Ever since the pandemic was announced by the World Health Organization on March 11th, 2020, we have been hyper-aware of the toll the virus might take on our healthcare systems, particularly hospitals.
But there is one department in the hospital that may not get the same consideration as others such as the Intensive Care Unit (ICU) or palliative care. That unit is the psychiatric ward which is often tied to stereotypes and stigma, but the truth is that America’s psychiatric care facilities, including those in hospitals, are essential services.
Often, psychiatric care can be the difference between leading a normal, healthy lifestyle and ending up homeless. In more serious cases, it can be the difference between life and death.
Maninderpal Singh Dhillon D.O. is a graduate from Michigan State University where he completed his undergraduate and medical school training as well as his residency in Psychiatry. Dr. Dhillon’s current psychiatric practice involves treating adult patients with a variety of mental illnesses. He has experience with community and private practices as well as patients in hospital settings. Dr. Dhillon’s experience working with so many people from different backgrounds and in different settings gives him a special understanding of how COVID-19 has affected psychiatry overall.
Enhanced Communication Efforts
As the pandemic has evolved and more information has been shared with medical practitioners and the public, protocols have had to change in order to adapt. “We’ve had to make changes quickly,” says Dr. Maninderpal Singh Dhillon. “In some cases, those changes needed to take effect the day new information was released by the WHO (World Health Organization) or the CDC (Centers for Disease Control).”
Particularly in large institutions, like hospitals, these changes are not always effectively communicated to all staff. Communicating the changes quickly and effectively to hospital visitors and patients has been even more challenging. From the emergency room to labour and delivery and more, communication on tight timelines has been problematic. Psychiatry has been no different.
Potential Risk Factors
In hospitals, the psychiatric department acts as an emergency center for mental illness. “In dangerous cases, patients can be held for up to 72 hours for their own safety and the safety of the community,” says Dr. Dhillon. “It allows psychiatrists to properly assess a patient and put together a plan of treatment that will be most effective for that individual.” But, since COVID-19, holding patients for that 72-hour period has become more troublesome.
The virus is potentially deadly, especially for anyone who may be immunocompromised, elderly, or have other underlying health conditions. In a psychiatric crisis, understanding the patient’s full health history can be difficult, depending on their presenting symptoms. “It has posed an ethical challenge for some psychiatrists,” explains Dr. Dhillon. “We have to ask ourselves if the patient is at higher risk of harming themselves or of contracting the virus while in hospital?”
Even for outpatients, the risk of contracting COVID-19 when returning to the clinic inside a hospital for additional treatment can increase. Right now, there simply isn’t enough data, but doctors like Dr. Maninderpal Dhillon are aware of the potential risk. In some cases, psychiatrists are opting for telehealth solutions and holding appointments over the phone.
Enhanced Support Networks
Treatment of mental illness often also relies on community. A support network is key to many people’s recovery above and beyond the psychiatric element. Dr. Dhillon responsibly combines psychopharmacology and psychotherapy to meet his patients’ needs. However, he is also an advocate for community groups that can help individuals build the support networks they require if they do not already exist.
During COVID-19, these groups are not able to meet in person as they normally would. Instead, some groups are taking to the internet and group video calls. Hospital-sanctioned groups may now be meeting in person again (depending on the institution), but with additional physical distancing requirements.
“Overall, the effort to stop the spread of COVID-19 has increased stress levels and anxiety for everyone, even psychiatrists themselves,” Dr. Maninderpal Dhillon points out. “Physical distancing is a very isolating experience, which can easily exacerbate existing psychiatric conditions.” For those suddenly working from home and not seeing friends, family, and other members of their support networks, physical distancing poses additional risk for the patient. In more severe cases, many psychiatric patients are homeless and living in communal gatherings in cities.
Suddenly, there is a choice to be made between living in a community of homeless individuals and increasing the risk of contracting the virus or living alone on the streets and suffering from isolation. In many cases, patients in this situation are not equipped to be making that decision. This is why hospital psychiatric services are so vital and yet simultaneously struggling to navigate the current situation.
Like many other aspects of society, psychiatric care is suffering from the uncertainty and constant need to pivot and adapt due to COVID-19. Hospitals are busy caring for the ill and now have the added stress of constantly changing protocols and an anxious public. Stress levels are increased for both patients and doctors, yet the medical professionals charged with caring for others are soldiering on and making the best of a bad situation. “As more data is collected, I expect to see more studies emerge about the impact of COVID-19 on psychiatric care in America,” says Maninderpal Singh Dhillon D.O. “Until then, we will continue with our best efforts to provide the care needed in our communities.”