These are difficult times. Social distancing, a lack of routine and a high level of apprehension for the health of the ones you care about. Many are wondering how these extra pressures brought by COVID-19 are affecting mental health. COVID-19 is a recipe for a mental health disaster; or so you’d think.
We Have Fewer Mental Health Patients Than Ever Before
What I have found most unusual about the current pandemic is the eery silence and relative tranquillity. It feels like ‘the calm before the storm’. Generally we have had much fewer mental health patients than we did several months ago. This makes me feel even more uneasy. Where are they? Are people too afraid to get help? Are we going to have a massive backlash of unmet need once the restrictions lift? Were all those patients really that unwell before?
The mental health patient turnover has dropped but staff sickness, redeployment and restructuring has made us as busy as ever. We are in uncharted territory and our roles have changed into pseudo-respiratory psychiatrists and lay public-health experts. Everything takes longer now. The frequent changing of equipment seems to put additional metaphorical, as well as physical, barriers between us and our patients. I will not miss having to ask a sensitive question at the top of my lungs so that I can overcome the voice-pacification effect of a cheap surgical mask.
The Good And The Bad Of Being An NHS ‘Hero’ During COVID-19
We are frequently told that we are ‘heroes’. The rounds of applause on Thursdays help to mitigate some of the isolation and resentment many of us felt only several years ago. That time when our profession was denigrated and dismissed as another public sector profession that the Government could dictate terms to and treat as they wished.
To some, it almost feels that in accepting the title of ‘heroes’ we are perhaps also accepting that we ought to be super-human, to work in unreasonable conditions, to be separated from our families and give our all. With longer hours, no extra pay and inadequate personal protective equipment, because that is what heroes do. They sacrifice themselves for the good of others. I’m not entirely sure that I want to be a hero.
The current COVID-19 pandemic has generally put additional strain on already stretched services. However there have been some changes for good. Firstly, unnecessary bureaucracy and paperwork have been streamlined to allow clinicians to focus on clinical care. Additionally, indemnity insurers (for once) seem to actually offer practical advice and give us the reassurance and validation that us institutionalised GMC-fearing doctors crave.
Digitisation Is The Way Forward
Everything seems to be online now. Many of us have very quickly decided which platforms we prefer; and which ones we despise with the frustration we had forgotten from times of the dial-up modem. Much to my surprise, teaching attendance appears to have soared. In removing the need to physically travel to a lecture, it now seems that most people have accepted online tutorials and meetings as a new way of learning (and perhaps with fewer excuses for not attending).
When the worst of COVID-19 is over and the dust settles, I imagine we can expect a significant push-back to those who might hope to return to how things were before. Many have seen a new and more efficient way of working and the grass seems greener over here.
Treating Mental Health Patients By Video Conferencing
We are told to minimise all unnecessary contact. I think it is fair to say that there were (and still are) a lot of apprehensive clinicians worried about the prospect of replacing face-to face psychiatric assessments with video conference technology. Would the subtleties and characteristic behaviours be lost? Will the rapport be good-enough to allow expansive conversation and dialogue? Will the patients with paranoid symptoms engage at all with a computer screen?
We know that tele/video conferencing is not without its own set of difficulties. There are the wider problems such as poor connection strength/video quality and the need for contingency communication methods. Not forgetting the more psychiatric-specific difficulties including the potential for a change in the qualitative behavioural reciprocity and an enhanced self-regulation as you primarily focus on your own image in the corner of the screen. Despite these challenges, perhaps one of the more surprising outcomes of the current COVID-19 pandemic for mental health patients and psychiatry is just how well the video conference assessments seem to work.
The New Normal For Mental Health Patients During Covid-19 And Beyond
It would appear to me that the overwhelming response to this ‘new normal’ way of working is positive. It seems to be easier and less unusual than we had initially predicted. My own experiences of teleconference assessments have been characterised initially by a preceding hesitation, then a brief period of persuading yourself that this is going to work (and that you will at least give it a go). Then very quickly you forget you are on a teleconference assessment at all and end up in the swing of your typical routine, doing the job you are trained to do and not giving it another thought until you reach the end.
I have felt fortunate to be supported by a college that has really kept its finger on the pulse of these changes. Perhaps unlike our sister colleges; the RCPsych has issued very extensive, useful and practical advice on using this technology and how to keep yourself safe.
Psychiatry does not appear to be alone in finding potential benefits to distance-medicine. My primary-care colleagues have told me just how surprised they are that so many of their consultations can just as easily take place (and often more quickly) over the phone than in-person. As a result, some GP practices plan to reorganise their surgery clinics to offer a larger proportion of phone appointments in the future to meet increasing patient demand. Just like psychiatry, it is hard to imagine such changes taking place had we not been put in our current situation by necessity.
Adapt Or Get Left Behind
It is an unusual time. Medicine has been given a push into the 21st century, and as I see it, we can either adapt to it or risk being left behind.
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Iain is a ST4 Specialist Trainee Registrar in General Adult Psychiatry working in Oxford and Buckinghamshire. He is currently part of the Community Mental Health Team and is a fellow of medical education at the University of Oxford. Iain has experienced first-hand the complexities and digital challenges associated with front-line mental healthcare and this led to his involvement with Thalamos. From issues with the existing paper-based process through to the lack of effective communication channels and the complexities of trust boundaries, Iain has a deep understanding of the situation on the ground.
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