Caitlin, Psychiatry PA on the frontlines of COVID-19

Frontline PAs
Written By Anne
 

Caitlin graduated the McMaster PA program in 2013 and began working at Ontario Shores Centre for Mental Health Sciences upon graduation and have been there since. She works on two inpatient general psychiatry wards with four supervising psychiatrists.

The hospital services individuals with complex mental health challenges, with a large portion of patients having a treatment-resistant psychotic illness. Ontario Shores is also a teaching hospital, Caitlin usually take a handful of PA students each year for their psychiatry rotation.

Outside of teaching and clinical roles, I am involved in various working groups aimed to improve adherence to quality standards and developing bundled care models for the treatment of mental illness.

 

April 2020 - The onset of the COVID-19 pandemic has led to drastic changes in the way mental health clinicians are able to safely care for and support individuals with severe or persistent mental illness; individuals who are exceptionally vulnerable in our “usual” world, let alone during a pandemic.

Statistics show that individuals living with persistent and severe mental illness have higher co-morbidities of various physical illnesses, such as heart disease and diabetes.

Furthermore, some of the psychotropic medications we use to alleviate the symptoms of mental illness have effects on the immune system which places these individuals at a higher risk of developing infections.

All of these factors culminate in our patients being at a significantly higher risk for poorer outcomes if they were to become ill with something like COVID-19.

In addition, the patients that we service do not have access to the luxuries that allow many of us to self-isolate and physically distance ourselves.

Challenges for Patients during COVID-19

Individuals with persistent and severe mental illness are often living at a low socioeconomic status, with very limited financial resources.  Most of our patients don’t have enough money for food on a daily basis and rely on soup kitchens and food banks, many of which have now closed.  Many of our patients cannot afford a car and therefore rely on public transportation which also increases their risk of exposure to the virus.

Furthermore, due to lack of supportive community housing, many of our patients are forced to live in private group homes with more than one person per bedroom, further limiting their ability to self isolate and increasing the risk for virus transmission.

Mitigating Risks for Psych Patient Admissions

In the inpatient world, like in other hospitals, our policies and plans are being updated on a daily basis.  We continue to admit patients from the community and accept transfers from general hospitals which poses a risk of bringing the virus into our hospital.

If we were to get a COVID-19 positive patient, it would spread very quickly because of the structural challenges which limits our ability to properly isolate a patient (unlike general hospitals, we don’t have bathrooms in each room).

In an effort to try to mitigate this risk, I have been involved in planning meetings to ensure an admission process that would improve our ability to isolate patients, ways to minimize staff shortages and how to safely manage acutely unwell patients who have symptoms that significantly impact their ability to engage in physical distancing and appropriate hygiene practices.

Hospital Changes in response to COVID-19

The way our hospital functions has also changed drastically. We are no longer allowing visitors, and patients are no longer allowed to leave the wards.

Many staff who can work offsite have switched to working from home. We’ve created a new admitting unit and are preparing another unit for COVID-19-positive cases (when they arrive).

Most of the programming available to our patients has ceased and staff on the wards are doing their best to come up with activities to prevent boredom.

Discharge planning has become increasingly more difficult as many outpatient clinics and services are closed or running at reduced hours and homes are not accepting new tenants.

While some clinics have moved to virtual appointments, many of our patients are unable to utilize these platforms as they don’t have access to the technology required for them.

How my PA Role has changed in response to COVID-19

My role and work have also changed in response to the pandemic.  Prior to the pandemic, I worked on multiple units with several physicians with a particular case load.  In an effort to cohort staff and lower the risk of transmission of the virus if it were to get here, I am now working only on one unit with one Psychiatrist who also works offsite some days. When the Psychiatrist is not on site, I am responsible for providing care to a total of 27 patients, 5 of which are patients in our Psychiatric Intensive Care Unit.

Despite these changes and challenges, I am very fortunate to work with an incredible interprofessional team.  They are all wonderful friends and extremely compassionate and caring clinicians who work tirelessly to care for and ensure the safety of our patients and each other.  Seeing the camaraderie and dedication amongst my colleagues makes coming to work in these difficult times much easier.

Moving Forward

When the pandemic resolves, some are projecting an increase in the number of individuals who will be seeking psychiatric services. Unless there is an increase in funding for psychiatric services, this has the potential to further slow down an already clogged system and will force people to wait for desperately needed (and sometimes life saving) psychiatric services and support.

I think that Physician Assistants could be of great value in helping to provide these services and hope to see a greater uptake of them working in mental health.

Final Notes

Lastly, if you are struggling with feeling anxious and overwhelmed in these difficult times, know that you are not alone.

While physical distancing is more important than ever, staying socially connected with friends and family is too.  Reach out to those who are important to you, to check in or to ask for help.  I also encourage you to access the various resources available to help you to cope in these difficult times.

The website https://mentalhealthcovid19.ca/ provides a thorough summary of coping strategies and available mental health resources dedicated to helping individuals cope during this pandemic.

 

Mental Health resources during COVID-19

Virtual Counselling (Telemedicine)

Crisis Services

Addictions

Domestic Abuse/Violence 

Anne

I am a Canadian trained and certified Physician Assistant working in Orthopaedic Surgery. I founded the Canadian PA blog as a way to raise awareness about the role and impact on the health care system.

http://canadianpa.ca
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