Our faculty and staff are contributing in a number of ways to support the mental health of our community now and in the months ahead as we collectively respond to COVID-19 challenges. After getting over the initial shock and fear, we have learned that as mental health professionals, we can take care of vulnerable patients, take on the care of new patients who are severely stressed and traumatized, and provide important support to our health care colleagues on the front lines. The following are a few examples of how we are stepping up.Transitioning to outpatient telehealth, inpatient safety protocols
Faculty and staff at our outpatient clinics have done an amazing job transitioning to offering appointments via zoom or phone. There has essentially been no disruption in service as we rapidly moved scheduled outpatient visits to telehealth care, going from doing almost no into-the-home telehealth to doing 90% of our visits in this manner. Our inpatient clinics have also risen to the occasion by developing protocols to screen all existing and new patients to our inpatient units for COVID-19 and conducting surveillance testing of staff who have been exposed, reducing the risk of COVID-19 spreading between psychiatric patients and staff. Our consultation-liaison services have also successfully transitioned to tele-video consultation. All of these changes happened in an incredibly short amount of time due to a tremendous effort by Service Chiefs Ryan Kimmel, MD, Mark Snowden, MD, Larry Wissow, MD, MPH, and Jesse Markman, MD, MBA; Medical Director of UWMC Psychiatry Outpatient Amanda Focht, MD; Cara Towle, MSN, RN, MA, Associate Director of Psychiatry Consultation & Telepsychiatry; and all of the faculty and staff who have stepped up to do their part. We also want to thank and acknowledge the hospital staff for their extraordinary efforts in supporting our faculty during COVID-19. We couldn’t do our work without them!
Mental health support for UW Medicine employees
The COVID-19 pandemic is challenging for all of us, but frontline health care workers and support staff are facing extraordinary challenges and risks: longer shifts, a daily fear of exposure for themselves and their families, increased patient anxiety and isolation, frustrated and anxious family members, and a looming surge in very sick patients. In the face of the current crisis, we have established the Psychiatry COVID Support Response Program that pairs department paid faculty-clinicians, courtesy faculty-clinicians, and staff-clinicians as well as some non-department psychologists with UW Medicine healthcare colleagues to help them manage the increased stress and anxiety during this difficult time. Nearly 100 faculty and staff have volunteered their time and skills to provide free, informal, video, telephone and in-person mental health support to some 20,000 UW Medicine health care workers. Within hours of the program’s launch, we had a virtual queue of healthcare workers reaching out for support, and based on data from past pandemics (e.g. SARS Ebola), we anticipate this need to continue for the months — and years — ahead.
Support strategies for mental health specialists, leaders and managers
Psychological First Aid (PFA) is an evidence-informed prevention strategy aimed at reducing distress and increasing resilience during and following mass disasters, including natural disasters and pandemics. Kristen Lindgren, PhD, Michele Bedard-Gilligan, PhD, and Emily Dworkin, PhD, from the Trauma Recovery Innovations program have been adapting PFA materials to address the unique situation of the COVID-19 pandemic. The team conducted a webinar for mental health specialists supporting health care workers and a revised version for UW Medicine leaders and managers. They continue to work on adaptations for other audiences as well.
Clinical consultation for Washington providers
With increased mental and behavioral health concerns due to COVID-19, our provider consultation lines are a crucial source of support and clinical advice for Washington providers. Psychiatrists staffing the Psychiatry Consultation Line (PCL) provide consultation to primary care providers and other health care professionals caring for patients with mental health or substance use problems anywhere in Washington State. After a short intake with a health navigator, providers consult with a UW Medicine psychiatrist regarding assessment, diagnosis and/or treatment planning, including medication management or other treatments. Similar consultation lines provide clinical advice to providers caring for children and adolescents (Partnership Access Line – PAL) and pregnant and new moms (PAL for Moms). In partnership with King County, the PCL is now also providing consultation to ARNPs who are staffing the tent/hotel facilities the county has organized for homeless patients in need of isolation.
Telepsychiatry for perinatal mental health
With philanthropic support, Amritha Bhat, MD, MPH, and Deborah Cowley, MD, are conducting a pilot program that will connect telepsychiatry to home visiting programs in order to increase clinical access to people experiencing perinatal mental health conditions, especially in the context of the COVID 19 pandemic. By partnering with organizations such as Perinatal Support of Washington (PS-WA) and the Nurse Family Partnership (NFP), faculty will interact directly with people requesting emotional and mental health support and be able to provide needed psychiatric services to vulnerable communities during this challenging time.
Increasing suicide prevention during the COVID-19 crisis: expanding Caring Letters
In the Caring Letters intervention (also called Caring Contacts), clinicians send patients brief, simple messages that let patients at high-risk for suicide know that their provider is thinking of them and wishes them well. Caring Letters is one of only two suicide prevention interventions that have reduced suicide mortality in a randomized controlled trial, and it can be implemented at a distance which is especially important during the COVID-19 crisis.
Although the Caring Letters intervention is an option for providers to consider in the VA’s REACH VET program which identifies Veterans who may be at high-risk for suicide, they are rarely used. Mark Reger, PhD, and Jesse Markman, MD, MBA, led a pilot program that centralized the work of Caring Letters to nearly eliminate provider burden, largely through the hiring of a part-time Caring Letters Coordinator. Though challenging to launch, after 11-months of implementation there was a 12-fold increase in their use. Two additional VA facilities are now using versions of this strategy, and VA Puget Sound is adapting the methods for expansion to their psychiatric inpatient unit. Similar approaches could be used to maximize the use of this evidence-based suicide prevention intervention during the COVID-19 crisis.
BHI Telehealth Rapid Response Initiative
The Behavioral Health Training, Workforce and Policy Center (BHTWPC) of the Harborview Behavioral Health Institute (BHI), in partnership with the Washington State Health Care Authority, Division of Behavioral Health and Recovery, is providing statewide coordination and mobilization to respond to the need for rapid behavioral health telehealth deployment, training and technical assistance. The BHI Telehealth Rapid Response Initiative, led by BHI Director Jim Vollendroff, MPA, will meet immediate telehealth needs (access to care, equipment, technical assistance, billing, staff training) while simultaneously beginning to address the long term workflow and policy/procedure development related to telehealth post COVID19. Department members of the Rapid Response Team include Bradford Felker, MD, and Cara Towle, MSN, RN, MA.
