Redefining the role of psychiatrists in the time of COVID-19

The unparalleled and pervasive nature of the evolving COVID-19 pandemic has touched all of us in some way. There is limited, albeit growing, research on the mental health effects of disasters.  A recent review article pointed out the potentially negative consequences of prolonged quarantine, while other research from Wuhan, China, highlighted the impact of COVID-19, particularly amongst healthcare personnel. Psychiatrists and mental health professionals will play a critical role in the aftermath of the pandemic, but this requires a shift in perception of who a psychiatrist is and what they have to offer:

1. We are physicians first. Psychiatrists are medical doctors that following medical school, complete four years of psychiatric residency. While we evaluate, diagnose, and treat mental disorders, we also have a background in general medicine that extends beyond a prescription pad. Psychiatrists continue to use their medical skills and knowledge, more broadly in the where medicine and mental health intersect: emergency psychiatry, consultation-liaison psychiatry, addiction psychiatry, and geriatric psychiatry. We can be called to the front-lines to be in service, if needed, while also offering psychiatric consultation to other physicians and medical professionals, emergency personnel, families, government entities, the legal system, and the media. 

2. We understand human behavior. We have witnessed people stock up and ration toilet paper and celebrate spring break on crowded beaches. While it is difficult to see these images, as a psychiatrist, I can understand this behavior because it stems from common beliefs and feelings about COVID-19 based on misinformation and lack of clear and consistent guidance. Denial and irrational beliefs or actions are a byproduct of this. Yet, in making sense of such behavior, psychiatrists can both educate and promote interventions that foster behavioral change. 

 3. We can distinguish between normal and unhealthy responses to pandemic-related distress. As I write this, “coronavirus anxiety” is a trending search term on Google. Physically, anxiety at its worst – a panic attack — can feel like an asthma attack:  hard to catch your breath, chest pain, fear of dying. This can be confused for the common symptoms of respiratory distress in COVID-19, adding more distress and confusion, which could be relieved by knowledge of what anxiety normally looks and feels like. This again underlines the role of psychiatrists as educators on mental health conditions.  Psychiatrists also are experts in the diagnosis and treatment of post-traumatic stress disorder (PTSD) and depression, the two most commonly diagnosed mental disorders following a disaster, and can provide knowledge about the signs and symptoms of each and suggests points of intervention.

4. We have a unique skill set. Psychiatrists are trained to recognize and intervene on mental illness, but we also seek to both identify and bolster the strengths in character and resilience in those we treat. This is fostered by our background in various modalities of psychotherapy (such as supportive, cognitive behavioral therapy, and interpersonal therapy). The good news is most people who are faced with traumatic situations or disasters fully recover psychologically, and psychiatrists can serve as a reminder that we all have the inner reserve to eventually get back to who we were before COVID-19. 

Chinenye Onyemaechi is a psychiatrist.

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