With in-person therapy limited, mental health care providers struggle to reach vulnerable patients
By Julia Raimondi and Riley Blake
Austin Sweigart was discharged from inpatient treatment at Virginia Commonwealth University Medical Center’s psychiatric ward in mid-March, days before the statewide stay-at-home order took effect.
Sweigart, a 29-year-old event planner and gay rights activist in Richmond, has since struggled to find follow-up treatment, as therapists have limited hours and acceptance of new patients in the wake of the coronavirus pandemic. Sweigart, who uses they and them pronouns, has had to go to an urgent care facility for medication they normally get from their mental health care provider.
The pandemic has made getting mental health treatment “nearly impossible,” they said.
Sweigart is not alone.
Public and private mental health care providers in Virginia say they have been forced to change not only the ways they offer certain services to patients, but also whether they offer them at all. The virus has upended care across state facilities, which serve more than 200,000 Virginians every year.
These changes can have a profound effect on patients, many of whom no longer get face-to-face treatment from mental health professionals or group therapy sessions.
At the Richmond Behavioral Health Authority, the daily psychosocial group rehabilitation program has been shut-down since March. The program provided as many as 100 patients with regular therapy and structure through the recovery process.
While group treatments are cancelled, more therapy sessions have moved to video conferencing, which has its own challenges and shortfalls.
Clinicians and patients have been forced to adjust, said John Lindstrom, the authority’s chief executive officer.
“A lot of people who engaged in services face-to-face are having to adjust to having less support in place,” Lindstrom said. “There are certain challenges with [keeping] the level of engagement that we think is important to support the individual’s recovery.”
One challenge to recovery is the potential for substance abuse.
While heightened stress is a common reaction to the coronavirus pandemic, people with post-traumatic stress disorder or a history of substance abuse may see their anxieties worsen, according to the Substance Abuse and Mental Health Administration.
Lindstrom has not seen evidence of more patients abusing substances during the pandemic, though he expected some patients would. In anticipation, health professionals have been giving patients longer prescriptions to help prevent relapses.
“Rather than coming in once a week [for a prescription], they may be coming in once every two weeks,” he said. “By giving them longer dosing to take home, that hopefully reduces their exposure to risk for COVID-19 and yet provides them the medication they need.”
Protecting patients and staff
Mental health care providers have also been careful to ensure their staffs stay healthy.
The Virginia Department of Behavioral Health and Developmental Services runs eight mental health hospitals for adults, one mental health hospital for children and adolescents, two training centers, a medical center and a center for behavioral rehabilitation. The department treats approximately 1,300 inpatients and offers counseling and other services for another 213,000 Virginians every year.
The department instituted new procedures in March to keep its hospital staff and patients safe from the virus. But the new measures have not protected everyone.
By early June, 60 staff members at DBHDS facilities across the state had tested positive for the virus, including 31 active cases. At these facilities, 12 patients at these state facilities tested positive, including three active cases. Across the state, 377 behavioral and mental health care patients from community partners licensed by the DBHDS tested positive. Of those 377 patients, 25 patients have died.
All behavioral health and developmental services facilities have limited visits and enacted screening protocols for anyone entering the buildings, said department spokeswoman Meghan McGuire.
Staff and essential contractors at treatment centers are required to have their temperatures taken before entering the workplace. Anyone testing positive for the virus is required to self-quarantine.
Incoming patients from other facilities, including private ones, are also screened, McGuire said.
Visitors for adult inpatients are not allowed unless they are lawyers representing a client. Parents and guardians of children in psychiatric facilities are allowed to visit under limited circumstances.
“New visitation policies will limit virus exposure to patients, many of whom are immunocompromised or medically fragile,” McGuire said. “They also protect staff from contracting the virus.”
The department is also trying to lower the number of people in its facilities by offering more telehealth services. Patients ready to reintegrate into society are discharged as soon as possible, McGuire said.
Private providers, such as the Kempsville Center for Behavioral Health in Norfolk, have also adjusted operating procedures.
The Kempsville Center, which provides acute inpatient treatment for at-risk children, typically allows loved ones to visit twice a week for an hour at a time. The visitation program has been suspended and replaced with Zoom video calls, said Jaime Fernandez, the Kempsville Center’s chief executive officer. Patients also have additional daily phone time to contact their parents or guardians.
Kempsville Center screens each patient and staff member daily, and has eliminated large gatherings for group meals and free time.
Other mental health care providers around the state report similar restrictions on patient visits, and regular screening of essential staff. At VCU Medical Center in Richmond, staff in the psychiatric department have created private rooms for inpatients.
Lindstrom acknowledged the pandemic has made outpatient treatment more difficult. For example, state clinics have stopped offering walk-in services.
Now, potential patients must schedule an appointment and be screened for symptoms. Lindstrom estimated that 80-90 people per week typically used the walk-in service, but he said that number has dropped to about 40-50 during the pandemic.
‘I have no clue when I will be able to find care’
Virginia colleges and universities have also seen patients drop out of care as therapists switch to telephone and video sessions.
Patient numbers at Roanoke College in Salem have significantly declined. “A lot of students have therapists at home they see,” said Wesley Brusseau, associate director of student health and counseling at Roanoke College. “We’ve told them even if they aren’t in Virginia how to get connected, to call us if they need help.”
At Virginia Tech, the Cook Counseling Center has lost 57 percent of its patients since it switched to telehealth, said Dr. Ellie Sturgis, the interim director of the center.
Students in rural parts of the state can find it difficult to get treatment. Lack of internet access and cell phone service hinders remote counseling. At the same time, fewer mental health professionals are practicing in southwest Virginia.
“It’s the same problem we’ve always had here,” Sturgis said. “A lack of psychiatrists and psychologists.”
Meanwhile, many patients are preparing for an uncertain future. Sweigart, who operates a LGBTQIA+ consulting, event planning and training business, #GayAgenda, with their spouse, has had difficulty even getting in contact with outpatient care over the phone.
They’ve been able to get their medication from urgent care, but have found little other support. “I haven’t been able to get in with a psychiatrist,” Sweigart said. “I’ve had no follow up therapy.”
The possibility of a second wave of virus outbreaks, meanwhile, has them pessimistic about their chances of receiving treatment within the next year.
“I have no clue when I will be able to find care,” Sweigart said. “That could be my anxiety talking. But it could also be how the nature of the virus pans out.”
Emergency Mental Health Resources:
National Suicide Prevention Hotline: 1-800-273-TALK (8255)
Text “NAMI” to 741741 if you are having suicidal thoughts or urges.
A COLLABORATIVE PROJECT BY THE UNIVERSITY OF RICHMOND DEPARTMENT OF JOURNALISM AND THE VIRGINIA CENTER FOR INVESTIGATIVE JOURNALISM
UPDATE: This post has been edited to add more recent figures on COVID-19 infections at DBHDS facilities.