Ethical and Safe Discharges from Psychiatric Units during the COVID-19 Pandemic

The current pandemic raises substantive ethical and legal challenges for inpatient psychiatric units striving simultaneously to contain COVID-19 and provide safe, high-quality psychiatric care. Among these challenges, psychiatric units need to consider their role in isolating and quarantining COVID-19 positive patients who are psychiatrically cleared for discharge. We examine this complex dilemma by evaluating mental health law, quarantine law, public health ethics, a case from an urban academic medical center's inpatient unit, and literature focused on treatment and isolation protocols during HIV and tuberculosis epidemics. Although inpatient units are highly restrictive and intended for acute psychiatric treatment, at present there are no obvious isolation, quarantine, or housing options for many patients with mental illness infected with COVID-19.