An Cosantóir

An Cosantóir July / August 2020 www.dfmagazine.ie 12 | Psychological Medicine and Covid19 BY DR MATTHEW MCCAULEY, CAPT, MEDICAL CORPS, ARMY RESERVE T he outbreak of Covid19 has brought devastating consequences, both nationally and internationally. Every part of Ireland has been touched by the pandemic, resulting in fundamental psychosocial changes, along with the continued loss of life. Many have contributed to the fight against Covid19 and I have been asked by Defence Forces (DF) col- leagues to outline my civilian and military duties during the crisis. The demands placed upon healthcare staff and patients are closely associated with acute disaster and crisis situations, simi- lar to those seen on some military deployments. As noted in the military medical response to the Ebola Crisis in recent years, clinical psychologists are a crucial asset in assuring the optimization of policies and systems for limiting the spread of the virus (e.g. social distancing, adherence to quarantine, etc.). Indeed, the integral role and importance of psychological science has been a defining feature of the fight against Covid19. Clinical psychology focuses on mental illness, behavioral health, and the psychology of organizational and healthcare systems. The specialty is therefore well placed to respond to the psychiatric needs of patients; along with the resiliency, readiness, mental health and performance of staff. As a consultant clinical psychologist at Blackrock Clinic in Dublin, I led on the formation of a Covid19 psychological medi- cine consultation team, which addresses the needs of patients and staff. Covid19 has seen healthcare personnel encounter changes to their role, working conditions, and personal coping resources. Some have been exposed to highly demanding and stressful clinical experiences. Framed within an occupational healthcare context, the resource is closely aligned with the Clinic's Human Resources Department. As noted in the research, the psycho- logical resiliency and wellness of staff requires a continuum of mental health resources. This model assures that for most, stress-related psychological reac- tions are viewed as 'normal' responses to 'abnormal' adversities; and an expecta- tion of recovery and return to functioning is maintained. This is aided by appropriate self-care, psychoeducation, and/or peer support. A minority may develop clinically significant symptoms of mental distress, which can be treated by mental health professionals. This reflects a stepped ap- proach to psychological consultation (see Figure 1). As mirrored in military settings, this 'continuum' model to mental health and wellbeing (see Figure 2) results in a significant role for personal responsibility, leadership and line management. The process addresses the importance of effective communication, information dissemina- tion, validation and recognition of staff engagement, access to self-care and peer support material and skills, reduced barriers for utilization of supportive counselling, and clear pathways for accessing professional psychological care. In addition to the above, Covid19 has also seen a growing requirement for formal psychological assessment and care for pa- tients. Such services respond to those with pre-existing psychiatric conditions. Other referrals involve patients with clinically significant symptoms of mental distress arising as a result of the pandemic, including patients exposed to trauma, undergo- ing quarantine, recovering from treatment in Intensive Care Units, etc. Clinical psychology outpatient services at Blackrock Clinic have transitioned to a tele-medicine mode of delivery, with emergent and acute care offered in-person with the use of PPE. As noted by the Royal College of Psychiatrists, the mental health impact of Covid19 will evolve in the weeks and months ahead. The psychological medicine response plan at Blackrock Clinic will adapt to these changes.

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