This post can be found on Medium.
The COVID-19 pandemic continues to present Americans with extraordinary levels of illness and death, disrupted work, family, or other circumstances, and ever-changing restrictions that are affecting us in profound ways. The impact is not being shared equally and is falling hardest on specific groups, including people of low income, Hispanic Americans, American Indians, African Americans, and the elderly. Although epidemiological studies have identified specific mental health issues and mental illnesses associated with at-risk groups, at the individual level, these issues are specific to their unique array of biological, psychological, and social circumstances.
Singula Institute was created to deliver precision mental health services with the explicit goal of engaging within our community toward increased understanding of mental health with greater social impact. New Yorkers have had a particularly high level of exposure to the virus and its impact on their overall health. I recently had the opportunity to present the mental health impact on clinical care during the pandemic during Grand Rounds & Case Conference at a premiere New York City Hospital.
Presenting specific cases and considering the conditions surrounding them provided time for me to reflect on the varied effects of the pandemic and receive feedback from other professionals on the front lines in the context of Singula’s biopsychosocial approach to mental health care.
In addition to identifying especially vulnerable groups, I made the following key points to help professionals guide their care for COVID patients and increase awareness of the impact the pandemic is having.
- Recognize when a person is going through stress, grief, anxiety, or trauma
- Recognize when a person is using substances to cope with stress, grief, anxiety, or trauma
- Recognize which mental health issues can be managed through specific avenues of support and why
- Health care professionals are being impacted by the pandemic directly or indirectly and need to know how to evaluate and triage the ways in which that impact is influencing each health care provider’s decisions.
My experience is that the mental health impacts are widespread. One case I dealt with was a woman in her 60s with a history of anxiety that caused her to remain at home in order to avoid having panic attacks (agoraphobia). The impact of the pandemic initially reduced her anxiety because the scale of the impact seemed to align with her worldview. However, over time she along with her husband slipped into a mild depression, requiring supportive psychotherapy sessions that allowed her and her husband to go outdoors between doctor visits.
Another case considered the mental health impacts on a family of elderly holocaust survivors who both contracted COVID-19 and faced the death of their husband and father. Neither the resilient elderly wife, who was her husband’s primary caregiver nor the adult children could be spared from the grief that was compounded by being unable to be with the elderly man at the end of his life. In this case, the helplessness that the family experienced could have mirrored that of the terror and trauma that was experienced by the elderly couple during the holocaust.
Another vulnerable group to anxiety and depression are health care workers who, on the front lines, confront the possibility of COVID-19 infection with high exposure to dying patients, long hours, and dwindling resources during pandemic waves. Concerns about these workers are so sufficiently widespread that the American Psychiatric Association has provided some considerations for healthcare workers exposed to the high level of death and illness caused by COVID. In my presentation, I considered these issues faced by health care professionals and began to examine how they are impacting them through their clinical experiences. In particular, moral injury and distress, a type of psychological conflict, occur when we are faced with choices that put our values at odds. Moral distress has become more prevalent as many of the clinical and social management decisions can produce further suffering due to shrinking resources and public health limitations due to COVID-19. Being able to process these situations collectively helps to reduce the emotional burden falling on any one individual within the clinical care team.
The opportunity to discuss these cases and the issues surrounding them underscores the dynamic nature of mental health issues as we confront challenging issues individually and as a society. Singula’s biopsychosocial approach to considering the issues faced during the current pandemic and supporting people according to their individual needs in real-world situations will provide the framework from which we intend to build our Learning Health System for Mental Health.