Coping with severe mental illness during COVID-19

Dr. Smith has just explained how severe and enduring mental illness (SMI) make some members of our societies especially vulnerable at the moment. Let’s think more about the risk to this group and what we can do to help.

In Week 1, some of you expressed concerns that Kevin might become so low he would consider harming himself.

Remember in the previous steps that we talked about what happens when we experience heightened emotional states?

Our attention narrows, the idea of “later or tomorrow” goes out the window, and therefore so does the idea that “this mood will pass”. We lose the ability to have some psychological distance from our current state of mind.

This is one reason why sleep deprivation and substance misuse are associated with self-harm: perspective and inhibition are impaired. Kevin is thankfully not at this stage currently. But others are.

Alongside the risks from the socioeconomic and physical health stressors that Dr. Smith described, individuals with SMI are also more vulnerable in this respect. Services and organisations play a key role in the care of these individuals, but some of what has helped Kevin with his depression will be especially important for more vulnerable individuals with SMI.

Do you recall how Kevin has things written down from his service?

This may seem like a small thing, but often people keep important numbers pinned somewhere where they can see them easily. This is helpful when we are attempting to implement any new behaviour, whenever we know we might be pulled toward old habits.

We make use of our surroundings, almost like an extension of our minds, in the way that we store phone numbers rather than trying to remember them. This is especially important when we are overwhelmed. Therapy offers this also – we have available another mind, or several other minds to assist our own.

More formally in mental health services, particularly when thinking about people with SMI, we refer to the joined-up thinking that can support a vulnerable individual as a care plan or a crisis plan. Now will be the time to ensure that such individuals have an updated version of their care plan. This should ideally involve their friends and family, or others in their network, as well as professionals who are important in their care with specific plans or actions to do when in crisis.

In clinical work, case-based discussions are a common way that professionals come together to think about individuals. Below, Dr. Stubley draws on two case studies to illustrate why, for individuals with severe mental health difficulties, the current context can really exacerbate their conditions, and why we really need to have individuals and services linked and thinking together.

Download Transcript of Jo Stubley on severe mental health difficulties (right click or tap/hold and open in new tab)

You will appreciate, as we describe the impact of the current situation on individuals with PTSD and SMI, that many of the methods for staying well that we have described so far will not work alone.

For many individuals who are unwell in this way, what they need to do individually to cope is so entwined with what services need to do to assist them that it is unhelpful to separate the two.

For some of these individuals, a capacity to engage in strategies to stay well will be closely linked to ongoing input and support – we will, therefore, revisit this group of individuals when we discuss therapy settings and the concept of containment in the coming steps.

This step has included especially emotive content – please take a break if you need to.