Hundreds have been released from a psychiatric hospital due to quarantine: the situation is called a disaster and it is already preparing for an influx

It is not yet clear exactly when this sector will start operating at its normal capacity. On Wednesday, the government decided that health care facilities could renew scheduled services subject to certain rules.

Health Minister A. Veryga said Tuesday that polyclinics and clinics themselves will decide when to renew planned care, depending on its availability.

“It is not the date that matters, it is important that the facility manages the flows, meets the infection control requirements, and as soon as it meets and sends data to the National Center for Public Health, it can start providing those services,” the health minister said Tuesday.

Therefore, it seems that the renewal of these services will have to wait.

Fear of falling back into the well

How Delphi He tells Irena (her real name is known to the editorial board), she has been fighting depression for years. Until recently, the woman was in bed in the Vilnius City Department of Mental Health Limit Conditions for three weeks, and just before quarantine, she continued her treatment by visiting a day hospital. However, according to the interlocutor, the six-week program could not be completed because the quarantine in the country was announced.

The woman says the closure of the day hospital was unexpected for her. Here he visited mutual aid groups and consulted with specialists five days a week.

“After a day in the hospital, he was completely healthy. Everything relaxed and I slept well. Depression is a disease that does not heal quickly, and in a month and a half I stood up. At first, it was brutally difficult when everything was cut in one day. Everything was unconscious ”, opens the interlocutor.

And although, according to her, she currently receives help from remote online specialists for the same number of days, the effects of such treatment are not the same and betrays the deterioration of well-being. According to Irena, closing at home does not help fight the disease, but there is no other way out, since it belongs to the risk group.

“Now we have created a mutual group through Skype. Better than nothing, but far from replacing what it was.

It got worse for me. I hold on to the last one to avoid falling into that well again, since there will be no place to climb. Not to that degree, but as it was, the hardest thing for me in the morning, sleeping at night or sleeping poorly. I take some medicine, but I am afraid they will run out and there is nowhere to get them. Complicated With depression you need live communication, you need movement. Since I am over 60 years old, I am not very strong since childhood, many squats are needed at home. Not only because of the closure of that department, I believe that quarantine affects all people, even if they do not have depression ”, Irena shares her experience.

When asked how she saves on medications, the interviewee says that she is not currently adhering to an established medication schedule.

“It just caught our attention then. On the one hand, it is good to reduce, but the condition is not good. Of course, that quarantine will divide the wood for the weakest, but it is the way it is,” says the woman.

The situation is called disaster

The Department of Marginal Conditions, located in the Mental Health Center of Vilnius city, is sometimes called the Department of Psychotherapy. According to the head of the department, the pioneer of psychotherapy in Lithuania is considered the psychiatrist-psychotherapist Aleksandras Alekseičikas, here the treatment of patients with drugs constitutes a small part, and the main method used is psychotherapy.

“In psychiatry, generally each person is between 50 and 50 percent. receive medical treatment and psychological assistance. In our department, pharmacy help was 20-30 percent, and psychological help: 70 percent. We have a variety of patients, from neurosis to a disorder in which a person seems to be watching them and wants to be forcibly treated. There have been addicted patients and those with obsessive compulsive conditions that are difficult to help with medication (…). We have worked with a wide range of disorders, but most of the time there are patients who already have experience that medications do not help them much, they need psychological effects and support, “says A. Alekseičikas about the department’s work.

The doctor explains that before quarantine, 15 people could be treated as inpatients in the Limit Conditions Department, and another 20 patients could be treated in a day hospital.

According to A. Alekseičikas, those who could pose a threat to themselves or those around them lay in the hospital. Also patients who needed medication. According to the psychiatrist, when the condition improved, the individuals were released to their homes and interacted with specialists and attended group classes for days only.

The department head says that after the introduction of quarantine, the hospital part of the department was abruptly closed, and later the day hospital.

“Our hospital, Summer 5, has 300 employees and generally treats about 250 patients. There were now about 50 patients in our hospital, others were not admitted due to quarantine. Not only was my room closed, but three others were closed, the hospital was closed all day. This is a type of disaster. There are 300 employees caring for 50 patients. Others went on vacation at downtime. Not everything is organized “, – a psychiatrist-psychotherapist talks about the situation.

He said that he had no complaints to the hospital regarding this situation, since he understood that a crisis of this magnitude was the first in Lithuania. However, according to him, it is surprising that psychotherapy is still not considered necessary care and it is not understood that the continuation of such treatment is directly related to the condition of the patients being treated.

“If you have a broken leg and do not have insurance, you are a foreigner, you still need help to avoid dying, it will be provided to you free of charge. Currently, most organizations and our minister do not consider psychotherapy to be a necessary help.

One of the most popular generalizations of psychotherapy is the effects on a person through relationships. Not only through thought, feelings, persuasion, medication, but also through relationships. Because there are other people nearby, nurses, other patients, the patient feels safe. We had to discharge all the patients who were with us, ”says the head of the department.

Accept only those who suffer from acute psychosis.

According to Vilnius Mental Health Center staff, the Border Conditions Unit was closed after the Vilnius Municipality decided to use a hospital building to isolate returnees. Although many isolated Lithuanians here were surprised by the living conditions offered by the municipality, 65-year-old women with various mental disorders were treated in this body for a long time.

All of them, when the municipality decided to use the hospital facilities for the isolation of those infected or who returned from abroad, were transferred to the rooms of the Department of Border Conditions, and the latter was completely closed.

However, the director of the Vilnius City Mental Health Center, psychiatrist Martynas Marcinkevičius, assures that no patient was discharged from the psychotherapy department before the end of treatment.

“Everyone finished the treatment, not everything was done suddenly. That transfer of the building did not take place in a day. No patient was discharged prematurely. Of the three doctors, two are on duty: one is on leave, the head of the department is consulting remotely and a doctor is working in another department with the same patients. If there is a patient who needs such help, he or she has been transferred to another department. We did not stop the activity, it really did not stop the treatment of any patient, “says M. Marcinkevičius.

According to the director, even if the psychiatric hospital had not released the building to isolate people infected with coronavirus, the State Quarantine Unit would still have had to close due to quarantine.

“Basically, there is planned assistance, there is practically no assistance needed according to the details of that department. Basically there is psychotherapy and we all understand that it is not an emergency, it is planned aid. Even if we had not given up on that building, we still would not have I was able to admit new patients to that Border States Department. Still, those patients would be discharged and the room would be empty, “says M. Marcinkevičius.

According to the hospital chief, there are currently two closed rooms in the medical institution: border states and crisis interventions. Also, not all day hospitals work.

However, the head of the institution confirmed that, although about 150 patients are generally treated in the hospital, there are currently around 50. When asked if they were all discharged from the hospital, M. Marcinkevičius confirmed this.

“Yes, we have a movement all the time, we are not a nursing home. With us, patients are in bed and discharged every day. Since now we cannot sleep with planned patients who have deteriorated with the shunt, essentially only the necessary care remains. Help needed, for example only acute psychosis. We cannot accept people with depression and neurosis at this time, “explains M. Marcinkevičius.

Waiting for the influx of patients

For his part, A. Alekseičikas assures that those who suffer from depression, neurosis and other similar illnesses will be the most affected by the quarantine and the change in treatment.

“That we isolate him well, but now many people, practically all people have been placed under house arrest. This is not good. It means that we are aggressive not only with the virus but also with people. Some people can survive this, but many people who are isolated, restricted in their activity and freedom, really feel very bad.

For those with severe psychosis, the outside world may not work well at all. But those who start to fear this epidemic or pandemic too much and fear not only themselves, but also others: their parents, relatives, children, this is their condition, it can be said that it is deplorable. But people are suffering. They cannot get help, they will survive and suffer, “said the doctor about the reality of the patients.

According to Andrius Jančiauskas, a psychologist who works in this department and currently in downtime, patients who visit a day hospital will be affected no less, or perhaps even more. The psychologist is convinced that due to the quarantine, “the mental health crisis will hit very hard.”

“It will have a very strong and very direct effect, because all the problems are maturing somewhere now, most of the people are just not being treated and those around them are still being tortured without treatment.” Homes are often complicated because they are complex patients and it spreads like a virus, you could say that it eats society. We, the health system that normally works as medicine, are doing nothing. We’re just waiting. And then we’ll have to deal with a bigger cloud. I think this will be a long-term consequence, “says the specialist.

M. Marcinkevičius also agrees that such strict restrictions will certainly aggravate the condition of people with mental disorders. According to him, the mental health center is already preparing for the influx of patients.

“After all the quarantines, as soon as the opportunity to receive these patients becomes available, we are gradually preparing for that increased influx. So now the employees are trying to take a vacation. As soon as scheduled patients, open day hospitals, we really expect a great flow. The longer the restrictions last, the greater the flow. We understand this perfectly, “predicts M. Marcinkevičius.

“All medical care is closed, not just mental health. All planned outpatient care is suspended, everywhere it is provided only in case of extra. Mental health is not excluded,” recalled M. Marcinkevičius, adding that although the Quarantine can really have a very painful effect on people’s mental health, so far the hospital cannot do anything, their hands are tied due to the restrictions introduced.

This is also confirmed by Viktorija Turauskytė, the temporary head of the Vilna Municipality Health Care Department.

“All current service restrictions were introduced pursuant to the Government’s March 14. Resolution This paragraph states that inpatient services may be provided only in the case of indications for emergency medical care, and outpatient services may be provided. provide only remotely.

Currently, patient services are provided to the extent permitted by the aforementioned government resolution. In the event of an acute condition and due to emergency care, all patients are admitted to the Admissions Emergency Department, hospitalized and treated in the relevant departments, ”says V. Turauskytė in his written comment.

Psychologist talks about volunteering, says hospital – minority in downtime

Although both the SAM and the hospital itself ensure that remote assistance is currently provided to patients, according to psychologist A. Jančiauskas, this is at the expense of the goodwill of the staff.

“It so happened that we lost the opportunity to work, but we created the department remotely. We operate voluntarily, actually how we live, but in fact as employees we are down time.

We make up for this at the expense of our personal lives. In times of crisis, that concentration is natural, but if that period of crisis lasts a month or more, it seems to be a state of incapacity. Well, we focused, we volunteered, but how much more to do? A month, two, three? Asks the psychologist.

M. Marcinkevičius claims that downtime has been applied to only a small part of employees, but did not mention exactly how much.

“There are some, but they are mainly those people who, for one reason or another, do not want to work.” Part went on vacation, part was adjusted for downtime, because about half of our employees provide outpatient care, ”says M. Marcinkevičius.

In total, the hospital employs about 300 specialists.

How Delphi V. Turauskytė reported, currently only one person infected with coronavirus is isolated at the mental health center.