Caring for persons in detention suffering with mental illness during the Covid-19 outbreak.
Caring for persons in detention suffering with mental illness during the Covid-19 outbreak.
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DOI：
10.1016/j.fsiml.2020.100013
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发表时间：
2020-11-01
期刊：
影响因子：
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通讯作者：
Schleifer, Roman
中科院分区：
文献类型：
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作者：
Liebrenz, Michael;Bhugra, Dinesh;Schleifer, Roman
在被拘留者中，患有精神和身体疾病的人数不成比例（Bhugra，2020年; Ginn，2012年）。还已知通过飞沫或密切接触在人与人之间传播的感染在密闭空间中传播得特别好。由于进一步治疗的转移选择更加困难（特别是在拘留设施中），因此大力强调预防措施，特别是在病毒飞沫感染的情况下。例如，在流感的情况下，建议为被拘留者和工作人员接种疫苗（NHS 2019）。如果没有这样的选择，监狱和其他封闭设施，如庇护中心，收容所和封闭的精神病医院，就会构成此类疾病快速传播的风险。例如，在过去，澳大利亚已经描述了流感在监狱囚犯中的快速传播（Awofeso等人，2001年）。据报道，西班牙流感也影响了大约四分之一的囚犯;与普通人群的数据相比，患病率要高得多（Finnie，Copley，Hall，& Leach，2014）。我们目前还收到来自中国的消息，报道称来自湖北省的囚犯中COVID-19感染迅速蔓延。关于新型冠状病毒，传播似乎是由受感染的安全人员将其输入拘留设施造成的。据媒体报道，中国政府对囚犯中的疫情做出了反应，封锁了受影响的监狱，暂停了货物运输，对与确诊的监狱长接触的囚犯进行了检测，还解雇了监狱长，并成立了一个委员会来分析病毒在被拘留者中的传播（财星环球2019）。正确的是，最近有传言称，媒体对新型冠状病毒在监狱囚犯中的传播存在”盲点”。（环球时报2020）我们认为，盲点进一步延伸到特别边缘化的群体，如使用和滥用毒品的个人和没有法律的居留身份的人，特别是因为这些群体经常与被拘留的个人重叠（Liem，Wang，Wariyanti，Latkin，& Hall，2020）。在正常情况下，监狱中个人的心理和精神护理已经是许多卫生保健系统的一个重大挑战;正如目前所观察到的那样，这一问题在危机时期甚至更加明显。这些困难出现在不同层面，影响到被拘留者、安全人员以及医务人员（Chen等人，2020年）。恐惧，担忧和不确定性，特别是对于被隔离或隔离的患者，可能会导致与压力相关的疾病增加，但也会加剧先前存在的精神障碍（Duan & Zhu，2020）。这就导致了一个两难的局面：与所需的更高水平的护理和支持相抵触的是，建议，特别是在隔离条件下，不建议为防止感染蔓延而例行咨询临床心理学家、精神病医生和社会工作者。在这种情况下，主要专注于治疗感染（或其并发症）的医务人员必须额外提供心理护理，并准备在心理健康危机期间进行干预。在这种背景下，一些作者主张使用在线咨询工具和网络平台来支持孤立的个人和受影响的人（Liu等人，2020年）。虽然这些建议针对的是一般民众而不是监狱人口，但不对被拘留的个人使用这种照料渠道似乎是不合理的。可以设想其他模式，如...
There is a disproportionate number of individuals with mental and somatic illnesses among persons in detention (Bhugra, 2020; Ginn, 2012). It is also known that infections which are transmitted human to human via droplet or close contact spread particularly well in confined spaces. Since transfer options for further treatment are more difficult (especially in detention facilities) preventive measures are strongly emphasized, particularly in the case of viral droplet infections. For example, in the context of influenza, vaccination of detainees and staff is recommended (NHS 2019). If such options are not available, prisons and other closed facilities, like asylum centers, shelters, and closed psychiatric hospitals, pose a risk for the rapid spread of such diseases. In the past, Australia for example has described the rapid spread of influenza among prison inmates (Awofeso et al., 2001). The Spanish flu is also reported to have affected about a quarter of all inmates; a prevalence much higher when compared to data from the general population (Finnie, Copley, Hall, & Leach, 2014). We are also currently receiving news from China, which reports a rapid spread of Covid-19 infections among prisoners from the Hubei Province. Regarding Covid-19, the spread seems to have been caused by infected security personnel importing it into detention facilities. According to the media, the Chinese government reacted to the outbreak among inmates by locking down affected prisons, suspending the transportation of goods, testing inmates who were in contact with the diagnosed wardens, and also by dismissing the prison directors and setting up a commission to analyse the spread of the virus among detained individuals (Caixing Global 2019). Correctly, there has recently been talk of a" blind spot" in the media regarding the spread of Covid-19 among prison inmates.(Global Times 2020) We argue that the blind spot extends further to particularly marginalized groups such as individuals using and abusing drugs and people without legal residence status, especially since these groups often overlap with individuals in detention (Liem, Wang, Wariyanti, Latkin, & Hall, 2020). Under normal circumstances, the psychological and psychiatric care of individuals in prison is already a major challenge for many health care systems; a problem that is even more evident in times of crisis, as is currently observed. The difficulties arise on different levels and affect detained individuals, security personnel, as well as medical staff alike (Chen et al., 2020). Fears, worries, and uncertainties, especially for isolated or quarantined patients, can cause an increase in stress-related illnesses but also the exacerbation of pre-existing mental disorders (Duan & Zhu, 2020). This leads to a dilemma: the higher level of care and support that is required is contravened by recommendations that, especially under conditions of isolation, advise against the routine consultation of clinical psychologists, psychiatrists, and social workers in order to prevent the spread of infections. In this situation, medical staff, who are primarily focused on treating the infection (or complications thereof), must then additionally provide psychological care and be ready to intervene during a mental health crisis. Against this backdrop, some authors advocate for the use of online counselling tools and web platforms to support individuals in isolation and those affected (Liu et al., 2020). Although these recommendations are directed at the general population and not at a prison population, it does not seem reasonable that such channels of care should not be used for individuals under detention as well. Other models could be envisaged, such as the …