Coronavirus Challenges for Psychiatric-Mental Health Nursing in 2021

From our initial incredulity and fear to our present state of grim weariness in winter darkness, we enter 2021 still grappling with the coronavirus plague that has rocked our world. We are still reading vivid and moving first-person accounts of what it is like to experience COVID-19, from a doctor with a so-called “mild case” (Siegelman, 2020), to survivors appearing on television to relate weeks of suffering, and ICU nurses who have never seen so many of their patients die.

The scope of death is staggering, and the existential crisis profound. By the time you read this editorial, any mortality numbers that I provide will be obsolete. In the USA where I live, as many people die every day as were killed during the attacks that took place on 9/11/2001, an event that “captured America and served to slow the pace of civic life as no single event had since the assassination of John F. Kennedy” (Pollio et al., 2011, p. 7). Those of us who yet survive in this time of global pandemic are shaken by its enormity. In their book about the aftermath of 9/11, Life and Death in a Time of Terror, Pollio and his coauthors reminded that “even if we have courage, the possibility of non-being yields anxiety and dread, terror and fear” (p. 27).

Complicating the response to COVID have been (1) widespread public distrust of science; (2) distrust of mainstream media messages about protective strategies against the virus, along with dissemination of wild theories that COVID is a hoax or the result of a conspiracy; and (3) misconduct by scientists who have cut corners in early clinical trials and rushed to publication (Henig, 2020). A premature claim that hydroxychloroquine "cured" COVID influenced the president of the United States to promulgate its use (Saag, 2020). Some COVID-related manuscripts were published without peer review (Pickler et al., 2020) and a steady stream of flawed papers are being retracted, including papers in the New England Journal of Medicine and Lancet (https://retractionwatch.com/retracted-coronavirus-covid-19-papers).

To psychiatric-mental health nurses, 2021 will present formidable challenges.

Ghebreyesus (2020) pointed out that depression is included among the mental and neurological manifestations of COVID-19, and a large study of COVID survivors found that one in five developed mental health problems (first-time diagnosis of anxiety, depression, or insomnia) within 90 days afterward (Kelland, 2020). Survivors were also found to have higher risks for dementia.

COVID-19 also exacerbates preexisting mental conditions (Ghebreyesus, 2020). Unutzer et al. (2020) warned of increased risk for developing suicidal ideation in those with preexisting mental health disorders, some of whom live in poverty, jobless and precariously housed or homeless. Individuals in minority communities have been disproportionately impacted by the pandemic and have inadequate access to mental health services.

Specialists in psychiatric nursing will also be called upon to counsel colleagues in our own profession. In a recent address, Hassmiller (2020) predicted increased prevalence of posttraumatic stress disorder in nurses, citing a survey of 30,000 American nurses reporting high levels of stress exacerbated by the pandemic. Brenda Marshall (2020) provided an excellent overview of the impact of COVID-19 on nurses’ mental health in a guest editorial in our October issue.

Beyond the impact of the pandemic on afflicted individuals and healthcare workers, we are beginning to deal with the grieving of thousands of families who have lost loved ones.

The number of bereaved is estimated to be 2 million in the US alone (Simon et al., 2020), creating another wave of individuals who may need mental health services if their grieving becomes prolonged. Complicating the grieving process in this pandemic are the suddenness of many deaths, the inability of families to gather together to mourn, and the painful inadequacy of funerals via Zoom.

Psychiatry in the age of COVID-19 must develop new ways to reach and help individuals who are traumatized, depressed, and misusing substances. As noted by Thomas (2020), the coronavirus has shut down important lifelines such as school-based counseling of depressed youth, respite opportunities for family caregivers, and face-to-face AA and NA meetings. Outpatient psychiatric treatment is being successfully delivered via telehealth (Unutzer et al., 2020), but many people who could benefit from telehealth do not have access. Primary care clinicians must conduct screening, using tools such as the PTSD Checklist for posttraumatic stress disorder symptoms, the Patient Health Questionnaire 9 for depression symptoms, and the Prolonged Grief 12 questionnaire for relatives of the deceased (Simon et al., 2020).

A final challenge for all of us in health professions is to help the public develop greater trust in science. During the early months of 2021, we can play a role in dispelling false conspiracy theories about the pandemic and/or the vaccine. We can encourage people in our communities to trust the vaccine and take it whenever it becomes available to them.

When we have turned the corner on the pandemic, later in 2021, in addition to dealing with its above-mentioned serious sequelae, we must turn our attention to longer-term goals such as addressing inequitable societal conditions and inadequate access to mental healthcare for the most vulnerable among us. The pandemic has revealed much that we did not want to see, and these inequities cannot be unseen. I welcome manuscripts with your fresh insights and innovative recommendations for next steps to be taken.