COVID adaptations shine a light on the future of care in mental health
Within just three weeks of Manitoba’s first reported case of COVID-19 in March 2020, HSC psychiatrist Jennifer Hensel led the team at Crisis Response Services through the implementation of a variety of virtual solutions to help patients experiencing a mental health crisis get the care they needed from the comfort and safety of their own homes.
“The timeline was amazing,” says Dr. James Bolton, Medical Director of Shared Health’s Crisis Response Services. “Jennifer had been leading some virtual care work in Ontario and in Manitoba, but COVID-19 really accelerated the effort. We knew that our population was going to be particularly vulnerable to the effects of social isolation.”
Aside from virtual outpatient visits—which are now increasingly commonplace across health care—one of the first innovations was the adaptation of virtual care to emergency care settings. Crisis services are in place for patients who need immediate, emergency psychiatric help. They could be suicidal or experiencing very acute psychotic episodes related to schizophrenia or major mood disorders.
“Instead of coming into the building where there would be a risk of COVID transmission, patients could call us from home. That would initiate a full in-depth crisis assessment by video or phone,” explains Dr. Hensel. Those patients who were assessed to need a higher level of care or observation were advised to come to the hospital; the majority were stabilized through virtual interventions.
The feedback from patients and their families was positive. “A hospital building can actually be quite traumatic and triggering for some patients with mental health challenges,” she says.
The feedback was similarly positive when Dr. Hensel and her colleagues moved psychotherapy groups from rooms to Zooms. “People attend these groups to learn skills for coping with mental health difficulties like depression, anxiety, and difficult emotions,” says Dr. Hensel. “We have 30 to 40 people attending those. We quickly made those virtual, which was novel at the time but has now become pretty common practice.”
But perhaps the greatest area of innovation—the adaptation that required the most effort to organize—was the virtual ward program, which Dr. Hensel and her colleagues based on the concept of “hospital at home”.
“I think this was the most impactful and the most novel thing we did,” says Dr. Hensel. “We needed to close down beds because of the pandemic, so we devised a way to provide daily psychiatric support to people who would have otherwise been admitted to hospital. Patients had access to us after hours. We involved families and other supports as much as possible in the care because they were our eyes on the individual in the home environment. We worked with pharmacies to coordinate prescriptions and did everything else we could to provide high-quality care.”
The patient and family feedback was largely positive—not an unexpected outcome given the growing body of literature on the subject—and the potential for the permanent use of virtual wards for some patients is significant. Rural patients in particular stand to benefit from this approach.
“Hospitalization is kind of a mixed thing. It is definitely essential for certain people who are really quite sick and struggling,” says Dr. Bolton. “But on the other hand, it’s not a fully benign process. It can be scary or traumatic for some people. And so this hybrid model we have built is serving a number of needs. Seeing the benefits of virtual care and the potential of this model of care is truly exciting. There is a wonderful opportunity in front of us.”
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