Behavioral Health Impacts of COVID

At the peak of the pandemic in 2020, while healthcare providers at Sentara RMH were dealing with the physical impacts of COVID-19, the hospital’s behavioral health providers were giving care to those struggling with its impacts on mental health, due to the prolonged need for isolation from friends, family and neighbors. 

Today, as the pandemic recedes and the numbers of those physically sickened by COVID continue to drop, the same cannot be said, unfortunately, of those dealing with the pandemic’s resulting mental health concerns.

According to Luanne Bender Long, PhD, LPC, clinical manager of Outpatient Behavioral Health at Sentara RMH, statistics have revealed pandemic-related increases in depression, anxiety and substance abuse due to mandatory social isolation. 

“Research showed there was a 100% increase in mental health concerns, including suicide ideation, anxiety, depression, obsessive-compulsive disorder and substance abuse,” she explains.

While this increase may be alarming, many people are seeking and receiving help for their issues, according to Tena Bibb, MSN, RN, director of Behavioral Health Services at Sentara RMH. She wants the community to know that Sentara RMH can offer them the help they need through a full continuum of care that includes inpatient services, as well as a wide variety of outpatient programs and counseling services. 

“Sentara RMH Behavioral Health Services is committed to addressing the mental health needs of the community,” Bibb emphasizes. “We will always explore ways to overcome barriers—COVID or whatever else may come—to meet our clients where they are.”

Bibb noted that many patients whose mental health had been stable for years became destabilized not only by the isolation and loneliness that came with COVID, but also by the disruption of the routines that had given them a sense of control over their lives. 

Likewise, many alcohol and substance abusers who had been substance-free for a long time experienced difficulties due to isolation and a loss of contact with their support systems. 

In addition, behavioral health providers began seeing a surge of new patients struggling with alcohol and substance abuse brought on by various factors related to COVID. 

Throughout the pandemic, Behavioral Health Services offered virtual counseling and therapy sessions, but not everyone had access to or felt comfortable with the online format. 

“We offer outpatient services, individual counseling sessions, partial hospitalization programs and an intensive outpatient program for substance abuse—all of which are now back up and running at full speed,” Bibb says.

Often, she adds, behavioral health care begins when a patient comes to the Emergency Department, where he or she sees a member of the Psychiatric Emergency Team (PET). “We’re now seeing a lot of the effects of social isolation and loneliness,” says Bibb. “People were fearful during the pandemic and often would not seek services until their needs became critical. At that point, many people came to the Emergency Department, where they were seen virtually by members of our PET. Once a patient is assessed and admitted to our inpatient unit, we can get them stabilized, then create a comprehensive plan for them to follow upon discharge.”

That discharge plan, which is up to the patient to follow, may include contacting Behavioral Health Services for medication follow-up, participation in an outpatient behavioral health program, or counseling services through Sentara RMH or other community resources. Importantly, now that COVID restrictions have eased, these patients are able to once again reach out to their “safety nets”—families, neighbors and community members—for additional support.

COVID Brought Change

When the COVID lockdown mandates first began in March 2020, Behavioral Health, like other departments at the hospital, had to make a number of changes to provide services safely. Suspending services at such a critical time was definitely not an option.

“It didn’t seem right to discontinue mental health services, especially when depression, anxiety and substance abuse were increasing as the pandemic progressed,” says Long. 

Bibb adds that COVID protocols affected a number of aspects of behavioral health care—everything from patient assessments in the Emergency Department to inpatient unit operations and the delivery of outpatient services. “We did everything we could to give patients a face-to-face experience, since we were not able to offer in-person sessions with counselors and physicians,” she says. “To improve access, we started doing PET assessments and inpatient therapy via telehealth and Zoom, and we began to offer sessions by telephone.” 

For most of the counseling staff and psychiatric team, the client load increased many times over.

“We’ve seen an increase in anxiety and depression,” says Danita Adamson, manager of Outpatient Behavioral Health Specialists. “Isolation has taken its toll on everyone—existing patients and new referrals are all dealing with it.”

For Sentara RMH mental health providers like Syed “Ali” Rizvi, MD, the pandemic’s impact on his existing patients was clear. 

Many patients receiving psychiatric treatment for any of a variety of conditions—such as bipolar disorder, schizophrenia, depression, mood disorders, anxiety, panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders and attention deficit disorders—struggled with the impacts of the pandemic.

“COVID stress worsened their symptoms,” Dr. Rizvi says.

Counseling to Address Feelings of Loss

Since the onset of the pandemic, behavioral health counselors at Sentara RMH have been dealing with another troubling response to COVID-19, known as disenfranchised grief. 

Also referred to as hidden grief or sorrow, this term refers to any type of grief that goes unacknowledged or unvalidated by society. Often minimized or misunderstood by others, disenfranchised grief can be particularly hard to process and work through.

“Nancy Shomo, our certified grief counselor, says disenfranchised grief occurs when we lose something: the death of a goal or a future hope—any type of expectation,” Long notes. “COVID-19 stripped us of life the way we expected it to be, so many of us were basically stuck in a state of disenfranchised grief because we didn’t know when the pandemic was going to end.” 

It’s the ambiguity surrounding the pandemic that seems to be the most stressful factor for many people, according to Long. “On top of dealing with job losses and kids who were not able to attend school in person, people have been confused by mixed messages in the media about issues like masks and vaccine effectiveness,” she observes. “Everyone just wants to know when the pandemic will be over and when they can resume their normal lives.”

“We’ve been addressing so much of that kind of loss,” Long continues. “We’re trying to work with people around the ambiguity, but some people do not do well with not knowing.” 

Getting Services Back to Normal

Behavioral Health services at Sentara RMH are now largely back to normal operations, Bibb notes. 

The PET team in the Emergency Department, which processes 40% of inpatient behavioral health admissions, is back to doing assessments face to face, rather than by Zoom. 

“There is something to be said for having the individual in the room with you,” Bibb says. “When doing telehealth assessments, you may not see an individual’s body language or certain facial expressions, and you might miss pertinent information for individuals seeking behavioral health services.” 

The Inpatient Behavioral Health Unit is once again offering family sessions, its music therapy program and other face-to-face services. 

Outpatient Behavioral Health services are also back to full, in-person capacity. Although the department’s move from University Boulevard to Elizabeth Street in downtown Harrisonburg in August 2020 did temporarily interfere with the staff’s ability to schedule appointments, it also expanded the department’s capacity.

“The move made it safer for patients, in terms of COVID, and also gave us room to grow,” Adamson says. “The new location is a welcoming, clean space with lots of natural light.”

With the full array of behavioral health services available in the community, no one needs to suffer alone, Bibb stresses. 

“There are plenty of support resources out there for patients in need,” she says. “And as a community, as we move from isolation and loneliness back to normal after COVID, there is great reason for hope for better times ahead.”

Addressing Mental Wellness for Staff During COVID

Sentara has long had an Employee Assistance Program (EAP) to help employees and their families deal with mental health concerns. Under the program, staff members can schedule individual appointments—virtual or in person—with outpatient therapists. 

Recognizing the unique challenges staff faced in caring for COVID patients, as well as dealing with the pandemic’s impact on team members’own families, counselors reached out to fellow employees—particularly during the most intense time of the pandemic.

“For six weeks starting in June 2020, we collaborated with the Psychiatric Emergency Team and Inpatient Behavioral Health and had someone available to meet face to face with hospital employees from 7 a.m. to 7 p.m., Monday through Friday, and on call over the weekend,” says Luanne Bender Long, PhD, LPC, clinical manager of Outpatient Behavioral Health at Sentara RMH. “My director, Tena Bibb, and I visited several departments to check in on employees and introduce what we were doing.” Those departments included the Emergency Department, Critical Care Unit, nursing units providing dedicated COVID care, and other clinical and nonclinical support areas. 

Long notes that weekly articles written by an outpatient therapist on COVID-related topics, such as stress and working, parenting, self-care, and the like, were also made available to employees. In addition, team members received weekly COVID updates from Donna Hahn, chief nursing executive, that included reminders about how to access EAP services.

Comprehensive Behavioral Health Services

The Sentara RMH Behavioral Health inpatient unit works diligently to stabilize patients and then to discharge them with a comprehensive plan, based on the expertise of the Outpatient Behavioral Health Services team. This team includes experts in the following areas:

  • Counseling for individuals of all needs 
  • Testing and assessment
  • Partial hospitalization programs
  • Intensive outpatient and life-recovery programs 
  • Bereavement services 

Family counseling and couples counseling are also offered, along with the Employee Assistance Program for Sentara RMH employees and their families. 

For more information about Sentara RMH Outpatient Behavioral Health Services, call 540-564-5104. To reach Sentara RMH Behavioral Health Specialists, call 540-564-5100. If you or a loved one is in crisis, call 540-434-1766, or contact the National Suicide Hotline at 800-273-8255. 

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Dr. da Vinci