The most vulnerable people in our society become that much more vulnerable amidst a pandemic. Recently, CAMH researchers assessed the associated risks for two such groups—people with schizophrenia, and those with Alzheimer’s and related dementias (ADRD)—and CAMH clinicians have implemented a number of recommendations to mitigate the effects of COVID-19 on these patients.
“Too often there are large gaps between the research literature and clinical practice. More often than not, there are long lags to implementing the findings,” says Dr. Nicole Kozloff, a staff psychiatrist at CAMH’s Slaight Centre Early Intervention Service and Schizophrenia Division. “The pandemic has pushed us to narrow these gaps in order to save lives.”
At CAMH, responding to the crisis has meant seamlessly transitioning most clinical services to virtual care, both within the Slaight Centre—a service for young people experiencing a first episode of psychosis—and the entire Schizophrenia Division. Nurses, social workers, occupational therapists and other clinicians assisted patients with setting up virtual schooling, finding employment and applying for government benefits. Prescribers also worked with CAMH clinicians and community partners to facilitate medication delivery at home, rather than at the hospital.
Many of the changes were based on recommendations Dr. Kozloff and colleagues made in a recently published article in Schizophrenia Bulletin. As part of their research, the investigators reviewed the early experiences of countries such as China and South Korea, and considered the myriad ways COVID-19 was affecting their patients. They also reviewed policy documents from the World Health Organization, the National Institutes of Health and elsewhere, along with scanning other peer-reviewed articles.
The authors made seven practical recommendations that could be immediately implemented, including suggesting that governments ensure there is adequate testing and resources for those with schizophrenia living in shelters and residential housing.
CAMH experts have also implemented several strategies to mitigate the effects of COVID-19 on people with ADRD. These strategies are consistent with recommendations resulting from an article they recently published in the American Journal of Geriatric Psychiatry.
“At CAMH, we are providing virtual outpatient care to patients and families living with Alzheimer’s or related dementias,” says Dr. Tarek Rajji, article co-author and Chief of Adult Neurodevelopment and Geriatric Psychiatry at CAMH. “We are supporting long-term care virtually, and in-person when possible. We are offering technical and mental health support to long-term care staff. And we continue to provide specialized inpatient services.”
“Through a CAMH Long-Term Care initiative, we recently sent out 21 tablets to several long-term care homes where our geriatric team are already providing virtual outreach. We also placed an order for dementia support tools and technologies to help the long-term care staff and residents manage the behavioural symptoms that are often observed in dementia. Finally, we are also piloting group support and coaching to front-line staff at three of the homes: groups of anywhere from five to 15 participants include a range of staff—everyone from nurses to personal support workers, and kitchen, laundry and recreation staff.“
People with ADRD are at a higher risk of severe illness from COVID-19, in part because they tend to be older and have other underlying medical conditions. The pandemic is challenging scientists to consider how research can be conducted remotely and at-home interventions expedited to help with care during the pandemic.
As Canada’s leading academic health sciences centre dedicated to mental health, CAMH experts are working to integrate the latest research findings with best practices for delivery of care.