Continuing Care in the Midst of COVID-19

By Dr. Jen Sotsky and Dr. Angela Coombs

We are two early-career psychiatrists in Columbia University Irving Medical Center’s Department of Psychiatry. Between the two us, we provide clinical services both inside the hospital through consult-liaison services to medical teams and the emergency room, as well as outpatient care to individuals experiencing depression, anxiety and other mental illnesses. We also provide support to our colleagues, many of whom are on the front lines treating COVID-19 patients and are experiencing significant anxiety and trauma themselves.

We offer our readers, patients and families, and our colleagues, three things:

  • What we are seeing in our psychiatric clinical settings
  • Suggesting a number of interventions specific to the COVID-19 crisis, and in the wake of any disaster
  • Resources you may find helpful

1. In a time when we are concerned about our patients experiencing growing distress and psychosocial stressors including isolation and loss of employment, we initially anticipated there being an increase in emergency room visits or an increase in requests for outpatient appointments from established patients. However, in these early weeks, not only have we not seen an increase in ER visits and consults, but a noticeable decrease. Many people with primary psychiatric concerns seem to be avoiding the emergency room. While we don’t know the exact reason for this pattern, or if it will continue, we are concerned that people may not be seeking emergency support as they might otherwise have if not for COVID-19. Additionally, some individuals unfamiliar with or skeptical toward telepsychiatrymay not seek out care that is being provided via this format. As the pandemic extends over time, we don’t know the full extent to which treatment has been compromised by reduced access to offices, substance use groups, and other clinical services as a result of stay-at-home guidelines and mandates for both patients and clinicians.

Many clinics, including public mental health settings, are offering virtual visits by video and phone. This shift, essential today, is backed by studies that show that video sessions are as effective as in-person. They certainly offer convenience and require far less time for patients who do not need to travel to an office. However, we still need to understand the nuanced experiences of the various patient populations we serve during this transition to virtual care.

As the pandemic progresses, mental health clinicians will be particularly in need and used. We may be particularly vital for patients and their families who have been directly affected by COVID-19 and for health professionals on the front lines who are experiencing significant distress. The skills most useful during this moment in time are in crisis counseling, which helps individuals affected by a disaster achieve a sense of safety. These methods calm and support those impacted by a disaster, enhancing what is called “self-efficacy,” namely how to best use our inherent adaptive capacities, increasing a sense of community and connection, and fostering hope.  

2. Distress is a normal reaction to any disaster - be it coronavirus, 9/11, Hurricanes Sandy and Katrina (and countless others). We all (patients, families, and clinicians) need to appreciate that feeling distressed and anxious is a normal and expectable response to the unexpected and the disruptive. Anxiety, in itself, can help to focus our attention, to alert us that there is a problem – and to prompt problem-solving, rather than freezing us in place. Self-care is a primary means of responding to stress - and the mental and physical symptoms it fosters.

Take a look at these mini-courses from Columbia Psychiatry (https://www.allencomm.com/courses/covid19_5_tips_to_face_your_anxiety/index.html and https://www.allencomm.com/courses/coping_with_covid_19_lockdown/index.html), as well as a blog distributed on the Bring Change 2 Mind website and from Lady Gaga's Born This Way Foundation summarizing five things we all can do, for free, to take care of ourselves during the pandemic we are living through.

3. You are not alone. Many others are experiencing what you are, including many health professionals. There are resources– online and by phone – to help those impacted by this pandemic. These include:

We all will get through this pandemic, though its duration and impact are yet to be known. Don’t go it alone. We are all in this together.

About the authors:
Dr. Jen Sotsky is a Chief Resident in the Department of Psychiatry at Columbia. Dr. Angela Coombs is an attending psychiatrist at the Washington Heights Community Service, the New York Presbyterian Hospital Columbia emergency room, as well as a fellow in the Columbia Public Psychiatry Fellowship.

Topics

Mental Health, Psychiatry

Tags

COVID-19, Anxiety