key: cord-0828363-geboovve authors: Xu, Yeqing; Shao, Yang; Huang, Jingjing title: Mental health services in Shanghai during the COVID-19 outbreak date: 2020-05-21 journal: Forensic science international. Mind and law DOI: 10.1016/j.fsiml.2020.100022 sha: 5ff906fa783c8bb996f39c9b9a6c8dec1d8a896b doc_id: 828363 cord_uid: geboovve nan The outbreak of coronavirus disease 2019 (COVID-19) emerged in China and has now spread to nearly every country in the world. The World Health Organization declared on March 11 that the spread of COVID-19 has become a pandemic. As of May 12 th 2020, 660 people had been diagnosed with novel coronavirus (including 321 imported cases) in Shanghai (Shanghai Municipal Health Commission, 2020a) . Shanghai is the most populous urban area in China with a population of 24.28 million. Although the cases are less than one in 10,000 of the population, people who live in Shanghai were asked to avoid public places since late January. Shanghai is at high risk of carriers of the COVID-19 virus entering the city because of the large population of migrant workers. Having more time at home triggered a wide variety of psychological problems (Qiu et al., 2020) . At the very beginning of the epidemic, experts from Shanghai mental health center (SMHC), the top-class psychiatric institution in China, were aware that this would be a challenging time for our mental health professionals. Psychological services were urgently needed to help ease the nerves amid the coronavirus epidemic both for the public and the medical workers battling the coronavirus. Furthermore, adequate and necessary attention was required for patients with mental health disorders in the COVID-19 epidemic (Yao, Chen & Xu, 2020) . To avoid a coronavirus outbreak in psychiatric hospitals, only people with green health QR color can enter. (The health QR code, which is available on the Suishenban app or through WeChat and Ali pay, has three colors -green for the healthy people, yellow for people returning from countries and regions heavily affected by coronavirus sand who are under quarantine, and red for confirmed or suspected patients still under medical observation. The code is updated when people's conditions change.) 2 Inpatient psychiatric facilities are facing a high risk from the rapid spread of COVID-19. To achieve the goal of zero infection, new rules were made for the inpatient admission process (National Health Commission, 2020) . Before admission, psychiatrists should make sure every patient has been ruled out of having Novel Coronavirus Pneumonia (NCP). Patients with high body temperature or with suspicious circumstances found through epidemiological investigation (for example close contact with confirmed or suspected cases) should be sent to designated fever clinics for further examination with our psychiatrists accompanying in case psychiatric consultation was needed there. If the test results are negative, patients will be taken back and admitted to psychiatric inpatient ward. If the test results are positive, patients will be transferred to Shanghai Public Health Clinical Center for further treatment (one to four psychiatrists are working there during the epidemic, offering psychiatric consultations for patients and psychological services for medics). All staff in the psychiatric hospital are asked not to leave Shanghai during the epidemic and should report their health conditions every day. Inpatients' family members are persuaded to make phone calls instead of face-to-face visits. Video chat is allowed under exceptional circumstances (for example, an elderly woman who lives in another province worried very much about her 50-year old daughter who was admitted before the epidemic. To relieve her anxiety, the nurse arranged a video chat for them). Most treatments are provided in inpatient department as normal except for group therapy. Routine outpatient services are provided but all patients should wear face masks, take body temperature test and undergo epidemiological investigation before they walk into the outpatient clinic buildings. If a patient was believed to be suspicious, they would be taken to see a psychiatrist wearing personal protective equipment in a clinic room outside the buildings to make sure they would be separated from other patients. The patient would also be registered and recommended to go to designated fever clinics. impractical due to the nationwide regulations on travel and quarantine (Yao, Chen & Xu, 2020) . Therefore, non-contact services are urgently needed. Online hospitals got the green light for insurance payments amid the fight of NCP. SMHC is about to become the first online psychiatric hospital in Shanghai. Although free online counselling was offered at the very beginning of the epidemic, patients still have difficulties in getting a refill of their medicines. Once the online hospital license has been issued by the local health commission, online prescriptions will be covered by the local medical insurance system and the drugs will be delivered to patients' homes. The coronavirus epidemic also affected the provision of mental health services in the judicial correction system. The above preventive measures for inpatient service are also applicable to the Ankang Hospital, the only secure psychiatry hospital in Shanghai for patients who were assessed as not having criminal responsibility because of mental illness. For prisoners with serious mental problems, outpatient services still exist. They may go to these clinics after obtaining the approval of the prison director, but adequate protection is required. After returning to prison, the accompanying prison guards and the prisoner must have a 14-day quarantine (Chinese Center for Disease Control and Prevention, 2020). All these strict measures help us to make sure there is no coronavirus infection in psychiatric hospitals, but also makes the access to mental health services more difficult. Accordingly, remote psychological services are provided for fighting the epidemic including online or hotline counseling services amid efforts to prevent and control the epidemic. Free online resources and interventions could benefit population mental health (Gunnell D et al. 2020 ). The Shanghai Psychological Assistance Hotline was launched to provide free counseling for more than twenty years. During the epidemic period, the daily number of calls is up about 80 percent compared with before the outbreak of novel coronavirus. A new line has been opened especially for the epidemic both in Chinese and English. Free online lectures are also offered by experts from SMHC and other mental health centers in Shanghai to advise people how to deal with negative emotions during the epidemic. Video chat were held with overseas Chinese and students, answering their questions on battling coronavirus. The official WeChat account of SMHC is regularly releasing coronavirus-related content. People can use the WeChat account to make an outpatient appointment as well. Psychological support is very important both for NCP patient and medics. Frontline medical staff are under enormous mental pressures due to overwork and the high risks of infection from their exposure . Mental health services are offered to patients and medics both in Shanghai and in Wuhan. Psychiatrists and psychologists have been working as part of a multi-disciplinary team at Shanghai Public Health Clinical Center since January. Their daily work is to offer psychiatric consultations for NCP patients with anxiety, depression or other mental health conditions. They also provide psychological counselling and help arrange a Balint group for staff. A medical team with 52 psychiatrists were sent to the Wuhan Hubei province to join other doctors from Shanghai fighting against COVID-19 for nearly two months. All the medics back from Wuhan had returned to their own hospitals in Shanghai after a 14-day quarantine in April. Mental health care for medical staff in China during the COVID-19 outbreak Technical plan for covid-19 prevention and control in prison Suicide risk and prevention during the COVID-19 pandemic A circular on the prevention and control of covid-19 in accordance with the law and in a scientific and accurate manner A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations Shanghai Municipal Health Commission. (2020a) Press release on the city's COVID-19 response Shanghai medical experts video-chat with overseas Chinese on COVID-19 Patients with mental health disorders in the COVID-19 epidemic Shanghai is now under greater pressure to contain imported cases of infection (Shanghai Municipal Health Commission, 2020b). All the strict measures to fight coronavirus will remain in place. Xie Bin, a psychologist with the Shanghai Mental Health Center, said "Everyone is on the same train heading toward the final stop of the pandemic. Please sit tight and have faith in the 'train crew' -medics and experts worldwide, who will drive the train safely to the destination." (Xinhuanet, 2020) The authors have no conflicts of interest to declare.