Considerations for the Care and Treatment of Mental and Substance Use Disorders in the COVID-19 Epidemic

Revised: May 7, 2020 Overview:

COVID-19 is a novel coronavirus spread by the respiratory route and contact with contaminated surfaces. It appears to be highly contagious and has a significant morbidity and mortality rate. Because these attributes are known and because this agent has been identified as responsible for a global pandemic, it is essential that behavioral healthcare facilities implement plans to protect patients and staff from infection to the greatest extent possible. The following are offered as considerations aimed at decreasing the likelihood of infection and viral transmission and providing for the behavioral health needs of patients.

There are many options for treating mental and substance use disorders which have an evidence base and/or are best practices. These include inpatient, outpatient and residential treatment options. Because of the substantial risk of coronavirus spread with congregation of individuals in a limited space such as in an inpatient or residential facility, SAMHSA is advising that outpatient treatment options, when clinically appropriate, be used to the greatest extent possible. Inpatient facilities and residential programs should be reserved for those for whom outpatient measures are not considered an adequate clinical option; i.e.: for those with mental disorders that are life threatening, (e.g.: the severely depressed suicidal person or persons with life threatening substance use disorders (e.g.: at high risk for overdose, complications from withdrawal). It is recommended that intensive outpatient treatment services be utilized whenever possible. Comprehensive long term residential treatment programs, where COVID related precautions can be implemented (social distancing, isolating, testing, etc.) remain a viable treatment option when clinically indicated.

CDC has released guidance on the expanded use of telehealth services. SAMHSA strongly recommends the use of telehealth and/or telephonic services to provide evaluation and treatment of patients. These resources can be used for initial evaluations including evaluations for consideration of the use of buprenorphine products to treat opioid use disorder. Further, these resources can be used to implement individual or group therapies such as evidence-based interventions including cognitive behavioral therapy for mental and/or substance use disorders.

For inpatient/residential programs that plan to remain open during the current COVID-19 related emergency; care should be taken to consider CDC guidance on precautions in admitting new patients, management of current residents who may have been exposed to or who are infected with COVID-19, and visitor policies.

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