In This Article
- Maurizio Fava, MD, psychiatrist-in-chief, within the Department of Psychiatry at Massachusetts General Hospital, explains the connection between COVID-19 and rising mental health concerns
- ?Telepsychiatry is allowing continuity of care for mental health patients and it is just as effective
- The Department of Psychiatry has curated a set of resources for providers feeling stress or other mental health concerns
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According to the American Psychiatric Association, 36% of Americans report that the coronavirus pandemic is having a serious impact on their mental health. COVID-19 may be responsible for rising rates of depressions among Americans. The highest risk groups include COVID-19 patients and their families, but also health care providers and first responders.
In this Q&A, Maurizio Fava, MD, psychiatrist-in-chief, within the Department of Psychiatry at Massachusetts General Hospital, explains the connection between COVID-19 and rising mental health concerns and what providers can do to help their patients and themselves.
Q: What is your reaction to the statistic that more than a third of Americans are feeling some mental health stress as a result of the pandemic?
Fava: It's quite understandable that the COVID-19 pandemic is likely to cause significant stress and psychological distress for a large proportion of the population. And there are various contributing factors including:
- Trauma from widespread disease
- Grief over losses of life
- Fear of getting sick
- Unprecedented physical distancing
- Financial concerns, including unemployment and housing insecurity
- Loss of community
- Reduced access to caregivers
People are not able to leave the home for support from their community, they have diminished access to caregivers and they may be avoiding seeing their doctor. All of these can lead to increased rates of depression and anxiety.
We know rates of depression are progressively increasing. But what we've seen with COVID-19 is far greater than we anticipated as part of the cohort effect.
There is still a stigma to depression and anxiety. So many people experience this stress, anxiety and depression, and don't necessarily talk about it. We hope that in 2020 people feel more comfortable acknowledging these types of experiences. Unfortunately, I think there's still a significant proportion of people who think they should tough it out or shouldn't really complain about it, but we need to challenge such attitude.
Q: Are there any groups that are at higher risk for mental health conditions during the pandemic?
Fava: You can imagine that COVID-19 patients and their families are at high risk, as are health care providers and first responders. But, in particular, we are concerned with those with preexisting mental health conditions. You can imagine that if you suffer from obsessive-compulsive disorder, this dynamic can only intensify your fears or obsessions about contaminations. You don't just wash your hands 20 times—you may wash them 50 or 60 times.
Q: How have telehealth and virtual visits made things easier for people with mental health conditions?
Fava: One of the things that COVID-19 has done is to challenge bureaucratic regulatory obstacles to telepsychiatry. In the past, typically, insurance companies had under-compensated telepsychiatry and there were obstacles to providing telepsychiatry for patients living out-of-state. Those obstacles should be removed so we can provide care to people anywhere. In March 2019, we saw 5% of patients through virtual visits and now it's 97%. We converted fully and very successfully.
Patients like it a lot because now they don't have to drive to Mass General, find parking, pay for gas, spend your 30 minutes with the doctor, and then drive back. Instead, you do a virtual visit from your home over video or phone. In psychiatry, we don't need to do physical examinations or procedures, and so delivery of care can clearly be virtual. We can reach our patients wherever they are to deliver care. It's just as effective as in-person visits and patients like them.
Q: Is there anything clinicians should be looking for that's different during COVID-19 in treating patients?
Fava: This is the right time to reach out to our patients and check in with them to see if they're okay. They are at increased risk for relapses or recurrences due to the significant stress. It's important to acknowledge to our patients that it's okay not to feel okay. This stress is affecting all of us one way or another to different degrees. And once you acknowledge it's okay to not be okay, you're also encouraging patients to tell you whether they're experiencing distress.
Q: You also mentioned providers are at a high-risk for mental health issues. What resources are available for clinicians?
Fava: An online survey was conducted from February 19 to March 6, 2020, in China, assessing the mental health of medical health workers, defined as those treating patients with COVID-19. Compared with non-medical health workers, medical health workers had a higher prevalence of insomnia, anxiety, depression, somatization and obsessive-compulsive symptoms.
We have compiled a Guide for Mental Health Resources, with a specific section for health care providers. Additionally, we've created a series of initiatives for staff and clinicians across the Mass General Brigham system:
- Urgent Access Psychiatry: Rapid assessment and care for patients, employees and their children
- CARES Clinic: Access to a broad array of outpatient mental health care options
- Resilience Augmentation in Medical Personnel (RAMP): Online programs of self-guided care and stress management
- Benson-Henry Institute Resiliency Groups: Virtual resiliency skills groups for frontline providers
- Employee Assistance Program: 24/7 availability with connection to resources and services
- I-CBT Program: Self-directed digital cognitive behavioral therapy program (also available for patients)
- Access to Mindfulness-promoting Apps: Evermind and Headspace
We are also looking into new research initiatives to assess the impact and risk factors and to evaluate new treatments.
In order to help our patients, we need to put the oxygen mask on ourselves first, so to speak. If you don't take care of yourself, it's very hard to take care of others.
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