Chronic illness and COVID-19: Psychological support for chronically ill patients in Biella, Italy

Dr Patrizia Tempia and her staff work in the Psychology Service of the Local Health Unit in Biella, Italy. Biella is part of the Piemonte region of northern Italy, which currently has the third highest number of infections in the country. Low diagnostic capacity presents particular challenges in containment efforts. This post addresses important considerations regarding the mental health and psychosocial support of people with chronic illness during the COVID-19 pandemic. 

Key messages Innovations
People with chronic illness must not be overlooked in pandemic responses Phone line for people with cancer providing psychological support and assistance to ensure continuity of care
Be experimental in online approaches to support mental health across the lifespan “United on the net” campaign with advice from psychologists and wellbeing activities for home isolation
Psychological support of frontline workers is necessary to prevent burnout and attrition Dedicated team to support the mental health of hospital staff and patients

Given the situation in neighbouring Lombardy and terrifying images in media coverage, our city's residents were overwhelmed with fear as the pandemic progressed – a fear validated by the first published data from the region. At present (April 18, 2020), the Piemonte region has seen 20,581 confirmed cases and 2,302 deaths, with 758 cases and 144 deaths in the city of Biella.

Everyone has been affected by this crisis. Health care workers at our hospital withstand intense pressure and exhaustion during grueling 12-hour shifts in uncomfortable personal protective equipment (PPE). Patients with COVID-19 are not allowed in-person visits from family and friends during hospitalisation. Families are in disbelief and anguish having been deprived the opportunity to say goodbye to loved ones.

The situation is particularly difficult for people with chronic illnesses, such as cancer, heart disease and kidney disease. Non-urgent surgeries and treatment have been suspended or postponed. They need to visit the hospital but are at highest risk of severe complications if infected. With their health state in danger of becoming even more fragile, they fear limited life-saving resources, such as respirators, will be allocated to patients with higher chances of survival. The chronically ill are considered the weakest link in a health system in crisis. Given the high demands on the system, will they be less cared for?

Psychological support helpline flyer

To support the mental health needs of chronically ill patients, the Psychology Service of Biella hospital partnered with the Edo Tempia ONLUS Fund. Together with the Piemonte and Aosta Valley Cancer Network, we created a support line for cancer patients whose care and treatment cannot slow down during the pandemic. A psychologist and social worker manage the line with a similar initiative for children.

As part of this partnership, the “United on the net” project was created following WHO guidelines to support all people struggling with home isolation. YouTube videos promoted on social media provide advice from psychologists and lessons from instructors inviting people to engage in wellbeing exercises from yoga to arts and music. The Compagnia di San Poalo Foundation promoted the project during its “Together will be all right” campaign, which highlighted initiatives for the wellbeing of citizens during the emergency period.

"United on the net" campaign

At our hospital, we also formed a Telephone Psychological Support Team, active 12 hours a day, in collaboration with the departments of Psychiatry, Addiction and Child Neuropsychiatry and advice from the Crisis Unit. We hold weekly conference calls to support and motivate each other and use a WhatsApp group for daily communications. The hospital’s Child Neuropsychiatry Department also made short videos and leaflets for parents, children, adolescents and teachers. The situation has required us to compare different methodologies in emergency psychology and be experimental with online approaches to support people in all phases of life, including the end of life.

In addition to patients and the general public, frontline workers in the COVID-19 response need urgent psychological support to prevent burnout and attrition. Health care workers as well as cleaners, administrators, drivers and vendors must withstand intense fatigue, discomfort, stress, fear and loneliness day after day. They are required to comply with political and organisational decisions they may not agree with, all the while risking their health and the health of their loved ones.

Human resources are our most precious asset in this response. Psychological support is necessary to transform feelings of inadequacy and powerlessness into validation, acceptance and understanding of what is happening.

Key Resources:

  • COVID-19 and NCDs: Information note on COVID-19  and noncommunicable diseases (WHO) [Link]

  • Webinar: Mental Health & COVID-19, Supporting the Mental Health of Frontline Health Workers (UnitedGMH, MHIN, MHPSS, The Lancet Psychiatry) [Link]

  • Mental Health and Psychosocial Support for Staff, Volunteers and Communities in an Outbreak of Novel Coronavirus (ICRC) [Link]

  • Basic psychological support for staff health doctors and nurses (ICRC) [Link]

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Region: 
Europe
Population: 
Non-communicable diseases (e.g. cancer, diabetes, stroke)
Setting: 
Primary care
Specialist care
Approach: 
Technology
Detection and diagnosis
Treatment, care and rehabilitation
Disorder: 
All disorders
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