The health and mental health impact of the coronavirus pandemic is widespread (Brooks, 2020; Fegert et al., 2020). How have these changes been manifest in our communities?
It is clear that the pandemic has disrupted the lives and the routines of everyone. The pandemic has quite naturally caused increased feelings of vulnerability and the ongoing uncertainty about health and safety, and concern about economic and social issues have had ongoing impact on virtually all. In so many pervasive ways, the pandemic has been a serious stressful event upon all of us with impacts across the lifespan. As the various states of quarantine have worn on, both children and adults and older adults have experienced more anxiety and higher rates of depression.
Behavioral health service delivery has changed drastically and though there are any number of new challenges for providers, patients and would-be patients, the modification of service delivery facilitated by the changed rules of access and funding have enabled continuity of care for most. The majority of mental health services are now being delivered via tele-health. This has allowed increased access to some, but even with this expansion of capacity tele-health has also remained limited for others without technology supports.
There is a general consensus that this shift in methodology has been well received overall, and certainly the availability of connectivity thru telehealth has been a valued resource when face-to-face contacts have been a health risk for both providers and patients. In the past, tele-psychiatry has been demonstrated to be a viable service delivery method for hard to reach areas or areas with limited providers. It remains to be seen how mental health outcomes will be impacted by this shift. More longitudinal study is need to evaluate this.
With regard to emergency care, available data does demonstrate the emergency rooms have seen a shift in the type of psychiatric presentations. Brooks outlines the following shifts in Buffalo, NY:
– Increase in level of acuity of presentation, but decrease in overall rates of children and adolescents coming to the Psychiatric ER
– Possible increase in suicidal patients, adults and children
– Increase in new-onset psychosis
– Increase in rates of domestic violence
Here in San Diego, trends seem to be similar for children and adolescents and it is likely that the ongoing restrictive measures for families and communities will continue to be a stressor for many and a challenge for all.
As regards emergency services, and in the context of our growing understanding of managing the risks of transmission, it is important for Primary Care providers and Mental Health professionals alike to educate families that the ER is a safe place to go when a significant mental health crisis presents itself within a family.
Ongoing flexibility to support alternative modes of services delivery will remain a needed feature of the behavioral healthcare ecology for the foreseeable future and ongoing efforts to enhance access to care and to reduce lingering issues of stigma should remain on the public health agenda.
Emergency Services in San Diego
– Rady Children’s Hospital Emergency Room
3020 Children’s Way, San Diego Ca 92123
– Emergency Screening Unit
4309 Third Ave, San Diego, CA 92103
(619) 876-4502
– Access and Crisis Line
(888) 724-7240
– Behavioral Health Urgent Care
4305 University Ave, San Diego, CA 92105
(858) 966-5484
Inpatient and Partial Hospital Care
Aurora 858 487-3200 (all ages)
Sharp Mesa Vista 858 836-8434 (all ages)
Rady Children’s CAPS Unit 858 576-1700 (Child & Adolescent only)
San Diego County Behavioral Health Services System of Care
https://www.sandiegocounty.gov/content/sdc/hhsa/programs/bhs/
SmartCare Behavioral Health Consultation Service remains accessible as a resource for providers facing dilemmas in managing mental health issues in primary care settings and continues to be available for families and individuals needing support, referral linkages and care coordination services. Hours of operation: — Mon- Fri 8:30 – 4:30.
– Provider Line 858 880-6405 for triage and psychiatric consultation.
– Parent/Patient Line 858 956-5900 for telephone consultation and referral coordination.
References:
Brooks, V (2020). “Covid-19’s effects on emergency psychiatry”, Current Psychiatry Vol 19, No. 7 July, 2020