Americans seek urgent mental health support as Covid-19 crisis recedes


PITTSBURGH – Before the coronavirus pandemic set in, psychiatrist Garrett Sparks typically treated a dozen patients on his night shift in the emergency department at Western Psychiatric Hospital, this city’s largest mental health hospital. On a recent Thursday night, he saw 21 cases.

As the night began, a restless man sitting on a couch in an acute area loudly called for turkey sandwiches. Parents of a 7-year-old who had been kicked out of school for emotional outbursts came out, claiming their child’s behavior was skyrocketing and becoming more aggressive. A few hours later, police called in a 17-year-old boy who had attempted suicide by jumping off a bridge.

“It seems like everyone has been holding their breath for a year, and now it’s just a total blast of everything, both in terms of the high volume but also the severity of the cases,” Dr Sparks said. “You see a lot more people who were, before the pandemic, a little overwhelmed and stressed, and now they have anxiety disorders or depression.”

In the coronavirus pandemic, a wave of mental health crises turned into a tsunami, inundating an already taxed healthcare system. As the country appears to be emerging from the worst of the Covid-19 crisis, emergency services say they are overwhelmed by patients who have delayed or have not been able to access outpatient care, or whose symptoms have worsened or no ‘were not diagnosed during the closures.

UPMC West Psychiatric Hospital, center; emergency departments are inundated with patients who have postponed treatment or have not been diagnosed during Covid-19 lockdowns.

Doctors say it could be years before we see the full impact of the pandemic on mental health, but a multitude of studies indicate how strained the system has become. Emergency visits for patients seeking help for overdoses and suicide attempts increased by 36% and 26% respectively between mid-March and mid-October of last year, announced in March. the United States Government Accountability Office. And surveys by the U.S. Centers for Disease Control and Prevention found that 38% of those surveyed reported symptoms of anxiety or depression between April of last year and February, up from around 11% in 2019.

Children were particularly affected. School closures have allowed serious mental health issues to go unnoticed, as teachers and school psychologists are the main source of referrals, doctors say. Even before the pandemic, the country faced a shortage of mental health professionals to serve minors; last year, the American Academy of Pediatrics estimated the need for child psychiatrists at 47 per 100,000 people, about four times the number in practice.

Emergency room visits for mental health crises among 12- to 17-year-olds increased by 31% between 2019 and 2020, the CDC reported in June. Within the same group, emergency room visits for suspected suicide attempts increased 22% last summer from the previous year and 39% last winter from the previous winter.

At the University of Pittsburgh Medical Center, which includes Western Psychiatry, the volume of outpatient pediatric patients increased by 30% in the first four months of 2021 from the previous year.

“We have more children waiting for care than ever before,” said Abigail Schlesinger, head of the hospital’s child and adolescent psychiatry department. “We are in the emergency mental health phase of this pandemic.”

Dr Abigail Schlesinger, Chief of Child and Adolescent Psychiatry at UPMC Western Psychiatric Hospital and Pittsburgh Children’s Hospital, said: “We are in the emergency phase of mental health of this pandemic “.

Mental health crisis cases are found in greater numbers in emergency rooms, in part because outpatient care facilities, including private psychiatric offices, therapy practices and crisis centers, are overcrowded. patients whose mental health problems worsened during the pandemic, doctors and hospitals say administrators.

“For us, these are certainly many people who either suffered from pre-existing conditions or who neglected to treat their new emotional imbalance,” said Damir Huremovic, psychiatrist at North Shore University Hospital on Long Island. “A lot of people developed anxiety or sleeplessness, and they tried to see a provider but no one was taking new patients, and then things snowballed.”

For patients with depression, anxiety, or eating disorders, doctors recommend getting out of the house, seeing people and establishing a normal routine, said Jeanne Noble, an emergency physician at the University. from California to San Francisco.

“This is exactly the opposite of what happened with school closings and closures,” said Dr Noble.

Alyssa Bauman, left, and Iren Evans, mobile crisis clinicians leaving Resolve Crisis Services; clinicians work in pairs to provide face-to-face support to people in urgent and serious need.

On a recent afternoon in the economically depressed Homewood neighborhood of Pittsburgh, clinicians wearing headsets used phones in a room resembling a call center at Resolve Crisis Services, a mental health crisis center serving Allegheny County, with a population of 1.2 million, including Pittsburgh.

Phones were ringing regularly: a woman said her neighbor had swallowed several Xanax pills and was in the middle of the road shouting death threats; a mother and father called to say their 23-year-old, who has struggled with drug addiction, repeatedly unwrapped moving boxes and became aggressive; a 33-year-old man heard voices telling him to kill himself.

Over the past six months, Resolve has handled hundreds of phone calls per day. Up to 50 of them are severe enough to require a home visit by trained clinicians, two to three times the level of two years ago, said Jack Rozel, a psychiatrist and lawyer who has run the center since. a decade.

The overall volume of Resolve from January to April was up 27% from the period a year earlier, according to UPMC, which administers the program.

“In clinics that could get people in in a matter of days, it now takes a few weeks or a few months,” said Dr Rozel. The past year has “shattered all paradigms” on how to deal with mental health cases in the community, he added.

“Isolation is the dominant theme,” said Jeff McFadden, a telephone crisis clinician at the center who says the call volume is the highest he has seen in his 13 years at Resolve. “That’s it, from ‘I’m alone’ or ‘My girlfriend broke up with me’ to ‘I have a gun right next to me, give me a reason to live’… There’s this perfect storm. where people feel trapped in their own homes and alone. We see it more and more. “

Dr Garrett Sparks, Assistant Medical Director of Child and Adolescent Inpatient Services at UPMC Western Psychiatric Hospital, relaxes at home after a night shift.

At Western Psychiatric, Dr. Sparks finished his shift at 7 a.m. “It’s one of those nights when every case is complicated,” he said. For some, the family was inaccessible. Others had been uncooperative or needed care and support that he could not provide.

At sunrise, Dr Sparks returned home to walk his dogs and chat with his wife before she left to work as a lawyer. After most of his night shifts, he sleeps during the day, a routine that has earned him the nickname “Emergency Vampire.”

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The pandemic has also taken its toll on mental health care providers. In his spare time, Dr. Sparks trains for marathons, listens to audiobooks, and sees a therapist to deal with his own long-standing depression. Over the past few months, he says, his shifts have left him feeling exhausted and hazy.

“You can’t take that much when you’re sleep deprived, exhausted, and juggling other people’s problems like burning balls for so many nights in a row,” he said.

Write to Robbie Whelan at [email protected]

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