Caring for Your Patients During the COVID‑19 Outbreak

Mental health providers play a key role in community response during times of crisis. From public health emergencies such as HIV/AIDS, SARS and EBOLA to terrorist attacks such as 9/11 and school shootings, and natural disasters such as Hurricanes Katrina and Sandy, mental health providers have shown up on the front lines to treat those affected.

According to the World Health Organization (WHO), most people affected by such crises will experience psychological distress including anxiety, sadness, hopelessness, sleep and concentration difficulties, irritability, anger and/or physical aches and pains. People tend to feel a loss of control and a sense of helplessness. While such responses are normal and will resolve over time, the prevalence of depression and anxiety is expected to more than double in times of crisis. Those with preexisting mental health conditions are particularly vulnerable at these times and are at greater risk for acute symptom exacerbation.

The COVID-19 outbreak is a time of crisis, and information and guidance are changing over time. In recent days, we’ve moved from “an abundance of caution,” to “social distancing” and now we’re “sheltering in place” as we try to stem the spread of the virus. There have been extreme disruptions of schedules, work and school routines, and relationships.

In addition, people are experiencing health concerns, worries about accessibility of food and household goods, employment and education stability and financial stress. Some are reporting bullying or discrimination due to some people associating the virus with particular racial or ethnic groups. As rules around social contact become more stringent, people may also be experiencing loneliness and isolation. This may be especially problematic in households with incidence or risk of domestic or child abuse. Those exposed to or infected with the virus may be subject to quarantine, which is associated with additional negative psychological effects.

Mental health providers are actively involved in helping their patients to negotiate the widespread impact of COVID-19. There has been a lot written about how to help people cope more effectively.

Here are some tips to help you support your patients:

1. Explore the use of telesolutions (phone or video-based sessions) with patients. Federal guidelines around the provision of teleservices have been loosened (e.g., changes to HIPAA enforcements and CMS regulations) to enable the healthcare workforce to provide support without patients (or providers) having to leave their homes. Look into these solutions to see if they may work for your practice. Make sure you have a plan should any crises arise with your patients.
2. Promote patients’ sense of safety and efficacy through education regarding virus transmission and preparedness. There are things that we can all actively do to reduce the chances of getting or spreading the virus. Encourage patients to continue to follow Centers for Disease Control guidelines around everyday preventive measures (e.g., hand washing, covering your coughs and sneezes, not touching your face, cleaning frequently touched surfaces) and local regulations or restrictions on activities. Discuss patients’ preparedness in terms of having several weeks’ supply of medication and groceries on hand. Patients with anxiety disorders, especially OCD, may need help to not overdo preventative measures and to distinguish anxiety symptoms from those of COVID-19. If patients are experiencing virus symptoms, they may require additional guidance around medical resources and emotional support.
3. Help patients to manage information and media consumption. Assist your patients to choose reliable and trusted sources of information, and to limit the amount of media they consume. This will differ by patient, but the goal is to keep informed without feeling overwhelmed. Patients may need assistance separating facts from their emotional reactions and in building skills around perspective-taking, correcting inaccuracies and challenging negative and catastrophic beliefs.
4. Encourage self-care. During times of crisis, people often forget how powerful the basics can be in keeping us feeling grounded. Encourage your patients to eat healthy meals, stay hydrated, and get enough sleep. Work with them on developing coping strategies that work for them — things like taking walks, indoor exercise, meditation/mindfulness, watching television or listening to music, or other activities that serve to reduce stress and promote a sense of calm or enjoyment. Patients should be monitored for coping strategies that are counter-productive such as increases in tobacco, alcohol, or other drug use. And of course, as you typically would, keep an eye out for acute symptoms (e.g., anxiety, depression, psychosis), or evidence of domestic violence or child abuse.
5. Stress the Importance of Staying Connected. “Social distancing” doesn’t mean social isolation. In fact, the WHO and other leaders are advocating to replace the term with “physical distancing” which more accurately describes efforts to reduce the spread of the virus while allowing for social connections. Create a plan with your patients to stay connected to friends, partners, family, service providers, and the general public in ways that are safe. Explore the use of phone, text, and video (e.g., Skype, Facetime) to communicate with others. There are many creative things that are happening through social media to connect people and build a sense of community.

And please don’t forget to engage in your own self-care. The adage about putting on your own oxygen mask before you help others with theirs rings true, and perhaps this should have been the very first bullet point above. As a mental health provider, it is always important to engage in self-care activities to maintain a sense of balance in your life and prevent burnout. During the current health crisis, it is even more important to be sure that you are in tune with your own thoughts and feelings and are doing what you can to address your own needs.

Sheri Kirshenbaum, PhD, is the Clinical Director at Quartet Health. She is a Clinical Psychologist licensed in New York and California. Her expertise in the healthcare field has focused on improving health outcomes for vulnerable or hard to reach populations including individuals living with chronic mental illness, substance use disorders, and HIV/AIDS. She was a 9/11 first responder and saw patients through the aftermath of Hurricane Sandy in New York City. She joined Quartet to have a wider influence on innovations to get patients the mental healthcare they need when they need it.