with Charles Raison, MD, Christoph Correll, MD, Christine Moutier, MD, and Peng Pang, MD

“We are the mental health professionals. We bend with stress; we don’t break. We have one purpose … and purpose brings us closer: the betterment of people’s mental health.” These were the words of Rakesh Jain, MD, MPH, Psych Congress steering committee member, as he welcomed attendees to the 33rd Psych Congress 2020 Virtual Experience this past September. Despite the challenges we are all going through, he noted, we’re still standing.

With these words of inspiration in mind, conference co-chair Charles Raison, MD, professor of psychiatry at the University of Wisconsin, Madison, School of Medicine and Public Health, kicked off the 2020 Psych Congress with a series of live interviews on how the COVID pandemic has impacted mental health worldwide. Leaders of three key initiatives shared their work to date – with highlights below.

Real-Time Mental Health Surveys

Christoph Correll, MD, professor of psychiatry and molecular medicine at Hofstra Northwell School of Medicine in New York, has mobilized resources to launch a Collaborative Outcomes Study on Health and Functioning During Infection Times (COH-FIT). This general population survey of the physical and mental effects of the pandemic has now engaged researchers and practitioners working in more than 35 countries.

Dr. Correll and co-founder Marco Solmi, MD, PhD, a researcher at the University of Padova in Italy, “felt we needed to do something and turn this passivity and also this extraordinary environmental pressure and stressor into research questions and research answers, so that we could inform the field,” he told the Psych Congress audience.

Drs. Correll and Solmi came up with the idea for the COH-FIT project on April 1, 2020, shortly after the pandemic rampantly spread across the United States. Just 10 days later, they had 200-plus collaborators around the globe. The project aims to identify risk and protective factors that will inform prevention and intervention programs for the COVID-19 pandemic and any future pandemics. It focuses on access to care (including telemedicine), global restrictions and lockdowns, and coping strategies. The way that COH-FIT’s ongoing survey is fielded will enable the team to correlate the timing of the responses with the actual events related to the pandemic.

The survey has been translated into 29 languages and takes 35 to 40 minutes for an adult or adolescent to complete. Respondents are asked to compare the past 2 weeks of their life now to the past 2 weeks before the start of the pandemic.

So far, 92,000 surveys have been collected. Early data shows that those with sound family structures have benefited from time at home together. However, women have experienced more stress during the outbreak, particularly those with children at home. Dr. Correll anticipates having a high rate of usable surveys to conduct an initial data analysis by the end of this fall.

COH-FIT will also issue surveys 6 and 12 months after the WHO declares the pandemic is over, which Dr. Correll estimates to be 12 to 18 months away (as of his September 2020 talk). His hope is that the findings will be helpful during future pandemics.

Doubling Suicide Prevention Efforts

As chief medical officer of the American Foundation for Suicide Prevention (AFSP), Christine Moutier, MD, is often asked whether the AFSP has seen an increase in suicide attempts and suicide deaths during the COVID-19 pandemic. “We’ll need to wait 18 months to see the effects from the pandemic,” she told the Psych Congress audience. Already, though, she said, “We can see increased rates of help-seeking and a willingness to reach out through telehealth.”

Dr. Moutier noted that a recent Harris Poll showed 26% of American adults are connecting to mental health services through virtual means such as teletherapy. She sees this as a proactive measure to help people cope and believes the situation is opening a national dialog on the mental health experience.

“The pandemic is a ubiquitous and oddly unifying experience,” she said. And when it comes to suicide, which she defines as multifaceted, “distress is part of it… living through this time requires connecting to resources, people you trust.”

Unfortunately, even during the pandemic, accessing mental health care has been difficult and challenging for many because providers may not be in an individual’s insurance network or visits may require cash only. Providers, therefore, may be missing opportunities for suicide prevention in American healthcare. (More on suicide prevention in the schizophrenic patient)

Dr. Moutier pointed to the initiative known as the Zero Suicide Framework. This system-wide, organizational commitment to safer suicide care in health systems offers practical approaches to prevention that can be taken in the ER and primary care clinic, as well as within mental health facilities. For example, reaching out regularly to patients at risk with “caring contacts” – ie, simple messages of caring and concern –  has been shown to reduce suicide by 60% in a high-risk population.

When individuals are in suicidal crisis, their ability to consider options aside from suicide diminish substantially, according to the AFSP. A Safety Planning Intervention can greatly reduce suicide risk. “Safety planning is different from what used to be,” explained Dr. Moutier. “Ten years ago, or more, we didn’t have the science to know what we were doing. Older providers learned methods that did not work. Now, a systemwide change is starting to happen in some health systems.”

Safety planning engages that part of the patient’s psyche that wants to remain safe and is unique to the individual: What are their triggers? What has helped? It requires developing one’s own self-soothing mechanisms and drawing upon trusted individuals in the family to help remind them of how it was when they were not in crisis. It also requires making the environment safe from lethal means.

“Individuals at risk don’t always need to go into residential treatment,” noted Dr. Moutier. “There are ways for individuals to match their level of need. Community resources can fill in between the ER and mobile crisis teams and residential crisis units. We need to move away from a 911 response to a health crisis.”

Supporting Frontline Workers

Peng Pang, MD, director of child and adolescent psychiatry and assistant professor at Hofstra University’s Northwell School of Medicine in New York, described how her journey to China to celebrate the Lunar New Year in January 2020 turned into establishing peer support groups for healthcare workers battling the pandemic. She could tell things were different when she arrived in Beijing for the celebrations – COVID was already rearing its ugly head.

“It was 1 day before the close-down order and the entire nation shut down, including restaurants, and families were not gathering together for the holiday. All travel closed down, and the streets were empty,” she shared. She had heard some news from Wuhan but did not realize how serious the situation was until she arrived there.

“The degree of lockdown was absolute,” she continued. On January 25, 2020, Dr. Pang gathered with six American psychiatrists to establish a peer-support group for healthcare workers in Wuhan. While the city was shut down, there was no support and workers had no training or experience to manage the huge influx of patients coming to the hospitals. In addition, she said there was no transparency related to information about deaths. The medical system broke down, she said, and there were no supplies for frontline workers.

Some members of the group she brought together had been involved in other disaster situations, such as 911 and Hurricane Katrina, so they knew what frontline workers were facing. They set up a chat group that included 300 medical staff. For 16 hours each day, they listened, validated healthcare workers’ feelings, and provided support.

Dr. Pang said she witnessed the spread of COVID-19 first-hand, first through Asia, then Europe, finally to her home state of New York. “Our medical system is much more trained, more psychology minded, with the staff clearly experiencing the seven stages of grief,” said Dr. Pang. “Here at my institution, we set up a hotline and in-person support for the hospital staff. The experiences with frontline staff in Wuhan helped me work with the staff here.”

She told the Psych Congress that long-term psychological effects will be similar to some extent between the two countries, but there will also be differences in the approach to healing. In China, those who experience loss and PTSD may be less likely to express their feelings or practice health-seeking behaviors for instance. There, it is considered shameful or weak to ask for help. Here in the United States, there is greater mental health literacy and less stigma (even though there is still work to be done). In addition, providers have more experience in identifying risk factors and providing outreach services.

 

What Mental Health Clinicians Can Do Now

Start by acknowledging, as Dr. Raison has, what so many have already feared: a mental health pandemic is brewing.

Rates of anxiety and depression are multiplying; the rates of clinical depression have doubled in the past 6 months, he said. Thus, mental health clinicians have become “one of the most essential of all specialties.”

Then, prepare yourself. Just as clinicians often advise patients, there are a few things you can that don’t take a lot of time but that have huge benefits:

  • Step back. Find ways to step back from the stress, Dr. Raison told Psycom Pro. Meditation, exercise, distractions such as movies and comedy, and importantly, being with others can help greatly. “You will be less likely to be depressed if you can have just one person you can be yourself with,” he advised.
  • Set a “worry time.” By setting aside a specific – but limited – period of time during the day to worry, you can avoid reviewing or agonizing over the day’s events in your head as you go to sleep (or if you wake up in the middle of the night). “Write down your thoughts. If you [do] wake up in the middle of the night, it’s better to get up and do something than lying there and looking at the clock,” he said.
  • Develop a wellness program. This can include exercise, healthy eating, and stress management.
  • Ask for help. “It’s important to recognize when you need professional help. When stress impacts your ability to function, or when you have thoughts such as ‘Life isn’t worth living’ it’s time to reach out.,,, There is no shame in reaching out,” he concluded.

 

See also, our report on mental health care for mental health professionals and how two psychiatric residents are trying to avoid pandemic burnout.

Psych Congress 2020 Highlights

Additional virtual meeting summaries

SUDs in ElderlyGADSuicide & Schizophrenia
Last Updated: Nov 30, 2020