Developing a Rational Approach Towards Offering Procedural Interventions (ECT & rTMS) for At Risk Populations in Psychiatry During the COVID-19 Pandemic: An Interdisciplinary Evidence Synthesis.

The COVID-19 pandemic will associate with parallel mental health pandemics, one during the pandemic and the other after. The mental health impact of COVID-19 will be disproportionately experienced by at risk populations, with increased prevalence of mental illness such as mood disorders where procedural neurostimulation treatments such as Electroconvulsive Therapy (ECT) and repetitive Transcranial Magnetic Stimulation (rTMS) have significant evidence. However, hospitals across the country have either discontinued or decreased ECT and rTMS offerings, procedural aspects remain arbitrary varying from hospital to hospital putting healthcare providers at risk, and there is a lack of an understanding of the short-term and long-term impact of these changes on the at-risk population. Thus, there is a need to bring together a more systematic approach with a Canadian perspective and adopt best practices from other countries and procedural disciplines. This rapid knowledge synthesis will bring together interdisciplinary teams from neurostimulation programs at three major hospital systems in Toronto who have been at the forefront of responsible delivery of their respective programs since the beginning of the COVID-19 pandemic. The project will be a collaborative effort with Infection Prevention & Control, Anesthesia, Nursing and Ethics across hospital systems. Importantly, the knowledge users will include leaders from academic hospitals across Ontario, pertinent stakeholders nationally & internationally and patients with lived experience. This project will offer a rational framework for decision makers at the hospital, provincial and other levels to offer neurostimulation treatments and mitigate the negative impact of COVID-19 on vulnerable populations. Further, it will form the foundation to develop services/targeted interventions, and delineate critical areas of knowledge gap in the procedural domain which need to addressed from an interdisciplinary perspective.