As coronavirus spreads, mentally ill Americans are left scrambling for options
WASHINGTON — Dr. James Griffith is trying his best. As the head of psychiatry and behavioral science at George Washington University, he bears the brunt of responsibility in helping keep patients and his medical staff well adjusted, cared for and alive.
Yet the coronavirus is making even the most basic tenet of his job — showing up — impossible.
“I’ll be 70 years old on my next birthday, and I kind of got chased out of the hospital,” Griffith said during a phone call. “The hospital said I’m too high risk to be there, so I’m not.”
The rapid spread of the coronavirus has dramatically affected the one in five Americans who deal with mental health in any given year, as well as those who work tirelessly to keep those individuals well, according to several doctors and field experts who spoke to Yahoo News.
Fears around the coronavirus extend beyond the physical threat of disease. The guidance issued to mitigate the spread of COVID-19 can also trigger those who suffer from depression, anxiety disorder, bipolar disorder and schizophrenia, explained Dr. Joshua Gordon, neuroscientist and director of the National Institute of Mental Health, the federal agency focused on the research of mental disorders.
“Obviously, this situation is stressful for everybody,” said Gordon. “We’ve all been asked to distance ourselves physically from other people, and if care isn’t taken ... that physical isolation can lead to social isolation, which can, of course, exacerbate their illness.”
Clinical psychologist Dr. Krystal Lewis said she has received an increase in calls specific to coronavirus-inspired anxiety and panic. Lewis, who specializes in children and teens, said most of her young clients worry about the potential of passing on the coronavirus to their older family members and are struggling to rebuild their now disrupted routines.
There’s a risk too, said Lewis, that those with depression might be particularly susceptible.
“For people who do have depression, they have limited options ... that can be a trigger for them in that there are fewer things that bring them pleasure to begin with,” she said. “And now we’re taking those off the table.”
The Reddit thread r/mentalhealth shows the grim reality for those who suffer, often alone.
One user called out for help in a sobering post titled: “Help! My mental health became complete trash in less than a week.”
“I have ADHD, anxiety, and depression. I haven’t had depression symptoms in a few years. … I was feeling 99% normal,” the user wrote. Then isolation hit. “I’m an absolute wreck now.”
Another user asked: “People who use social interactions as a distraction from depression, how are you doing while social distancing?”
“It’s been almost 3 weeks now that I've been social distancing and my mental health is sliding downhill very quickly,” that person wrote.
Griffith stressed that he and his department have been working “every waking hour” for the last week to meet needs and move their outpatient services, such as therapy and medication prescriptions, entirely online. He said he’s been able to conduct “business as usual” for his tele-therapy, a service that more and more people will need as mandatory quarantine and isolation orders continue through most parts of the country.
But that technology isn’t intuitive — or even accessible — for every patient or doctor, said Dr. Paul Nestadt, the co-director of the Johns Hopkins Anxiety Disorders Clinic.
“A lot of psychiatrists and patients aren’t equipped for that,” said Nestadt. “I had a 76-year-old patient begin evaluation. I called her to help walk her through how to set up our system for telehealth, and she’s like, ‘I’m a 76-year-old woman, I don’t have a webcam.’”
And as psychiatrists try to juggle how the illness affects their own lives, their ability to offer services might suffer too.
“Everything is slowed down, and a lot of psychiatrists are feeling, well, you know, just like everybody else,” added Nestadt. “Many of us have kids we have to take care of. So it's hard to maintain your normal hours even if telehealth is super-easy to set up. So how do you see many patients? You just can't.”
There’s precedent for health care workers developing their own psychiatric symptoms, said Dr. Daniel Yohanna, the interim chair of the department of psychiatry and behavioral neuroscience at the University of Chicago.
“We know that patients who have psychiatric disorders will have more problems during this period. We also know health care workers, from data out of Singapore, have increased numbers of posttraumatic stress disorders, depression and anxiety,” Yohanna said. In Singapore, 9 percent of health care workers during the SARS epidemic developed PTSD symptoms.
The University of Chicago has begun a resilience and stress-reduction program for its health care workers to get ahead of the curve, said Yohanna. Trainers in various departments will dedicate a few minutes to the rest of their staff, most coordinated through the internet teleconference tool Zoom.
At GWU, Griffith is scheduled to give three grand rounds to different departments around the hospital to help equip the doctors in “building resilience to pandemic-related stressors.”
But doctors can’t account for all contingencies in psychiatric treatment, and the half dozen who spoke to Yahoo News said psychiatric wards simply aren’t equipped to deal with a pandemic.
Yohanna explained that in Chicago, most psychiatric wards have low staffing, due to workers getting sick, and are facing difficulty maintaining a safe environment, because psych wards aren’t built for isolation.
Typically, patients are encouraged to walk around the unit, befriend other inpatients through group therapy activities and hold intimate sessions with their case workers. The intake capacity can range from just a few dozen beds to about 100, and more often than not patients are put in rooms of two. New patients can’t be admitted unless another is discharged, leaving them to wait in a bed in the emergency room for hours, or days, on end.
Just one individual contracting COVID-19 can disrupt the entire system of patients who are already grappling with horrifying trauma.
“This is generally true that psychiatry units are not set up where they can safely manage COVID-positive patients,” explained Griffith. “And when people are in a confused mental state, how they interpret all this is not good.”
Doctors at the GWU psych ward have set up three rotational teams of pairs of doctors who will attend the unit to properly maintain CDC guidelines. Griffith said there are contingency plans for nearly every possible outcome, such as dealing with a patient who tests positive for COVID-19, or if a ward has to be flipped into a triage center for those physically affected by the pandemic — a tactic Gordon experienced in New York on 9/11.
Gordon, who was a psychiatric resident on Sept. 11, was part of the team at New York Presbyterian that cleared out its psychiatric emergency room so there would be extra beds for those who were injured in the attacks.
Many factors can cause an individual to need immediate psychiatric inpatient help, including thoughts of suicide. In Hong Kong during the SARS epidemic, suicide rates hit a “historical high,” according to data from the National Institutes of Health.
“I think that it’s reasonable to expect suicide rates to go up in this context. All the risk factors are there,” said Nestadt, who has closely studied suicide.
“People are all of a sudden out of work, but they can get alcohol. Another big suicide risk factor is grief,” he said. Part of that stems from the isolation imposed on people by the pandemic, and it could be compounded by the loss of family members.
“It is the perfect storm: alcohol, isolation, unemployment, economic outfall, grief, these are all the sort of things that can make suicide rates go up,” said Nestadt. “I’m really worried about that.”
Already, the National Alliance on Mental Illness, the largest grassroots mental health organization in the country, has increased staffing on its crisis hotline to 40 volunteers in order to keep up with increased demand, said Dr. Ken Duckworth, the group’s chief medical officer. Typically, it staffs around 10 volunteers.
“The volume is substantially up. People are anxious, and people are looking for support.”
Even as people are turning to support lines, Nestadt fears that many who might need psychiatric help in an emergency room are not seeking it due to fears about coronavirus infection, or concerns that such wards won’t be available.
“There’s a lot of rumors about closing psychiatric beds in the interest of using that space for medical beds, which you know they’re reasonable to think about,” he said. “But it would be a disaster if we all of a sudden had nowhere to put people that really needed patient care.”
Griffith stressed that hospitals like GWU’s have several strategies in place to meet the needs of COVID-19 patients, and any plan for repurposing the psychiatric ward is only theoretical.
“Nobody’s throwing all these things out there saying it’s going to happen,” he said.
Caitlin Dickson contributed reporting from New York.
If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741-741.
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