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In the best of times, patients with mental health issues face challenges in finding support. Cuts in community services and limits on long-term care facilities can mean difficulty in accessing mental health services. As a consequence, those patients may find themselves being cared for in acute-care psychiatric hospitals or units.

Add a pandemic to the mix, and the dilemma for patients needing inpatient psychiatric care gets far worse. “It’s getting to somewhat of a crisis point,” says Judy L. Sheehan MSN, RN-BC, Director, Nursing Education at Butler Hospital in Providence, Rhode Island. Sheehan, a nurse since 1977, is primary editor of the forthcoming Inpatient Psychiatric Nursing, second edition. 

System Strain

Inpatient psych hospitals are under significant strain from COVID. For example, the governor of Virginia stopped admissions to psychiatric hospitals to lessen the spread of COVID, according to an article in STAT. In Kingston and Brooklyn, NY, psych units were closed to increase capacity for COVID patients, the story notes.

At Butler, a nonprofit, free-standing psychiatric hospital, the patient census was frequently at or above capacity. A patient who develops or begins to show COVID symptoms has to be quarantined, meaning that two patients cannot be in the same room, notes Sheehan. Similarly, if an admitted patient initially tests negative for COVID but then tests positive in two or three days, the patient would need to be isolated to a single room and no other patients would likely be admitted to that unit.

What’s more, while COVID patients who do not need psychiatric care can go to a field hospital, “there are no field hospitals set up for psychiatric patients who have COVID or are recovering from COVID,” Sheehan says. “When someone is a psych patient, it’s challenging for the medical environment to care for them in a way that deals with the psychiatric symptoms in the same way that it might be done in the psychiatric hospital.”

The length of the pandemic has also taken its toll, with patients suffering from mental health sequelae from COVID, notes Sheehan. “We’re starting to see more people with anxiety disorders who may never have come into the psych facility before.”

Add to this the impact on healthcare staff. As the virus spread through the community, Butler staff found themselves unable to work due to exposure to the virus or because of their becoming infected. That has since improved, but now Butler is dealing with staff out of work due to the side effects of the COVID vaccine.

Seeking Solutions

Telemedicine and outpatient programs can help relieve the burden, says Sheehan. “I think that telemedicine is going to continue,” she says. “I hope that people begin to replace some of the discharge options for people out in the community. It’s hard for people who need sustained help,” she says.

Strengthening the concept of integrated multidisciplinary care can help mental health institutions deal with patients with medical diseases, notes an article in Translational Psychiatry,  which offers recommendations learned in China.

Fortifying community-based mental health services, full use of information technology, and strengthening the coordinating role of government are other recommendations the Translational Psychiatry paper makes.

“Psychiatric patients do in fact have medical issues, and medical patients do in fact get psychiatric issues. So we’ve got to be more integrated in our approach. We have to be able to become well-versed in both behavioral health and medical care,” Sheehan says.

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