Northwestern doctors face challenges in psychiatric care, anticipate mental health crisis ahead

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Illustration by Emma Ruck

Amy Li, In Focus Editor

The United Nations warned of an emerging mental health crisis as a result of the COVID-19 pandemic in a Thursday report. It cites higher levels of depression and anxiety globally, which may be exacerbated by factors like social isolation and domestic violence.

Danesh Alam, medical director of behavioral health at Northwestern Memorial Hospital, said the impact on mental health might be a surprising side effect of the pandemic that could persist beyond the physical effects of the virus.

Northwestern Memorial has also seen a surge in patients who have been struggling with mental health issues caused by the pandemic.

“You have those who have developed pandemic-related symptoms: anxiety, stress, hopelessness, helplessness — which may or may not be complicated by financial or other issues, rational and irrational fears — not knowing what’s going to happen and not being able to process things into support systems,” Alam said.

Aderonke O. Pederson, a psychiatrist at Northwestern Memorial, said for her inpatients with underlying illnesses — whether it’s anxiety, depression, mania or psychosis — a stressor like a pandemic may be more likely to trigger an acute phase of illness.

Some of her outpatients who initially reported they had been doing well have increased their requests for anti-anxiety medications.

“I think the mental health crisis is ongoing during the pandemic, and I think there will likely be a larger search for us as mental health providers after the pandemic,” Pederson said.

Safe distancing in inpatient care

Northwestern Memorial’s inpatient clinics face challenges while following safe distancing guidelines. For example, inpatient units are built in a “behavioral activation model,” designed to push patients out of their rooms and into social areas to interact, Pederson said.

To support safe distancing, Alam said the size of therapeutic groups have been reduced and all double rooms have turned into single rooms. However, Pederson said changes like terminating visits, communal mealtimes and other group activities have been hard on patients who benefit from social stimulation.

“Psychiatric units kind of function like nursing homes in terms of this community-based practice — how you’re engaging with patients, nursing staff, and mental health workers all on the unit together,” Pederson said. “Changes have been difficult since there’s no handbook out there for us to look at and say, ‘OK, this is what you do with psychiatric patients in a pandemic.’”

Outpatient care relies on telemedicine, children and adolescents at risk

Most of Northwestern Memorial’s clinics have transitioned into virtual care by using a secure video conferencing system that ensures patient confidentiality.

Alam said the expansion of telepsychiatry has improved mental health access, especially in the children and adolescent subspecialties. There are very few psychiatrists who work outside of the Greater Chicago Area, and in southern Illinois, a very limited number of psychiatrists work with children, Alam said.

The UN report warned that the adverse mental health impacts of the pandemic may have especially long-lasting effects on young children and adolescents as stress, social isolation and reduced physical and mental stimulation may expose children to higher risks of cognitive decline and dementia in their adulthood.

Rachel Ballard, a psychiatrist specializing in children and adolescent care at Northwestern Memorial, said many of her patients are feeling the impacts of school closures and lack of access to their peers and the activities that enrich their lives.

Ballard said she anticipates higher rates of school dropouts and poor academic performance following the pandemic.

“Some kids have been able to get online and complete all their work, and others have very limited access to any type of education,” Ballard said. “Missing two to three months of school can set kids who are doing marginally well back in a way that is going to be very difficult for them to recover from.”

Ballard has also seen children whose parents recently lost their jobs or who have lost older family members to the pandemic especially struggle to keep up with their mental health.

Depression tends to worsen for children when they are unable to enjoy physical and mental stimulation or when they are cut off from regular contact with their peers, social workers and teachers who have become an integral part of their lives, Ballard said.

Parents of newborn children are also feeling the strain of navigating parenthood during a pandemic. Sheehan Fisher, a parietal clinical psychologist at Northwestern, said postpartum parents face the compounded stress of trying to develop a certain level of normalcy and safety for their newborn child.

Additionally, because the pandemic has deprived people of their normal social and recreational engagements that help them maintain their moods, individuals who didn’t need mental health support previously may need support now.

COVID-19 pandemic highlights pre-existing disparities

Pederson said she is especially concerned with the intersection of severe mental illness, COVID-19 and a lack of socioeconomic resources.

Some of Northwestern Memorial’s severely ill psychotic patients may already have difficulties articulating symptoms of COVID-19. The same scenario could occur amongst marginalized groups of people with limited access to health care and an increased risk of infection, which becomes “daunting” to think about, Pederson said.

Fisher has been writing a grant application for a project centered on minority communities in Chicago to get a better understanding of their experiences and their mental health during the pandemic.

Lifestyle, financial access to health care and exposure to the virus, among other factors, all impact one’s health, but “what we don’t know is if [those factors] are better or worse within different communities,” Fisher said.

For Pederson, mental health is not separate from physical health. Both have seen persistent disparities in access to quality health care available exacerbated by the ongoing pandemic.

“The big word in academia and community health care for it is ‘intersectionality,'” Pederson said. “So what happens when you start to stack up the disparities on one individual? Say this person is low income, this person is African American, this person has a severe mental illness, this person has low social support, this person is homeless — it’s just layers of the disparities that already exist in our society when it comes to mental health.”

Telepsychiatry and early intervention is the future

Even though the ongoing mental health crisis will continue to be a challenge for healthcare providers in the years to come, Alam said he believes “telehealth will go a long way” to address the problem.

Moving forward, he said it’s important for the healthcare workers on the frontline to identify and screen patients who may be dealing with mental health issues early on and be well-enough aware of mental health resources to refer them to nearby sources.

Meanwhile, inpatient services have not slowed down, and Alam said the hospital continues to see a significant number of people trying to get admitted to inpatient care.

“The mental footprint is going to be much larger than the medical footprint after all of this is over — that’s what we’re going to learn,” Alam said.

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