Skip to main content
Article

Mental health care during the COVID-19 pandemic

Risk & Analytics
COVID 19 Coronavirus

By Doris Fischer-Sanchez | May 11, 2020

The state of mental health and lack of mental health providers pre-pandemic has only been exacerbated by stressors realized during COVID-19. There are solutions to help address staff and patient mental health care.

Prior to the COVID-19 pandemic, approximately one in five of U.S. adults (47 million) reported having a mental illness in the past year, and over 11 million had a serious mental illness. In 2017-2018, the prevalence of depression and anxiety was also high; nearly 17 million adults and an additional 3 million adolescents had a major depressive episode in the past year.1 In 2018, nearly a third (32.5%) of adults reported feeling worried, nervous, or anxious on a daily, weekly, or monthly basis. Deaths due to drug overdose have increased more than threefold over the past 19 years (from 6.1 deaths per 100,000 people in 1999 to 20.7 deaths per 100,000 people in 2018). In 2018, over 48,000 Americans died by suicide, and in 2017-2018, over ten million adults (4.3%) reported having serious thoughts of suicide in the past year.2

Since the declaration of the COVID-19 pandemic, there have been unanticipated and unintended repercussions such as: economic downturn, job loss, anxiety, depression, increased substance abuse, suicidality and the potential for poor mental health outcomes, partly due to the need to shelter in place and a the consequence of social isolation.3 The effort placed to preserve life, has created stressors and challenges that have affected everyone in some way.

The state of mental health options and the lack of adequate numbers of mental health providers pre-pandemic has only been exacerbated by the stressors that have been realized as a result of COVID-19 pandemic interventions and numerous tragic circumstances.

Many providers have turned to telemental health to provide mental healthcare remotely. The recently-passed Coronavirus Aid, Relief, and Economic Security Act (CARES Act) helps address the increased need for mental health and substance use services.4 It includes a $425 million appropriation for use by the Substance Abuse and Mental Health Services Administration (SAMHSA), in addition to several provisions aimed at expanding coverage for, and availability of, telehealth and other remote care for those covered by Medicare, private insurance, and other federally-funded programs. It also allows for the Secretary of The Department of Veterans Affairs to arrange expansion of mental health services to isolated veterans via telehealth or other remote care services. 5

Recommendations for staff and patient mental care during the pandemic

Even with expansion of coverage due to the 1135 waiver, how does a mental health practice manage current patients and potentially an influx of new patients/clients needing help through these uncertain times?6 Most COVID-19 cases will be identified and treated by people with little to no mental healthcare training.7 It is important to include mental health professionals in developing approaches to COVID-19 mental healthcare for the benefit of patients and healthcare providers.

The American Medical Association, the American Psychiatric Association and the American Psychological Association all have developed guidelines to help navigate the COVID-19 pandemic as a practice owner and mental health practice provider. Some of the recommendations for the office/ambulatory practice and patients include8 :

  • Take care of staff

    • Adjust staffing procedures and schedules where possible
    • Train on and implement enhanced office infection control practices
    • Offer access to psychosocial support
    • Monitor and review staff member well-being
    • Create an environment of open communication
  • Take care of patients

    • Establish a system to identify and provide care for mental health conditions
    • Facilitate additional training for frontline staff
    • Verify referral pathways
    • Provide clear, understandable communication to patients
    • Incorporate guidance about stress into general care practices
    • Utilize telehealth whenever possible and appropriate to alleviate the risks of face-to-face contact (remember to follow the guidelines of the 1135 waiver and to be mindful of individual state rules and regulations)
    • Educate patients on enhanced office infection control policies in the event an in-person visit is essential

Stressors and coping mechanisms for those on the front lines

It is important to remember that many of the expansion of service options and licensure relaxation will revert to pre COVID-19 pandemic service once the pandemic waiver period has expired.9

Another area of concern is the potential for decreasing mental health for first responders, healthcare professionals and essential workers as a result of moral distress, compassion fatigue, burnout and potential post-traumatic stress.10 The pandemic is likely to have a great impact on both mental health and substance abuse for the very people who have the daunting responsibility of care during this pandemic.

The Centers for Disease Control (CDC) and SAMHSA have developed many resources for first responders and healthcare providers to recognize, cope and overcome stressors as a result of the pandemic.11 Some significant issues addressed with coping strategies include:12

  • Signs of Stress

    • Bodily sensations and physical effects such as: rapid heart rate, headaches, nausea, inability to relax when off duty, trouble falling asleep or staying asleep
    • Strong negative feelings
    • Difficulty thinking clearly
    • Problematic or risky behaviors
    • Social conflicts
  • Stress Management Tips

    • Know your role during a disaster
    • Develop a self-care plan prior to deployment and use it during deployment
    • Practice stress management during all phases of the disaster response effort
    • Involve loved ones in your preparation, planning and recovery activities
    • Make sure you have an individual and family preparedness plan to cover loved ones if the disaster is in your community

Suicide risk

It is a reality that with the uncertainty that a pandemic brings, some people, regardless of educational, socioeconomic level, race or gender may become suicidal. It is important for any clinical practice, mental health provider or healthcare organization to acknowledge the possibility of increased incidence of suicidal thoughts and feelings and/or possible completion. While the causes of suicide are complex, the pandemic has contributed to risk factors, such as: painful losses, social isolation and combined with a history of mental illness, substance abuse, extreme stress, fatigue and fear of the unknown. Some warning signs to look for include13 :

  • Talking about wanting to die or kill oneself
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated, behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The risk of completion can be greater if the behavior is new, is increasing or related to a particularly stressful event.14 It is important to prepare healthcare staff for the possibility of being exposed to the threat of suicide and provide training on how to triage such a call or encounter.

Stanford medicine recently conducted a listening project of frontline healthcare professionals where eight sources of anxiety and five solutions to those stressors during the COVID-19 pandemic and beyond were shared. The stressors included:

  1. Access to appropriate personal protective equipment
  2. Exposure to COVID-19 at work and taking the infection home to their family
  3. Lack of access to rapid testing if COVID-19 symptoms develop and concomitant fear of propagating infection at work
  4. Uncertainty about whether the organization will support/take care of their personal and family needs if an infection develops
  5. Access to childcare during increased work hours and school closures
  6. Support for other personal and family needs as work hours and demands increase (food, hydration, lodging, transportation)
  7. Competent medical care if deployed to a new area (i.e. non-ICU nurses having to function as ICU nurses)
  8. Lack of access to up-to-date information and communication

The proposed solutions that healthcare organizations can incorporate to respond to the needs and anxieties that healthcare professionals face are: by listening to, supporting, protecting, preparing and caring for their staff.15

There are so many considerations during a pandemic, mental health cannot be forgotten.16 It is easy to get caught up in the day-to-day stressors of the new norm this pandemic has brought about. There is a need to acknowledge, prepare for mental health help and provide it now, as the risk is an additional tragedy as a result of not being prepared.

Disclaimer

Each applicable policy of insurance must be reviewed to determine the extent, if any, of coverage for COVID-19. Coverage may vary depending on the jurisdiction and circumstances. For global client programs it is critical to consider all local operations and how policies may or may not include COVID-19 coverage. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal and/or other professional advisors. Some of the information in this publication may be compiled by third party sources we consider to be reliable, however we do not guarantee and are not responsible for the accuracy of such information. We assume no duty in contract, tort, or otherwise in connection with this publication and expressly disclaim, to the fullest extent permitted by law, any liability in connection with this publication. Willis Towers Watson offers insurance-related services through its appropriately licensed entities in each jurisdiction in which it operates. COVID-19 is a rapidly evolving situation and changes are occurring frequently. Willis Towers Watson does not undertake to update the information included herein after the date of publication. Accordingly, readers should be aware that certain content may have changed since the date of this publication. Please reach out to the author or your Willis Towers Watson contact for more information.

Footnotes

1 National Alliance on Mental Illness, Mental Health by The Numbers. Retrieved at: https://nami.org/mhstats

2 Ibid. Retrieved at: https://nami.org/mhstats

3 Panchal, N., Kamal, R., Orgera, K., et. al. (2020). The Implications of COVID-19 for Mental Health and Substance Abuse. Retrieved at: https://www.kff.org/health-reform/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/

4 Coronavirus Aid, Relief, and Economic Security Act. Retrieved at: https://www.congress.gov/116/bills/hr748/BILLS-116hr748enr.pdf

5 Ibid. Retrieved at: https://www.congress.gov/116/bills/hr748/BILLS-116hr748enr.pdf

6 1135 Waiver at A Glance. Retrieved at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/1135-Waivers-At-A-Glance.pdf

7 Pfefferbaum, B. and North, C. (2020). Mental Health and the COVID-19 Pandemic. The New England Journal of Medicine. DOI: 10.1056/NEJMp2008017

8 The American Medical Association (2020). Managing Mental Health During COVID-19. Retrieved at: https://www.ama-assn.org/delivering-care/public-health/managing-mental-health-during-covid-19

9 1135 Waiver at A Glance. Retrieved at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/1135-Waivers-At-A-Glance.pdf

10 Ibid. Retrieved at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/1135-Waivers-At-A-Glance.pdf

11 Substance Abuse and Mental Health Services Administration (2020) Disaster Technical Assistance Center. Retrieved at: https://www.samhsa.gov/dtac/disaster-responders

12 Substance Abuse and Mental Health Services Administration (2020) Disaster Behavioral Health Resources. Retrieved at: https://www.samhsa.gov/dtac/disaster-behavioral-health-resources

13 Substance Abuse and Mental Health Services Administration (2020). Suicide Prevention. Retrieved at: https://www.samhsa.gov/find-help/suicide-prevention

14 Ibid. Retrieved at: https://www.samhsa.gov/find-help/suicide-prevention

15 Shanafeldt, T., Ripp, J., Trockel, M. (2020). Understanding and Addressing Sources of Anxiety Among Healthcare Professionals During the COVID-19 Pandemic. The New England Journal of Medicine. doi:10.1001/jama.2020.5893

16 Gold, J. (2020). The COVID-19 crisis too few are talking about: healthcare worker’s mental health. Retrieved at:https://www.statnews.com/2020/04/03/the-covid-19-crisis-too-few-are-talking-about-health-care-workers-mental-health/

Author

Senior Clinical and Enterprise Risk Management Consultant

Contact Us
Related content tags, list of links Article Risk & Analytics Healthcare COVID-19 (Coronavirus)