In a time when physical distancing and isolation are necessary responses to COVID-19, healthcare clinicians are rightfully concerned about their personal mental health as well as that of their colleagues, family members, and patients. Join our discussion about how COVID-19 has affected mental health needs within your practice and how you are working to address both your own, and your patients’ needs within the current context.
Between distance learning and lack of normal social interaction with peers, some children and teens need more guidance, not less. What can you do to provide that if they are hesitant to come into the office for their annual check-up?
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Physician
We have made use of the relaxed regulations allowing for telehealth (video and phone) care and e-prescribing for our MAT patients. This has worked well, based on both retention and the low rate of ED visits of patients in treatment. We have made active use of Peer Recovery Specialists to proactively maintain contact as part of this process. We have also been offering video groups as well, but that is challenging both due to technology as well as the availability of our patients to access internet or afford the cost for the data. Bottom line: we are caring for the same number of patients, fewer than 5% in person, but we are nevertheless concerned about the outcomes downstream.
She/Her/Hers
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Physician
The practice immediately launched The Recovery Platform (TRP) for all medication assisted treatment patients as part of the North Carolina Medical Society Foundation Project Obot. In addition, the team partnered with the local Peer Support Team and continued participation with the Hope N Hoke Community collaborative. While none of us predicted a pandemic would threaten the lives of substance use disorder patients beyond the direct impact of the virus the partners provided the safety net necessary to prevent loss of life due to addiction.
Millions of people watched the death of a man, George Floyd via television and social media. Unfortunately this event unfolded at the same time many states entered into re-opening phase of the Covid-19 pandemic with thousands of people responding with public protests and destruction of businesses. The multivariate issue of witnessing a death, strained finances, racial inequality, health disparities, are among issues which have led to observed anger, frustration, and anxiety. The impact of this event and many similar interactions may lead to new or exacerbation of mental disorders with impact on individuals overall health.
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I think the question of preparedness is a great one Karen. On the one hand I want to say that we are all too prepared given that many of us have lived through similar incidents in the past, regrettably. And yet, this one feels different. There is a collective grief we all share right now and hopefully a sense of collective responsibility to be part of the solution. My one tidbit for physicians and mental health professionals is to simply be brave and address this head on with all patients. Something as simple as asking at the beginning of a visit, "There is a lot going on right now with the pandemic and with race relations in our communities - how are you handling these things?" This gives the patient an opportunity to address it if they wish. I know it can be scary to open up what feels like it could be a long conversation (and we don't have the time in a typical visit), but addressing this reality can really build relationship. AND it doesn't have to overwhelm the visit. A skilled clinician can pivot to the presenting complaint tactfully. Frankly there is not much that can be said about it at present - practicing presence is most of what our patients need.
Dr. Serrano I appreciate your statement to be brave which resonates with our practice. While I'm certain preparedness varies related to witnessing and processing traumatic events, we are prepared to continue to show up for our patients to denounce racism, end inequality and promote access to high quality healthcare. We ask permission to serve our patients needs as they define them and correct us when we get it wrong so that we can collaborate together. Wellness checks with patients who may experience exacerbated stress or compromised safety has been a practice we started in March. Feedback from patients has been positive that we are proactively reaching out to see how they are doing, offering support and linkages to community resources.
She/Her/Hers
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Physician
The physical, emotional, and spiritual health of people are challenged during a time when social distancing is advised to save lives. A suggested mechanism to assist people with maintaining mental well being is to first start "connecting" with the providers of care and their team. Encourage the team by acknowledging the crisis we live in is legitimate but one of many crisis known to humanity. It is important for each individual to focus on what we can do when efforts are directed toward specific tasks as identified by the team. As the pandemic progresses and new crisis unfold the ability to adapt and modify workflow is valuable to sustain resilience. Recognition of implicit bias assist with providing culturally sensitive ways to connect with people during challenges of the current day. Success is achieved when identified positive encouraging leaders are present early in the process to provide vision, support the ideas of the flank, and protect the vulnerabilities of the rear as the team forges through unknown territory.
We are seeing a range of responses from having behavioral health staff remain in virtual service mode to bringing them in as usual but with PPE and spacing precautions. Interested to hear the what and why of your decision-making!
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He/Him/His
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Physician
Our behavioral health staff maintained a full schedule via telemental visits. Now, several patients are preferring face to face visits. We have set up a plexiglass screen between the counselor and the patient which allows them to take off their masks while talking during a session. It was very difficult doing a face to face session with a mask on (I guess it was a mask to mask session!). Both counselors and patients are pleased with this arrangement. Still, at least half are being done via telemental.
Jay, that is precisely the experience of many clinics I have heard about, but yours is the first I have heard of placing plexiglass! That is an ingenious idea. I go back to seeing patients in-person in two weeks and the mask is definitely going to be an issue. One Behavioral Health Consultant in our network mentioned that she has a drawing she carries around with interesting things about herself and a smile on it to make up for the masked appearance. That said, I think a combination of telehealth and in-person will be the new normal for a while.
Physician
We have just restarted in-person visits ( we are still 90% or more telehealth) and are working out efficient processes for bringing people back in. Our existing space makes this challenging. We are asking people to wait in their cars and use texting to bring them in just in time, avoiding issues with the waiting room. But we are still struggling with the issues around workflow and distancing. I also like Jay's use of plexiglas, but hope that doesn't create issues and problems of its own.
She/Her/Hers
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Physician
The North Carolina Secretary of Health office introduced Wear a Mask, Wait six feet back, and Wash your hands based on CDC guidelines. Expansion of this theme promoted team based workflow modifications. Continuation of televideo services as much as possible as long as the payers support the service eliminate the need for protection strategies and improved appointment compliance. Reduction in face to face visits with new sanitizing procedures, temperature upon arrival, closure of the lobby, stream line urine drug analysis, and spacing visits allow the safety precautions to be implemented.
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Hi Gail and hope things are improving in NY. We are finding that our patients are returning for their check ups. In April, we had about a 50% fill rate, but in May it rose to 80%.
But interestingly, our mental health providers (we have 4) were 100% booked, albeit telemental. Now, some patients want face to face visits for their counseling, and we are providing that too.
I think the demand for mental heath visits will increase, especially if schools do not get started normally.
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I think we will need to do more virtual check-ins with this patient group. I would love to see clinics enable their EHR platforms for minors (with parental consent) in order to send questionnaires or supportive messages directly to teen's devices. This is of course a generation that will be more responsive to this kind of interaction anyway.