COVID-19 (C19) presents significant challenges to in-patient mental health care settings. While many guidance documents provide infection control advice, few appear to have addressed the psychosocial challenges associated with doing so in in-patient mental health settings.

Ultimately, in-patient services must strive to implement public health measures during a pandemic but delivering safety in this context goes beyond the prevention of infection. Therapeutic environments require strengths-based, recovery-oriented, and trauma-informed person-centred care facilitated through collaborative engagement that builds trust (Ashman et al., 2017; Bowers, 2014; Canacott et al., 2019; Fletcher et al., 2019). The challenges involved can be framed as structural, procedural, and ethical (Wu & McGoogan, 2020). From a structural perspective, the consistent enactment of social distancing and other environmental isolation measures poses challenges in settings designed to foster social engagement and discourage social isolation (Kavoor, 2020; Zhu et al., 2020).

From a procedural perspective, implementing restrictive infection control procedures and the care protocols for managing complex medical illnesses are particularly challenging in environments focused on psychosocial rather than somatic/medical care (Kang et al., 2020; Chen et al., 2020; Royal College of Physicians, 2020; International Council of Nurses, 2020). Potentially complex ethical decisions may confront clinicians and services, requiring the judicious balancing of obligations to the rights, interests, and values of all concerned (Brooks et al., 2020; Government of Ireland, 2020). Potential tensions emerge when reconciling public health mandates with the resulting limitations such measures may impose on the rights and preferences of individuals who may not understand their necessity or agree that they are desirable. Service managers and clinicians may struggle to reconcile their ‘public health’ obligations to society with their ‘person-centred’ commitment to patients (Government of Ireland, 2020).