Psychiatry and the pandemic: "Violence has increased"

Professor Heinz Ulrich Hegerl, Chairman of the Board of the German Depression Aid Foundation, criticized in 2021 that politicians did not sufficiently weigh up how much suffering the corona measures would prevent on the one hand, but also cause on the other.

Do you agree?

Sebastian Eder

Editor in the society department at FAZ.NET.

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I do believe that politicians are carefully considering this.

Mr. Hegerl mentioned that loneliness and social isolation are stress factors for the psyche.

I agree.

But that this is not sufficiently considered is a somewhat bold statement.

There is no one from the Department of Psychiatry on the Corona Expert Council.

Isn't that a mistake?

Basically, I think it's always good when our department is represented.

But I know the experts from Charité on the council - and I have full confidence that they are also sensitive in this area.

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At the beginning of the pandemic I had this fear because social isolation is a massive psychological stress factor.

However, the numbers from the first lockdowns did not confirm this for adults.

However, we have already seen many people who were massively stressed because of the situation.

And we had to give up treatment capacities to make room for people with Covid - here at the Charité too.

The supply situation in many hospitals has deteriorated because there was less capacity for non-Covid patients.

At times we even had to give up about a third of our bed capacity.

What other impact has the pandemic had on the treatment situation?

There was a visitor stop several times to prevent infection routes into the house, from which only minors and the seriously ill were excluded.

We have interpreted this with the mentally ill in their interest.

Nevertheless, the strict rules and isolation were stressful for many patients - just like the obligation to wear masks in the corridors.

Conflicts arose that would otherwise not exist.

For the first time in my forty years of professional life, I have suffered a massive physical attack.

The whole escalation had to do with the Corona measures: If a manic patient wants to tell me how he is currently conquering the cosmos, there is usually no conflict.

But when he takes off his mask to be able to explain it to us better, you have to say something to protect the other patients.

Did coercive measures have to be resorted to more often?

In Berlin, we actually try to leave the door open as often as possible, even on acute wards.

Even when patients are housed against their will, intensive care is usually sufficient.

This is how we reduce the number of coercive measures.

This is hardly possible with a door policy that has to control Corona visiting rules.

As a result, we had the impression that the number of acts of violence and the resulting coercive measures had increased again.

But the value is still low, we come to one to three percent coercive measures among all treated patients.

The vast majority of patients come to psychiatry voluntarily and have nothing at all to do with violence and coercion.

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Many psychotic experiences are very personally colored, and experiences from current events flow in there.

This is also reflected in fears and the compulsion to ponder.

Should there be something like incidences of mental illness -- and policy responses when numbers rise?

Those numbers are harder to come by because we don't have an easy-to-read test like the PCR test.

Mental disorders range from dementia to social phobias of large crowds.

That's a very broad spectrum.

The term disease is traditionally reserved for severe mental disorders, such as psychoses.

It would be important to see how that changes over time.

You are already taking the first steps.

We are currently planning with relatives and those affected at the German Center for Mental Health to continuously collect data on the mental health of a representative number of people - to then see how factors such as climate change or other events are reflected there.

We already know, for example, that mental illnesses depend heavily on economic factors.

For example, one of the most important predictors for the number of mental illnesses worldwide is the gap between rich and poor.

We would like to know more about that.

Do you expect a wave of mental illness after the pandemic?

You certainly have to look very closely at child and adolescent psychiatric institutions.

In adults, we have not seen a linear increase in the need for treatment.

It is difficult to say how this will develop.

Social isolation is an essential disease factor, on the other hand the factors that only affect us personally and not others are always the most effective for us humans.

If someone is racially attacked, the risk of post-traumatic stress disorder is high - in the case of a tsunami that hits everyone equally, the individual burden of illness is not so high.

A pandemic is actually more likely to be assigned to the second area.

It therefore remains to be seen which effect will predominate.