by using all available options (for example telepsychiatry); 4) to increase communication and cooperation between different health care providers.

3rd Faculty of Medicine Charles University Prague Czech Republic

Belgian Professional Association of Medical Specialists in Psychiatry Collaborative Antwerp Psychiatric Research Institute Antwerp Belgium

CMME GHU Paris Psychiatrie et Neurosciences Hôpital Sainte Anne Paris France

Croatian Psychiatric Association Zagreb Croatia

Czech Psychiatric Association National Institute of Mental Health Klecany Czechia

Department of Adult Psychiatry College of Psychiatrists of Ireland Mater Misericordiae University Hospital Dublin Ireland

Department of Child and Adolescent Psychiatry Institute of Psychiatry and Mental Health Hospital General Universitario Gregorio Marañón IiSGM CIBERSAM School of Medicine Universidad Complutense Madrid Spain

Department of Developmental and Clinical Child Psychology Institute of Psychology Eötvös Loránd University Budapest Hungary

Department of Psychiatry Ege University Medicine Faculty Affective Disorders Unit Izmir Turkey

Department of Psychiatry Faculty of Medical Science University of Kragujevac Kragujevac Serbia

Department of Psychiatry University Clinical Center Tuzla School of Medicine University of Tuzla Bosnia and Herzegovina Psychiatric Association of Bosnia Herzegovina Tuzla Bosnia Herzegovina

Department of Psychiatry University of Campania L Vanvitelli Naples Italy

Estonian Psychiatric Association Centre Tartu University Psychiatry Clinic TartuEstonia

Hungarian Psychiatric Association Bjørknes University College Oslo Norway

INSERM U1266 Université de Paris Paris France

Institute of Biomedical Sciences Abel Salazar University of Porto Porto Portugal

Institute of Psychiatry Psychology and Neuroscience King's College London London United Kingdom

Lithuanian Psychiatric Association Lithuanian Health Sciences university Psychiatric Clinic Lithuanian Health Sciences university Kaunas hospital Kaunas Lithuania

Norwich Medical School University of East Anglia Norwich United Kingdom

Polish Psychiatric Association Department of Psychiatry Pomeranian Medical University in Szczecin Poland Szczecin Poland

Psychiatry and Medical Psychology Department Belarusian Psychiatric Association Belarusian State Medical University Minsk Belarus

Romanian Association of Psychiatry and Psychotherapy University of Medicine and Pharmacy Iuliu Hatieganu Cluj Napoca Romania

Slovak Psychiatric Association Department of Psychiatry Faculty of Medicine Comenius University in Bratislava Bratislava Slovakia

Society of Georgian Psychiatrists Tbilisi State Medical University Tbilisi Georgia

Society of Psychiatrists Narcologists Psychotherapists and Clinical Psychologists from Republic of Moldova Department of Psychiatry Narcology Medical Psychology State Medical and Pharmaceutical University Nicolae Testemitanu from Republic of Moldova Kishinev Moldova

Tallinn Children Hospital Children Mental Health Tallinn Estonia

Zagreb School of Medicine Zagreb University Hospital Centre Zagreb Croatia

Zobrazit více v PubMed

World Health Organisation. Guidelines to help countries maintain essential health services during the COVID-19 pandemic, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/maintaining-essential-health-services-and-systems; 2019 [accessed 30 March 2020].

Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry. 2020;1;63(1):e32. doi:10.1192/j.eurpsy.2020.35. PubMed DOI PMC

Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry. 2020;7(9):813–24. doi:10.1016/S2215-0366(20)30307-2. PubMed DOI PMC

Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020;7(10):875–82. doi:10.1016/S2215-0366(20)30287-X. PubMed DOI PMC

Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic: United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049–57. doi:10.15585/mmwr.mm6932a1. PubMed DOI PMC

Fiorillo A, Sampogna G, Giallonardo V, Del Vecchio V, Luciano M, Albert U, et al. Effects of the lockdown on the mental health of the general population during the COVID-19 pandemic in Italy: results from the COMET collaborative network. Eur Psychiatry. 2020;63(1):E87. doi:10.1192/j.eurpsy.2020.89. PubMed DOI PMC

Daly M, Sutin AR, Robinson E. Longitudinal changes in mental health and the COVID-19 pandemic: evidence from the UK Household Longitudinal Study. Psychol. Med. 2020. Nov 13;1–10 PubMed PMC

Zhou F, Ting Yu, Ronghui D, Guohui F, Ying L, Zhibo L, et al. Clinical course and risk factors mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–62. doi:10.1016/S0140-6736(20)30566-3. PubMed DOI PMC

Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62,354 COVID-19 cases in the USA. Lancet Psychiatry. 2021. Feb;8(2):130–140. doi:10.1016/S2215-0366(20)30462-4. PubMed DOI PMC

Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosomat. 2020;89(4):242–50. doi:10.1159/000507639. PubMed DOI PMC

Dong Z, Ma J, Hao Y, Shen X, Liu F, Gao Y, et al. The social psychological impact of the COVID-19 pandemic on medical staff in China: a cross-sectional study. Eur Psychiatry. 2020;63(1):E65. doi:10.1192/j.eurpsy.2020.59. PubMed DOI PMC

Shah K, Kamrai D, Mekala H, Mann B, Desai K, Patel RS. Focus on mental health during the coronavirus (COVID-19) pandemic: applying learnings from the past outbreaks. Cureus. 2020;12(3):e7405. doi:10.7759/cureus.7405. PubMed DOI PMC

World Health Organisation. The impact of COVID-19 on mental, neurological and substance use services: results of a rapid assessment. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

European Psychiatric Association. COVID-19 Resource Centre, https://www.europsy.net/epa-resources-for-covid-19/ [accessed 30 November].

World Psychiatric Association Coronavirus (COVID-19) Mental Health Resources. https://www.wpanet.org/covid-19-resources?lang=de

Chevance A, Gourion D, Hoertel N, Llorca PM, Thomas P, Bocher R, et al. Ensuring mental health care during the SARS-CoV-2 epidemic in France: a narrative review. Encephale. 2020;46(3S):S3–13. PubMed PMC

WHO. Coronavirus situation report, https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200430-sitrep-101-covid-19.pdf?sfvrsn=2ba4e093_2positive; 2020. [accessed 10 October 2020].

Winkler P, Krupchanka D, Roberts T, Kondratova L, Vendula M, Höschl C, et al. A blind spot on the global mental health map: a scoping review of 25 years’ development of mental health care for people with severe mental illnesses in central and eastern Europe. Lancet Psychiatry. 2017;4:634–42. doi:10.1016/S2215-0366(17)30135-9. PubMed DOI

Xiang YT, Zhao YI, Liu ZH, Li XH, Zhao N, Cheung T et al. The COVID-19 outbreak and psychiatric hospitals in China: managing challenges through mental health service reform. Int J Biol Sci. 2020;16(10):1741–4. doi:10.7150/ijbs.45072. PubMed DOI PMC

Thome J, Coogan A, Simon F, Fischer M, Tucha O, Faltraco F, et al. The impact of the COVID-19 outbreak on the medico-legal and human rights of psychiatric patients. Eur Psychiatry. 2020;63(1):E50. doi:10.1192/j.eurpsy.2020.58. PubMed DOI PMC

Moser D, Glaus J, Frangou S, Schechter D. Years of life lost due to the psychosocial consequences of COVID-19 mitigation strategies based on Swiss data. Eur Psychiatry. 2020;63(1):E58. doi:10.1192/j.eurpsy.2020.56. PubMed DOI PMC

Sani G, Janiri D, Di Nicola M, Janiri L, Ferretti S, Chieffo D. Mental health during and after the COVID-19 emergency in Italy. Psychiatry Clin Neurosci. 2020. Jun;74(6):372. doi:10.1111/pcn.13004. PubMed DOI

Lu W, Wang H, Lin Y, Li L. Psychological status of medical workforce during the COVID-19 pandemic: a cross-sectional study. Psychiatry Res. 2020;288:1–5. doi:10.1016/j.psychres.2020.112936. PubMed DOI PMC

Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020. Aug;88:901–907. doi:10.1016/j.bbi.2020.05.026. PubMed DOI PMC

Ramalho R, Adiukwu F, Bytyçi DG, El Hayek S, Gonzalez-Diaz JM, Larnaout A, et al. Telepsychiatry during the COVID-19 pandemic: development of a protocol for telemental health care. Front Psychiatry. 2020. Sep 23;11:552450. doi:10.3389/fpsyt.2020.552450. PubMed DOI PMC

Montani D, Savale L, Beurnier A, Colle R, Noël N, Pham T, et al. Multidisciplinary approach for post-acute COVID-19 syndrome: time to break down the walls. Eur Respir J. 2021. PubMed PMC

Ashton M. Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States. PNAS. 2020;117(30):17695–701. PubMed PMC

Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry. 2020. Feb;20(1):124–130. doi:10.1002/wps.20806. PubMed DOI PMC

Clinician treatment choices for post-traumatic stress disorder: ambassadors survey of psychiatrists in 39 European countries