Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Amidst the COVID-19 crisis, we must not neglect the needs of those with mental illness

Michael Ziffra, MD
Conditions
April 17, 2020
2K Shares
Share
Tweet
Share

“I’m in a constant state of fear.”

“I have nothing to look forward to now.”

“I don’t know when my life will go back to normal.”

As a psychiatrist practicing in a busy urban academic medical center, I have started to see the toll that the COVID-19 pandemic has taken on individuals’ mental health. Although some patients primarily worry about the virus itself, I have been more struck by the emotional distress associated with the shelter-in-place orders that have been enacted throughout much of the nation. With the potential for a “quarantine” to last many more weeks, if not months, we face the prospect of tackling a mental health crisis in addition to taming the coronavirus.

Few medical professionals question the necessity of social distancing and shelter-in-place orders to reduce the spread of the coronavirus and prevent hospitals from being overwhelmed. There has been comparatively less discussion of how prolonged social isolation will impact individuals’ emotional health. As much of the medical world rightly focuses on those with COVID-19 and those at risk for the infection, there is the potential for other patient populations to be overlooked.

Human beings are social creatures. Lack of regular human contact can be psychologically devastating. Those who experience significant social isolation are at greater risk for depression, anxiety, suicide, addictions, and a host of other mental health issues. For many, the injurious effects of social isolation will be exacerbated by other consequences of the pandemic, such as job insecurity and economic distress.

Despite the abundance of humorous memes about how some are using the “quarantine” to indulge in binge-watching and comfort food, many people are finding the experience anything but pleasant. Many are demoralized and frightened about the possibility of having minimal face-to-face social contact for months on end.

Depression and anxiety are two common reactions to catastrophic events, such as the COVID-19 pandemic. In this current crisis, depression, in many ways, represents a bereavement process. People are grieving the loss of things big (college graduation, family vacation, wedding) and small (happy hour, basketball games, trips to the mall) that now will never be or will not happen for a long time. For some, their outlook will become darker, believing that nothing good is happening in their life, or that there is nothing positive to look forward to.

Anxiety is often associated with uncertainty, and those more prone to anxiety have a greater intolerance of uncertainty. Very few individuals have experienced a situation more uncertain than this pandemic. Countless patients have told me that they can endure living in isolation for a few weeks, but they dread the prospect of being in a “lockdown” for months. There is palpable fear that life will not return to “normal” anytime soon, or that it will never do so at all.

At times I have been amazed by how some of my sickest patients have accepted this situation with grace, resilience, and humor. But I increasingly fear how patients with mental illness will cope with a “quarantine” that lasts into the latter half of 2020. Even the healthiest of individuals will find it difficult to tolerate social isolation for months on end. Those with mental illness will likely fare much worse.

Just as more of our patients are at increased risk for psychological problems, psychiatrists and other mental health treaters are impaired in our ability to optimally care for our patients. To minimize the risk of infection for both our patients and us, many psychiatrists have been conducting appointments via telemedicine — i.e., meeting with our patients via phone call or video call. We are fortunate that modern technology enables this, and patients are grateful for any means of maintaining contact with us. That said, no technology replaces face-to-face interaction, and much is lost when in-person interactions are translated to video. All patients value “in the flesh” meetings with their physicians, and this is even more true for patients with mental illness. Patients cherish these face-to-face contacts. Sadly, now they are much less available when patients need them most.

Other aspects of shelter-in-place orders impede physicians’ ability to effectively treat our patients with anxiety, depression, and similar ailments. A mainstay of managing mental illness is the use of behavioral interventions – changing the day-to-day habits and routines that shape our thoughts and feelings. Ironically, the types of behavioral interventions we consistently recommend to patients with mental illness — getting out of the home, exercising regularly, being socially active, planning pleasurable activities – are things that shelter-in-place orders forbid or make very difficult.

While premature relaxation of social distancing rules would be irresponsible, public health leaders must also explore how prolonged social isolation will imperil those with mental illness. Although a shelter-in-place policy lasting into the late summer or even autumn would undoubtedly reduce the spread of COVID-19, will it be worth the costs borne by those with mental illness? It is admittedly a challenge to weigh the varying needs of different patient populations, and no solution will be perfect. But the impact of these decisions on those with mental illness cannot be omitted from these discussions.

As the nation debates how to optimally manage COVID-19, there are things we can do now to protect our own and others’ mental health, both on an individual level and a societal level. Now more than ever, it is critical for all of us to stay in close contact with friends, family, and other social supports. For those with friends or family who are struggling emotionally, proactively reaching out to them can literally be a lifesaver.

While our government is devoting many resources to fighting the coronavirus, it must also commit to providing sufficient funding for mental health care.

This is true both now and going forward, as many psychiatric ailments that begin during the pandemic will persist as COVID-19 subsides. The government must ensure that health insurance companies cover mental health issues the same as they cover all other medical problems. This still does not happen consistently, despite mental health parity laws on the books. Despite its imperfections, telemedicine has been a lifeline for patients during this pandemic, and new regulations can help guarantee that health insurance companies pay for telemedicine visits.

The COVID-19 pandemic will be not one health care crisis, but many crises are occurring simultaneously. Our choices in the coming weeks and months will determine whether a surge in mental illness will be one of these crises.

Michael Ziffra is a psychiatrist.

Image credit: Shutterstock.com

Prev

Nurses are not getting the protection they need and no one seems to care

April 17, 2020 Kevin 1
…
Next

The individuals who inspire this resident physician in COVID-19 era

April 17, 2020 Kevin 0
…

Tagged as: COVID, Infectious Disease, Psychiatry

Post navigation

< Previous Post
Nurses are not getting the protection they need and no one seems to care
Next Post >
The individuals who inspire this resident physician in COVID-19 era

Related Posts

  • Forgetting mental health is a miss for the Biden COVID-19 task force

    Jennifer Piel, MD, JD
  • COVID-19 misinformation is a public health crisis

    Jacob Uskavitch
  • How to get patients vaccinated against COVID-19 [PODCAST]

    The Podcast by KevinMD
  • COVID-19 divides and conquers

    Michele Luckenbaugh
  • State sanctioned executions in the age of COVID-19

    Kasey Johnson, DO
  • A patient’s COVID-19 reflections

    Michele Luckenbaugh

More in Conditions

  • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

    Harvey Max Chochinov, MD, PhD
  • Proposed USPSTF guideline update: Advocating for earlier breast cancer screening at age 40

    Hoag Memorial Hospital Presbyterian
  • The rising threat of lung cancer in Asian American female nonsmokers

    Alice S. Y. Lee, MD
  • Urgent innovation needed to address growing mental health crisis among children and families

    Monika Roots, MD
  • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

    Cheryl Lazarus
  • The unjust reality of racial disparities in pediatric kidney transplants

    Lien Morcate
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • VA Doc Fired; Brain Inflammation and Mental Health; In Debt and Cut Off From Care
  • FGFR Inhibitor Stakes Claim to Post-Anti-PD-1 Role in Advanced Bladder Cancer
  • Multimorbidity Patterns and Healthcare Utilization in Vets With Schizophrenia
  • Checkpoint Blockade Stumbles in Advanced EGFR-Mutant NSCLC
  • Secret Past of Slain Doctor; Pope Needs Intestinal Surgery; More MIs on Mondays

Meeting Coverage

  • FGFR Inhibitor Stakes Claim to Post-Anti-PD-1 Role in Advanced Bladder Cancer
  • Multimorbidity Patterns and Healthcare Utilization in Vets With Schizophrenia
  • Checkpoint Blockade Stumbles in Advanced EGFR-Mutant NSCLC
  • Phase II Study: Bispecific Oral Drug Tops Leading JAK Inhibitor for RA
  • Closing the Diversity Gaps in Urologic Oncology Leadership
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...