How COVID-19 Has Impacted Mental Health Care

COVID-19 has resulted in the development and exacerbation of psychiatric illness, and these issues may be compounded by the fact that access to mental health care services may be limited during this pandemic. During a presentation at the Neuroscience Education Institute Max! Virtual Meeting, William M. Sauvé, MD, regional medical director of Greenbrook TMS NeuroHealth Centers, examined the mental health consequences that have and continue to ensue in response to this pandemic.

“The effect of COVID-19 goes well beyond the physical considerations,” he said. The COVID-19 pandemic has forced many to practice social distancing, has impacted some financially, and has resulted in a lack of social support. This has led to increased food, alcohol, and drug consumption, as well as inactivity. He called this the “perfect storm” for mental illness: “I am fully convinced that there is a large slice of the population that has not been well but has been well enough to exist in denial or [didn’t] have time to address their illness. Something like COVID-19 can basically cause this massive slice of the population to decompensate.”

Symptoms of anxiety or depressive disorder from January to June 2019 were 11.0% compared with 40.3% from July 9-14, 2020. “I strongly suspect these were people who were not perfectly well but were getting by but suddenly the veil of denial was ripped off,” said Dr. Sauvé. There was nothing to distract from those feelings anymore.

Most importantly, he said, people with preexisting mental health disorders might have a higher risk of SARS-CoV-2 infection than those without mental health disorder. People with mental health disorders are at increased risk of infections in general, thereby potentially increasing their risk of COVID-19. They are also more likely to develop severe organ dysfunction and to die in intensive care units than people without mental health disorders.

Quarantine related to COVID-19 has resulted in early discharge of patients from psychiatric units and disrupted face-to-face psychiatric care. Alcoholics Anonymous has also moved to an online-only format, which Dr. Sauvé said “is not the same” level of support for people.

Black populations have experienced higher mortality from COVID-19, per data from New Orleans, La.; Chicago, Ill.; Milwaukee, Wis.; Detroit, Mich.; and Georgia. Due to structural societal flaws beyond simply poor lifestyle choices, underlying conditions such as cardiovascular disease, hypertension, diabetes, obesity, and asthma are higher in Black communities, placing them at higher mortality risk for COVID-19.

Health care workers, especially those on the frontline during the COVID-19 pandemic, have also reported negative consequences as a result of stress, fear of infecting themselves, and fear of infecting loved ones. This has to do with the trauma experienced by health care workers who were thrust into this situation, according to Dr. Sauvé.

For patients who have had COVID-19, high rates of post-traumatic stress disorder symptoms have been reported in clinically stable people discharged from the hospital after recovering from COVID-19. People who have had COVID-19 can experience post-intensive care syndrome, which includes cognitive, psychological, and neurological symptoms.

Previous research indicates that telepsychiatry is comparable to face-to-face services in terms of reliability of treatment outcome and has also been shown to deliver high patient satisfaction. During COVID-19, telepsychiatry has allowed for the preservation of a large proportion of clinician-patient interactions and continued therapeutic work. However, older patients, those with low socioeconomic status, and people with low technology understanding may have a compromised ability to participate in telepsychiatry. Dr. Sauvé says most regulations around telemedicine “are irrational at best.” They differ by state, so a positive outcome of COVID-19 could be that the provision, delivery, data protection policies, and reimbursement of telemedicine are optimized in the future.

“Quite a few holes have been revealed in the ways we do things,” he said of the impact of COVID-19 and where the health care industry may go post-pandemic. “We may see governmental and non-governmental financial support for mental health and social services and for research focusing on monitoring and improvement of mental health services.” It is essential that mental health care providers continue to monitor the effects of these changes and prepare for long-term incorporation for alterations that prove beneficial.

Presentation: Situation Critical: The Impact of COVID-19 on Mental Health Care. Presented at the Neuroscience Education Institute Max! Virtual Meeting, Nov. 5-8, 2020.