Mar 18, 2020
Col. (Ret.) Elspeth Cameron Ritchie, MD, MPH, conducts a
Masterclass on what psychiatrists and other mental health
clinicians can do to mitigate the impact of COVID-19.
Ritchie is writing additional commentaries on this topic for
And later, in the “Dr. RK” segment, Renee Kohanski, MD, says that, with
simple tools or guidelines, humans have the ability to withstand
adversity that is stronger than we will ever know.
- Epidemics and pandemics are characterized by fear and
- Quarantine will be a challenge for patients with addictions and
vulnerable populations such as individuals who are homeless.
- Psychiatrists can aid with social distancing by providing
patients refills for psychotropic medications without requiring an
in-person visit and switching to telepsychiatry where possible. The
Coronavirus Preparedness and Response Supplemental Appropriations
Act waives Medicare telehealth reimbursement restrictions for
mental health services during certain emergency periods.
Inpatient psychiatric units must take special precautions to
prevent spread of COVID-19, such as improving procedures for
sanitizing communal areas and items, limiting visitation, screening
patients for symptoms, and arranging transfer when appropriate.
COVID-19 infection can spread on units to patients and staff and
may compromise clinicians’ ability to provide care safely.
- Psychiatrists also play a role in helping address the shortage
of personal protective equipment (PPE) by talking to patients about
the appropriate use of PPE and sanitizer.
- Emotional response to pandemics: Epidemics and
pandemics are characterized by fear and anxiety as people worry
about their risk of exposure, infection, and spreading the
pathogen. Clinics can alleviate the anxiety by transitioning to
telehealth when possible, discouraging handshakes, keeping a
distance from patients, and rearranging waiting rooms and other
spaces to provide more room between chairs and tables.
Psychiatrists can encourage patients and fellow clinicians to
engage in activities that normally reduce anxiety, such as
exercising, setting aside time for relaxation at home, and taking
regularly prescribed or over-the-counter medications.
- Quarantine considerations: Quarantine and
isolation will be difficult for most people, and especially so for
patients with psychiatric disorders, including substance use
disorders. Psychiatrists can prepare themselves and patients for
quarantine by refilling medications for more than 30 days. The
Centers for Disease Control and Prevention recommends clinicians
refill nonurgent medications without an in-person visit. Patients
who are addicted to alcohol or other substances may be tempted to
leave the house to acquire those substances. It may be a
physician’s responsibility to either suggest to patients that they
have enough of their substance at home or give them something to
treat withdrawal or cravings.
- Considerations for inpatient psychiatric
units: Psychiatric units are built for socialization and
communal treatment; thus, psychiatric units will have to change
policies, including limiting visitors; decreasing occupancy on the
units; and ensuring that communal items such as phones, chairs, and
books are properly sanitized.
- Long-term psychological impact of a pandemic:
The negative economic impact of the pandemic, such as unemployment
in the tourism and service industries, may have consequences
including rising rates of depression and anxiety, suicides, and
increases in domestic violence and substance abuse.
Psychiatrists can help address the shortage of PPE by talking to
patients about the appropriate use of PPE and sanitizer. It is wise
to have a stock of food, medications, and supplies for 14-21 days
of quarantine, but in a public health emergency we can urge
patients and ourselves to be mindful of the needs of others and
avoid hoarding. We need to remind ourselves, our patients, and our
colleagues to stay healthy by getting enough sleep, taking on the
appropriate level of readiness, and remaining flexible as our daily
lives are changed by the pandemic.
Centers for Disease Control and Prevention.
Interim guidelines for healthcare facilities: Preparing for
community transmission of COVID-19 in the United States.
H.R. 6074: Coronavirus Preparedness and Response Supplemental
Appropriations Act. Passed Congress 2020 Mar 6.
Brooks SK et al. The psychological impact of quarantine and how
to reduce it: Rapid review of the evidence.
Lancet. 2020 Mar 14;395(10227):912-20.
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