Jerry McKee, PharmD, MS, BCPP
CEO of Psychopharm Solutions LLC
Morganton, NC
Psychiatric Pharmacy Specialist Member, BPS Board of Directors
May is Mental Health Month in the United States and at this moment, we are faced with the most significant healthcare threat in decade, that of the COVID-19 pandemic. How are these two topics related? The COVID-19 pandemic isn’t affecting just physical health but is having a significant impact on mental health as well. Several studies following the SARS outbreak revealed that post-traumatic stress disorder and depressive disorders were prevalent long-term psychological conditions. In a similar vein, a recent web-based study involving over 7000 participants in China during the current pandemic found that one in three participants had symptoms of an anxiety disorder, whereas one in five participants had depressive symptoms and sleep quality issues. Consider also that, prior to the pandemic, there were national concerns regarding increases in suicides and substance use disorder deaths- referred to as “deaths of despair”. If our past experience with traumatic events is predictive, we can expect suicides and substance use disorder morbidity and mortality to increase with the current crisis. These situations may be expected to escalate due to the pandemic itself, to unemployment, and the social isolation required to manage the pandemic. Whole-person care has been the watchword of psychiatry and primary care for over a decade and now, more than ever, this is true as we attempt to manage the most serious threat to our national health and well-being in our lifetime.
The coronavirus can significantly affect mental health for everyone, but especially for those with pre-existing mental illness or substance use disorder. Both the anxiety of contracting the disease as well as the increase in loneliness and isolation can worsen and trigger symptoms. For those without pre-existing mental health disorders, anxiety, obsessions around disease prevention and possible contamination, and loneliness due to social distancing and isolation may contribute to a depressive episode.
Individuals who have been quarantined , as well as healthcare providers and others on the front lines of healthcare and commerce may experience traumatic stress. High rates of trauma may be seen in healthcare personnel due to exhaustion, fear, feeling out of control regarding being able to help their patients get well, and lack of adequate PPE. These individuals may also have concerns regarding their own health as well as the risk of infecting their families. Consider also that decisions are difficult, with increasing likelihood that physicians may be faced with life or death decisions in times of limited resources. Giving our healthcare providers and caregivers the equipment and support they need to avoid being in this type of scenario is essential.
What Can We Do to Make Difference?
Ambulatory care and community-based pharmacists, due to accessibility, are in a position to have a significant impact in screening for mental health problems and substance use disorders and acting in this regard is especially critical at this juncture. Board certified pharmacists, looked upon as clinical and policy setting leaders both locally and nationally, must advocate for these screenings (and referrals as appropriate) to become a standard of care in community pharmacies and ambulatory care clinics, that is reimbursed. In a less clinical domain, we should also remind ourselves, our patients, families and colleagues that eventually this will come to an end. It’s important for all of us to keep that light at the end of the tunnel (hope) in sight. Keep in mind that stigma may confer additional risk for persons with mental health and substance use disorders. Why is this especially important now? If hospitals and clinics are pushed to their capacity, it could be that people with mental illness and substance use disorder, who are already stigmatized and underserved by the healthcare system, will experience access issues and other barriers to treatment for COVID-19.
For those already in mental health or SUD treatment, encourage them to take medicine as prescribed. For those who are not yet in treatment, but who screen positive for anxiety, depression, or SUD, encourage them to seek treatment. For everyone, sticking to a regular routine or adopting one can help create structure for those who lack it. Exercise, a walk outside, or just stretching or meditating at home can all be effective strategies and can be done while maintaining social distancing practices. For healthcare workers on the front lines, we need to give them as much support and appreciation as we can. Anything we can do to shore up their mental wellbeing is worthwhile.
Stay connected with friends and family virtually, especially those who may be isolated. Social connectedness is critically important to warding off loneliness and resulting depression. It’s essential to make your health a priority during this time. Self-care activities such as sleep, physical exercise and a healthy diet can be effective in reducing stress.
Maintaining a sense of normality and routine can also reduce stress. Identifying activities that distract you from current events can be helpful. Reading, connecting with friends and colleagues virtually, movies, television, arts/crafts are just some examples of such activities.
Silver Lining for Pharmacy?
Winston Churchill is alleged to have once said “Never let a serious crisis go to waste”. In that regard, pharmacy personnel have been deemed to be essential workers during the COVID-19 crisis, a fact that we already knew, however the national platform that pharmacy has been handed due to the pandemic can be useful for educating the public and other healthcare colleagues of the importance of pharmacy and pharmacist access at all times, but in particular during a crisis. Further, with almost every community having access to a pharmacist, we are the most accessible and available healthcare professionals and the entry point into the healthcare system and must be empowered to use their training and be reimbursed to provide care. There are already positive movements. Recently, the Office of the Assistant Secretary of Health at the U.S. Department of Health and Human Services (HHS) issued guidance authorizing licensed pharmacists to order and administer FDA-authorized COVID-19 tests, including serology tests. Pharmacists, using appropriate procedures and PPE, can be a critical resource for screening as the United States considers strategies for returning to work. Many organizations have been working tirelessly for many years to have Congress recognize pharmacists as health care providers. The current contagion crisis may intensify the focus on pharmacy to get this mission accomplished to help bring this crisis under control and save lives.