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Covid-19: Highest risk patients are asked to stay at home for 12 weeks

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1170 (Published 23 March 2020) Cite this as: BMJ 2020;368:m1170

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Re: Covid-19: Highest risk patients are asked to stay at home for 12 weeks

Dear Editor
People with intellectual disability are a vulnerable group in society because of their level of dependence on services and other people to support them. The prevalence of physical and mental disorders is higher among them than other groups of people across the age span.

The current pandemic poses specific challenges to them and their carers that include minimising the risk of infection to them; access to information on the disease; risks of their home support breaking down due to infection of the person or support staff; risk of increased agitation and distress; placement breakdown because of behavioural challenges. The rapid changes in support structures for example, day-time support provided by Local Authorities in the UK is having an impact on people with intellectual disability and people with Autism who find it difficult to tolerate changes in their lives. Families often rely on this daily support for their own well-being and in continuing in their employment.

Psychiatrists working with people with ID are seeing an increase in requests for psychotropic medication to support people and to assist families and carers manage behaviours that are challenging to them. Considering self-isolating or shielding a person with ID for twelve weeks is an immense challenge for families and services especially where such support may contravene a person's human rights and their liberty.

Adaptive measures are being used by support services and clinicians to ensure continuity of care and to maintain people living in the community. To be successful such efforts will require a willingness by all agencies to collaborate in supporting services and families to reduce the risk of infection and the impact the environmental changes have on the person.

Competing interests: No competing interests

27 March 2020
Ken Courtenay
Consultant Psychiatrist in Intellectual Disability
Chair, Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists UK
St. Ann's Hospital London N15 3TH