Impact of COVID-19 on the lives of people with severe mental illness-front-line community psychiatry workers observation from a provincial survey of assertive community treatment teams in Ontario, Canada

Aly Kassam; Michaela Beder; Saadia Sediqzadah; Matthew Levy; Madeleine Ritts; John Maher; Nicole Kirwan; Samuel Law

doi:10.1186/s13033-023-00585-8

Impact of COVID-19 on the lives of people with severe mental illness-front-line community psychiatry workers observation from a provincial survey of assertive community treatment teams in Ontario, Canada

Int J Ment Health Syst. 2023 Jun 16;17(1):18. doi: 10.1186/s13033-023-00585-8.

Authors

Aly Kassam¹, Michaela Beder^{2

3}, Saadia Sediqzadah^{1

2

3}, Matthew Levy^{2

3}, Madeleine Ritts³, John Maher⁴, Nicole Kirwan³, Samuel Law^{5

6

7}

Affiliations

¹ MAP Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
² Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada.
⁴ Canadian Mental Health Association, Barrie and Ontario Association of ACT and FACT, Barrie, ON, Canada.
⁵ MAP Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. Samuel.Law@unityhealth.to.
⁶ Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Samuel.Law@unityhealth.to.
⁷ Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada. Samuel.Law@unityhealth.to.

Abstract

Using an online survey distributed to members of the provincial organization that represents the 88 Assertive Community Treatment (ACT) and Flexible ACT teams in Ontario, Canada, this descriptive study relied on the unique vantage points and observations of the front-line community psychiatry workers who maintained contact with patients through outreach and telecommunication during the height of COVID-19. The patients who suffer from serious mental illness (SMI) were uniquely affected by COVID-19 due to the changes, reduction or shut down of many essential clinical and community support services. Thematic and quantitative analyses of the workers' observations highlighted 6 main areas of note, including significant social isolation and loneliness, clinical course deterioration and life disruption, increased hospital and ER use, police and legal contacts, and substance abuse and related deaths. There were also encouraging signs of positive adaptations in terms of independence and resilience. Reflections of these impacts and potential ameliorating approaches are further discussed.

Keywords: Assertive community treatment; COVID-19; Community mental health; Observational study; Observed impact; Serious mental illness.