Battle to keep virus out of asylums

RANCHI: On the frontline of inpatient psychiatric treatment in the country, the two most prominent mental health hospitals in Ranchi are now taking all measures to ensure the coronavirus outbreak does not reach the facilities.
With the city reporting more than 100 Covid cases every day since the last week, the Central Institute of Psychiatry (CIP) and Ranchi Institute of Neuro Psychiatry and Allied Sciences (Rinpas), which have a capacity to lodge about 1,200 patients, have managed to keep their premises protected until now.
While officials at these British era hospitals are following all precautionary protocols, there are various challenges to battle pandemic in settings like these. “You get one case in these institutions, and you will have 10 in a few days. Most patients here are in the high-risk category – they are elderly, some have chronic medical conditions and most are on various medications,” said Shradha Bhair, a leading psychologist associated with Civil Society Network for Child Rights.
While both the institutions have made arrangements to ensure that their staff – the bridge between the patients and the outside world – take all precautions, social distancing and other norms is easier said than done in a psychiatric facility.
“We need to understand that they are suffering from mental health disorders and it can be difficult to explain the situation to them, especially those with illnesses like dementia or Alzheimer's. Moreover, isolation can be dangerous at psychiatric hospitals – particularly for those with severe depression or schizophrenia -- and social interaction is mandatory for therapy. Patients also need to walk, eat and exercise. Likewise, alcohol-based sanitizer can be fatal if ingested,” she said, adding managing mildly ill patients is not difficult, but for those suffering from serious disorders can be highly challenging.”
Officials at both the institutes agreed that the virus is slippery and they must be prepared for any eventuality.
CIP director Dr Daya Ram said the institute now has a triage outside the campus where patients are being admitted along with their guardian and are being released from there “We are keeping serious patients in the triage for necessary treatment and releasing them within 72 hours. We are avoiding admitting new patients, but our emergency services are available round the clock. The hospital staff is screened every day and the campus is sanitized frequently,” he said.
CPI has 643 beds, but has 150 the number of in-patients is as low as 150 and the administration is trying to treat new patients at the triage and discharge them as soon as possible, instead of admitting them to hospital. Ram admitted that there is no separate facility within the hospital for anyone infected with Covid-19 and any patients with symptoms will be sent to Rajendra Institute of Medical Science (Rims), Ram said.
Dr Nishant Goyal, associate professor of psychiatry at CIP, said the hospital staff has been trained to handle the patients while observing social distancing. “The staff is screened every day before they are allowed to enter the campus and suspected cases are sent for testing,” he said. Sanitizers, gloves, face masks and face shields are compulsory. “Based on the degree of risk involved in any medical procedure, the doctors are also using adequate safety measures,” he said.
At Rinpas, the second biggest psychiatric hospital in the state, — there is enough space to ensure adequate distance between each beds in the wards, officials said. Dr Siddhartha Sinha, senior consultant at the department of neuro-psychiatry, said, “The number of patients coming to the hospital has decreased ever since the lockdown was imposed in March and we have sufficient room for every patient to ensure social distancing. Visitors and staff are being screened every day,” he said, adding that the institute is focusing on helping the patients with medicines rather admitting them immediately.
Dispelling a major concern, Sinha said though most people believe that mentally ill patients have to be handled manually to keep them under control, less than 1% require manual handling. “About 99% of the patients understand and abide by the directions given by medical professionals. It is not really difficult to explain social distancing to them. Most patients do not mingle and live in seclusion. It is easy for the hospital management to ensure sanitization and distancing among patients,” he said.
Admitting that the pandemic has caused anxiety, depression and other mental disorders, Sinha said such cases are handled through counseling and in OPDs. “In case of suspicion of Covid infection to any patients coming at the OPDs, we are sending them for tests and admitting only those with a negative report,” Sinha said, clarifying that Rims has a department of psychiatry and they can handle infected patients.