COVID-19 is ravaging America’s psychiatric facilities
Though often out of sight and out of mind, psychiatric facilities are essential to our nation’s emotional wellbeing. While coronavirus has shuttered many institutions, they don’t have the option of closing their doors, even temporarily.
As we struggle to comprehend the new reality that coronavirus has forced upon us, our national mental health is rapidly deteriorating and we need the services of psychiatric facilities more than ever. Anti-anxiety prescriptions are way up and calls to suicide hotlines are surging. Many foresee the pandemic’s coming mental health crisis. However, few realize the places where it’ll be addressed are already under siege from coronavirus and losing ground quickly.
Recent outbreaks in psychiatric facilities — many fatal — have occurred in Connecticut, Delaware, Kentucky, Louisiana, Maryland, Missouri, Michigan, Nevada, New Jersey, Washington, Wisconsin and Washington, D.C. At least 63 state psychiatric hospitals — which can house thousands of patients with the most severe forms of mental illness — are known to be afflicted across the country. Those in New York have been hit particularly hard, with 259 patients and 283 staff members infected with coronavirus so far. At least thirty patients have died, with seven more suspected cases awaiting laboratory confirmation.
Psychiatric facilities are especially vulnerable to the spread of respiratory diseases for many reasons. The inpatient psychiatric treatment model rests heavily upon group therapy and communal interaction: the antithesis to social distancing. To prevent suicides, windows are closed, meaning poor ventilation. Alcohol-based hand sanitizer access is restricted for safety reasons, meaning more contaminated hands.
Our patients’ mental illnesses lead to poor personal hygiene, putting them at risk for coronavirus infection. Many also have conditions like obesity, high blood pressure and diabetes, increasing the chances of more severe complications if they’re infected. On top of this, our patients regularly cycle through other high-risk coronavirus environments such as homeless shelters, emergency rooms, medical wards, nursing homes and jails, increasing the possibility they’ll bring it into our facilities.
Staff in psychiatric facilities are at grave risk of contracting coronavirus themselves due to a lack of personal protective equipment (PPE). In addition to the risks that come with working in any hospital, they also have to regularly physically restrain patients who are on the verge of hurting themselves or others. Coming into such close contact with someone who might have the virus is a serious occupational hazard.
Anyone facing such risks on the job deserves PPE. The lack of it presents a severe workforce challenge as well, requiring doctors, nurses and others to be quarantined en masse when exposures occur. If hospitals run out of staff, they can’t operate. Recognizing this, the American Psychiatric Association and other mental health organizations sent a letter to Vice President Mike Pence on April 1 asking for assistance with PPE shortages at psychiatric hospitals and residential treatment facilities. There’s been no public response.
Despite these challenges, staff at psychiatric facilities are taking stop-gap measures to keep themselves and patients safe. Patients with coronavirus symptoms are being routed to general hospitals and visitors have been barred. Treatment teams are meeting virtually and group therapy sessions have been adjusted to comply with social distancing. Telemedicine is also being used by physicians to see inpatients in some places. However, it’s an option that isn’t available to nurses and other staff members or facilities that can’t afford the cost.
The U.S. has failed to invest in mental health care the way it invests in other types of health care. Most psychiatric facilities operate on tight budgets due to low insurance reimbursement and government investment, so there were already few resources to prepare for something like this. The pandemic has made their financial situations even worse due to hospitals closing outpatient psychiatric services.
Policymakers have made some efforts to help. They’ve attempted to bolster community treatment by passing the CARES Act and relaxing federal health care regulations to catalyze expansion of outpatient telepsychiatry.
While these interventions should help keep some patients out of psychiatric facilities, what they really need is funding — and fast. Earlier this week, the American Psychiatric Association and other organizations warned that our mental health care system is “crumbling” in a letter to Congressional leadership. They noted that, without assistance, 62 percent of mental health organizations believe they will survive three months or less. Among other requests, the authors asked that the Department of Health and Human Services immediately direct $38.5 billion to essential mental health providers.
In addition to funding, PPE is also urgently required to protect inpatient staff working in difficult conditions. Access to rapid coronavirus tests at psychiatric facilities would also be immensely helpful, by allowing for quick identification and transfer of infected patients. Making more video technology equipment available would improve the safety of group therapy. That would also minimize workforce disruptions by allowing physicians to see inpatients remotely, thus reducing mass quarantines of health care workers after exposures.
We’ll always need psychiatric facilities for those who’ve become too mentally ill to remain at home safely. And though we’ve long overlooked the important work these places do, now is the time to give them the attention they deserve. In our fight against this new threat, the needs of their patients and those caring for them shouldn’t be ignored.
Brian Barnett is a psychiatrist in Cleveland, Ohio. Jack Turban is a resident physician in psychiatry at Massachusetts General Hospital.