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To Fight COVID‑19, We Must Also Fight Stigma

David Lim, MD, Ph.DChief Medical Officer at Quartet

Blog | Mar 24, 2020

As more cases of COVID-19 are confirmed, people are taking important precautions against the spread of the virus: staying informed, washing hands, social distancing, and even quarantine. As we focus on maintaining the physical health of ourselves and others, it’s important not to neglect the impact COVID-19 has on our mental health.

The spread of an infectious disease like COVID-19 also comes with the spread of stigma, which can have an adverse effect on an individual’s mental health. This isn’t the first time we’ve seen how a public health crisis can trigger mental health conditions — the HIV/AIDS crisis, for instance, is a prime example

We recently sat down with David Lim, MD, Ph.D., Quartet’s Chief Medical Officer, to discuss the effect of stigma on mental health. Dr. Lim’s specialty lies in infectious diseases, having worked at UCSF during the HIV/AIDS epidemic. What can the past teach us about stigma in times of crisis? Read on to learn how stigma, mental and physical health are entwined.

Quartet: What did working with HIV/AIDS patients teach you about mental health?

David Lim: When working with HIV/AIDS patients, I saw firsthand the stigma and shame they faced. It led to anxiety and depression in my patients. At first, I wasn’t looking for my patients’ [mental health symptoms]. Eventually, when it became clear I needed to address the mental health of my patients in order to treat their physical health, it was extremely hard to find care for them. I would rarely hear back from psychiatrists. If I did, it was incredibly difficult for the patients to coordinate care between myself and the mental health provider. That experience is part of the reason I decided to come to Quartet to help address that gap in care. I wanted to use my background to improve access to mental health care, as a part of total care.

Q: What parallels around stigma are you seeing between Coronavirus and past health epidemics?

D: We’re seeing some of the same stigmas around COVID-19 as we did around HIV/AIDS. These include accusations against individuals who still go out in public when they might have symptoms and even more troubling as we saw with HIV/AIDS, prejudice of specific groups or types of people assumed to be infected. We shouldn’t accuse and ostracize individuals who are diagnosed with COVID-19; nor should we blame the pandemic on others. We need to support one another. If we don’t, the stigma around coronavirus can remind people of their experiences with the stigma related to their mental health conditions. That could trigger a relapse in a mental health condition.

Q: How could that relapse in a mental health condition affect the physical health of someone with COVID-19?

D: Sometimes when a patient would get diagnosed with HIV/AID they would become withdrawn. They would not feel safe telling their friends or family about their diagnosis. They would see the diagnosis as a death sentence and would not take their prescribed medication even though the medication was life-saving. That same mindset could easily happen in the case of coronavirus. Someone who’s infected must be quarantined and told to avoid others to avoid the spread of infection — they are literally told to isolate themselves. This could easily extend to the belief they need to isolate socially from friends and family (even virtually) and not seek the help and support they need. The community must provide them with the resources to combat anxiety and depression, especially with telehealth options.

Q: What are some tools people with mental health conditions can use to reduce their symptoms?

D: Everyone has a different way of taking care of their mental health. Some folks become more introverted and sit with their own thoughts. For these individuals, meditation might be helpful in calming symptoms.

Other people address their mental health needs by being active and social — they need to connect and communicate with others. For these individuals, working out or calling a friend will help manage their symptoms.

There are many ways to take care of your mental health, and it’s about finding the one that works for you. If individuals with preexisting physical health conditions don’t find the tools and resources to maintain motivation and hope, they risk worsening these preexisting health conditions. There is so much stress during this unprecedented time from job or income insecurity, social isolation, or fear for yourself or loved ones. Any of these thoughts or emotions can trigger a preexisting or even new onset mental health condition. Just as it’s important to know your coping mechanisms, it’s important to learn to recognize signs and symptoms and potential triggers. We live in stressful times so people must find a coping mechanism that works for them.

That’s why it’s important to get mental health care. A mental health provider can help you learn different coping mechanisms, identify ones that work best for you, and how to apply them to address the day-to-day challenges we are all enduring right now. If you are unable to see your provider in person, they may be able to offer virtual telehealth options.

Q: What advice do you have for people who are experiencing anxiety about COVID-19?

D: There are many things you can do if you are feeling anxious about COVID-19. For example, you can schedule a time to talk with your friends and family, limit your news consumption, exercise, meditate, or talk with your therapist. Find what coping mechanism works for you and make it a part of your everyday routine.

Q: Teletherapy — So I don’t have to leave the house?

D: No, you don’t. Teletherapy is mental health therapy via phone or video conference. Some mental health practitioners have this as an option. If you are unable to go into the office, ask your therapist if they offer teletherapy options. Many insurance companies are expanding their health coverage during the COVID-19 crisis to include teletherapy. If you’re in therapy and unable to get to your appointments, look into available tele options — perhaps your therapist offers video sessions.

Q: Awesome, sign me up. Thank you, David!

D: No problem and don’t forget to wash your hands!

David Lim, MD, Ph.D. is the Chief Medical Officer at Quartet. Dave is a founding team member and has worked at Quartet since December 2014. He previously served at Castlight Health where he led Provider Relations and Innovation. Prior to this, he was a Project Leader at The Boston Consulting Group (BCG) where he launched the International Consortium for Health Outcomes Measurement (ICHOM). By background, Dave is an infectious disease specialist completing a fellowship at UCSF (University of California, San Francisco) and an internal medicine residency at Johns Hopkins Hospital. He received his MD/Ph.D. degrees from Columbia University, Vagelos College of Physicians and Surgeons. A graduate of Harvard College, Dave has experienced first-hand the challenges of navigating his patients from his infectious disease practice into effective behavioral health care pathways.

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