通常災難對貧窮及弱勢族群影響程度與一般人不同,而對有嚴重心理疾病者更是雪上加霜。吸菸等較不健康的行為、居無定所、無足夠的保險、社交圈小等,皆有可能增加感染率;若不幸感染,甚至可能有較差的預後。

那麼,該採取哪些措施以減輕武漢肺炎對這個族群的影響?

支持嚴重心理疾病患者:給一般民眾的指引應針對這個族群的健康識能進行修改,而社交距離的指引亦應考慮這個族群普遍貧窮及居無定所的現況。

增能心理醫師:心理醫師應接受訓練以辨認疾病的症狀並學習採取適當的方法以減輕疾病在病患及醫師間的傳染。

加強心理健康照護系統:武漢肺炎非常有可能對社區內的心理健康中心或州立心理醫院造成威脅;這些醫院通常不具有篩檢或治療武漢肺炎的能力,而且僅有少數醫院與社區或州內的公衛單位有合作關係。心理醫師們需要辨認及轉診疑似個案的標準程序,即一旦出現症狀時的自我隔離措施。機構式的單位,如州立心理醫院、護理之家、及長照機構有較高爆發感染的風險,尤其需要應變措施,以在疾病爆發時,偵測及圍堵疾病。

擴展心理健康政策:社會政策,如營養協助、住家支持、及帶薪病假對確保這個族群的健康及福利非常重要。

(財團法人國家衛生研究院 莊淑鈞博士摘要整理)

The coronavirus disease 2019 (COVID-19) pandemic will present an unprecedented stressor to patients and health care systems across the globe. Because there is currently no vaccine or treatment for the underlying infection, current health efforts are focused on providing prevention and screening, maintaining continuity of treatment for other chronic conditions, and ensuring access to appropriately intensive services for those with the most severe symptoms.1

Disasters disproportionately affect poor and vulnerable populations, and patients with serious mental illness may be among the hardest hit. High rates of smoking in this population may raise the risk of infection and confer a worse prognosis among those who develop the illness.2 Residential instability and homelessness can raise the risk of infection and make it harder to identify, follow up, and treat those who are infected.3 Individuals with serious mental illnesses who are employed may have challenges taking time off from work and may lack sufficient insurance coverage to cover testing or treatment. Small social networks may limit opportunities to obtain support from friends and family members should individuals with serious mental illness become ill. Taken together, these factors may lead to elevated infection rates and worse prognoses in this population.

What strategies are available to mitigate the outcome of this epidemic among patients with serious mental illness? Federal preparedness policies developed in the wake of complex disasters have increasingly embraced the notion of whole community preparedness, which supports building and supporting structures at multiple levels to prepare and respond, particularly for vulnerable populations.4 Within the public mental health care system, this includes engagement with mental health service users, clinicians, and federal and state policies.

…

Author:Benjamin G. Druss
原文連結:https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2764227