Healthcare News & Insights

Addressing coronavirus, behavioral health crisis and public health concerns

Prior to the coronavirus pandemic, the United States was already in the midst of a suicide and opioid epidemic. Suicides are the tenth overall leading cause of death with 48,344 fatalities in 2018. 

The opioid epidemic caused dramatic increases in intentional overdose fatalities going from a rate of 6. 1 per 100,000 in 1999 to 21.7 per 100,000 in 2017. Within the first three months of the coronavirus there have been stressors leading to an 891% increase in suicide hotline calls. It’s expected, as a result of the significant stressors including unemployment rates, financial hardships, loss of loved ones, social isolation, and a change in the delivery of healthcare services, that rates of mental health and substance use disorders will increase.

There are key public health complications that will arise which require effective planning, preparation and collaboration, in order to mitigate fatalities from a combination of the coronavirus and patients presenting in a behavioral health crisis during the coming 12 to 24 months.

In a simple world, most patients positive for the coronavirus will quarantine at home to recover. Patients positive for coronavirus with medical complications will be admitted to a hospital. And patients with a behavioral health condition will be admitted to a mental health or substance abuse treatment center. However, those healthcare providers with boots on the ground in the healthcare system during this pandemic understand well the complications that arise when these simple decision-making algorithms no longer apply.

The complicated scenario occurs when a patient arrives at the emergency department with, for example, a diagnosis of bipolar disorder in a manic episode. The patient stopped taking their medications six weeks ago. During the emergency department evaluation it’s determined the patient is positive for the coronavirus. The patient’s medical symptoms from the coronavirus indicate the patient can medically be discharged. The psychiatric evaluation in the emergency department, however, determines the patient needs inpatient hospitalization for the management of mental health symptoms.

The healthcare team now has three challenges:

  1. The patient needs inpatient psychiatric treatment for the management of acute manic symptoms and is declined by all behavioral health hospitals due to the positive coronavirus status
  2. The patient does not meet criteria for a medical admission, and
  3. The patient is a public health risk to the general population if discharged to the community as a result of not being able to follow the instruction to self-quarantine at home.

Hospital systems have different challenges as a result of this scenario and there’s no coordinated approach between health systems. Most behavioral health hospitals currently are NOT accepting patients that have symptoms of or have a confirmed case of the coronavirus, limiting the availability of inpatient behavioral health treatment for patients in crisis who are positive for the coronavirus. Many large health systems are currently admitting patients that present to their emergency department in a psychiatric crisis positive for the coronavirus to their med-surg floor and providing psychiatric treatment to the patient through their psychiatric consult and liaison team. However, rural and mid-sized hospitals typically don’t have a psychiatric team available to provide treatment to mental health patients admitted to their med-surg floor, and the larger urban hospitals are unlikely to accept the patients for a medical transfer.

Key challenges

#1: Hospitals have limited options for transferring a patient who presents to their emergency department in a psychiatric crisis that is positive or has symptoms of the coronavirus and often have to make the decision to admit the patient to a medical unit or discharge the patient to the community.

#2: Behavioral health patients in crisis who are positive for the coronavirus have limited access to needed crisis mental health treatment and services.

#3: If discharged home, patients in a psychiatric crisis who are positive for the coronavirus present increased public health concerns for spreading it. This is especially a concern for patients with symptoms that interfere with their ability to follow quarantine instructions.

In order to effectively manage the complexity of this challenge, key steps are recommended to reduce risk, increase access to treatment and improve operational efficiency within the healthcare and public health systems.

Key recommendations

Recommendation #1: Regional and State-Wide Emergency Response Teams are recommended to develop a coordinated response for all health systems in the region in response to patients who present in a behavioral health crisis who are positive with or suspected of having the coronavirus.

Recommendation #2: Identify specific units/beds that are allocated in acute hospitals, behavioral health hospitals or treatment centers that are dedicated for patients in a behavioral health crisis who are coronavirus positive.

Recommendation #3: Use telehealth platforms as needed to provide mental health treatment for patients presenting in a psychiatry crisis admitted to a med-surg floor due the coronavirus if on-site mental health professionals aren’t available.

Recommendation #4: Use a proven digital solution to route patients and coordinate interfacility hospital transfers to hospitals and units identified to accept patients in a behavioral health crisis who are positive for the coronavirus.

It’s critical for healthcare leaders, public health and emergency response teams coordinated through the regional or state government to develop a streamlined system of care to mitigate the spread of the coronavirus and provide easily accessible treatment for individuals presenting with a behavioral health crisis. There are significant risks to public health for the spread of the coronavirus and for unnecessary fatalities as a result of untreated mental health emergencies if a plan is not put in place to identify and coordinate services for patients presenting in a psychiatric crisis who are positive for the coronavirus. Creating a collaborative model using evidence-based clinical care, digital solutions and a streamlined systematic approach will reduce risk to the community for the spread of the coronavirus and fatalities from both the coronavirus and psychiatric emergencies.

Shana Palmieri is a licensed clinical social worker and co-founder & CCO at XFERALL Patient Transfer Network.

 

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