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Covid-19 HSE Clinical Guidance and Evidence

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Managing Self-Harm and Suicidal Ideation

Managing Self-Harm and Suicidal Ideation during the Coronavirus outbreak, (CD19-024.-001 V2./09_04_2020)


Purpose

To help reduce the spread of coronavirus (Covid 19) all patients should be encouraged to phone their GP or mental health service before they present at Emergency Department (ED) for assessment. For people who self-harm or have suicidal ideation key to management is ensuring the person receives a biopsychosocial assessment and a management plan addresses safety issues and linkage to next care. This is in line with the Model of Care for the Clinical Programme for the Assessment and Management of Patients presenting to the emergency Department following self-harm and is pertinent for patients presenting in all settings.

Target audience:  Mental Health Clinicians working in ED, Emergency Department clinicians, Liaison Psychiatry Teams and Community Mental Health Teams.
 

Clinical Guidance

A recent systematic review of comparative studies Are there interactional differences between telephone and face-to-face psychological therapy? A. J Affect Disord. 2020; 265: 120–131. The most striking finding of this review is that, for the most part, they found no evidence of mode-related difference in a range of interactional features including therapeutic alliance, disclosure, empathy, attentiveness or participation. According to the results of this review, there is no empirical evidence to corroborate perceptions that the telephone mode, specifically its absence of visual and physical co-presence, is detrimental to alliance formation. The consistent finding is that alliance is rated similarly across modes.

  • Many people will be appropriately supported by phone discussion, text or email. Remote consulting via video link may be required for some and others will require face to face assessment.
  • If patients are referred to ED, early assessment by Mental Health (MH) staff will ensure the patient can move quickly through the ED. In some cases this could be through parallel assessments with ED staff, and in other cases the MH could consider seeing the patient immediately following triage. In some cases this assessment could be by phone or video link.  Discussion with ED staff as early as possible will support this.
  • Each service identifies a suitable place for face to face assessments. In some cases this will be in the ED, ensuring patient and staff safety. In others it will be the Department of Psychiatry, or a community facility and in many a mixture of all.
  • Each service identifies the optimal use and placement of video consultation facility.  
  • Each service identifies a suitable place for face to face assessments. In some cases this will be in the ED, ensuring patient and staff safety. In others it will be the Department of Psychiatry, or a community facility and in many a mixture of all.
  • Following assessment a clear management plan identifying the patient safety and route to next care should be well documented.
  • Information on CrisisText Lines Text YMH to 086 1800 280 to text with trained and supervised volunteers, or Samaritans, 116123 should be provided.
  • The use of a follow-up phone call to the patient within 24 hours of assessment has been shown to have benefit. This call would review safety planning and repeat advice or information.

Prescribing During Covid-19

The Medicinal Products (Prescription and Control of Supply) (Amendment) Regulations 2020 has facilitated a change in how prescription only medicines, including controlled drugs, can be supplied to patients by pharmacists during the COVID-19 pandemic to ensure continued care and treatment for patients.

The changes amend the Medicinal Products (Prescription and Control of Supply) Regulations 2003 (as amended) and the Misuse of Drugs Regulations 2017 (as amended). The purpose of these changes is to ensure continuity of care and access to treatment for patients during the Covid-19 pandemic and to reduce some of the burden on prescribers and the broader healthcare system.

Joint Guidance
To assist pharmacists and prescribers, the PSI, Medical Council and HSE have published joint guidance setting out the amendments to the legislation for supply of prescription-only medicines during the Covid-19 pandemic.

Key Changes

National electronic prescription transfer: The electronic transfer of a prescription between the prescriber and pharmacy is provided for through the use of the HSE Healthmail® system. This will remove the requirement for paper copy of a prescription to be forwarded to a pharmacy once this closed-system electronic service is used.

Maximum validity of prescriptions: This has increased temporarily from 6 months to 9 months from the date specified on the prescription (some restrictions continue to apply around the dispensing of Controlled Drugs); only where in the pharmacist’s professional judgement, after consultation with the patient, and if needs be the prescriber, continued treatment is required and it is safe and appropriate to do so. 

Repeating prescriptions: The number of repeats which may be supplied for both S1A and S1B medicinal products has been increased temporarily to enable pharmacists’ continuity of patient care without necessarily requiring a new prescription.

Emergency supply provisions: 

  • A pharmacist can dispense up to 10 days’ emergency supply of a prescription only medicinal product at the request of a patient, including the Schedule 4 Part 1 Controlled Drugs: midazolam, clobazam and clonazepam for the treatment of epilepsy.
  • A pharmacist can dispense up to five days’ emergency supply of a Schedule 2, 3 or 4 Controlled Drug in defined circumstances, at the request of a prescriber or a patient.

In addition to the existing provisions for emergency supply at the request of a prescriber, a prescriber can also request an emergency supply of the Schedule 4 Part 1 Controlled Drugs - midazolam, clobazam and clonazepam for the treatment of epilepsy.

References:

Are there interactional differences between telephone and face-to-face psychological therapy? A systematic review of comparative studies. J Affect Disord. 2020; 265: 120–131.

Managing Self-Harm and Suicidal Ideation: Summary of Evidence

April 15 - What is the impact of the COVID-19 pandemic on suicide rates? Keywords: Suicide, Suicidal Ideation

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