Psychiatrists Lean Hard On Teletherapy To Reach Isolated Patients In Emotional Pain

Psychiatrist Philip Muskin is quarantined at home in New York City because he's been feeling a little under the weather and doesn't want to expose anyone to whatever he has. But he continues to see his patients the only way he can: over the phone.

"I've been a psychiatrist for more than 40 years; I have never FaceTimed a patient in my entire career," says Muskin, who works at Columbia University Medical Center, treating outpatients in his clinical practice, as well as people who have been hospitalized. Normally, he says he walks patients to the door, shakes their hand or touches their arm or shoulder to reassure them. "Now I'm not doing that, and that's weird to me. So it's a whole new, very unpleasant world."

The pandemic has already robbed many of his patients of their livelihood, or at least their sense of safety. People literally feel trapped, he says.

That, in turn, is leading to a spike in anxiety, depression and addiction — not just among Muskin's patients, but across the U.S. To try to address those needs, physicians of all kinds are adopting the techniques and technology of telemedicine, which had been only slowly gaining wide acceptance — until the pandemic forced everyone to isolate themselves, mostly at home. The recent demand for telecounseling, as well as for other types of online medical visits, is causing backlogs of care for many providers who offer it.

There are now also even fewer in-person treatment options for some of the most acutely mentally ill in New York, Muskin says; the psychiatric wards at Columbia, where Muskin normally works, have all been converted to beds for COVID-19 patients.

"That means," he says, "we have no place to send patients who need admission."

Some of Columbia's patients with schizophrenia or bipolar disorder who were most in need of hospitalization when the storm of COVID-19 cases hit, were transferred to the very limited number of other inpatient facilities, Muskin says. Others were discharged to return home — which often means families are left struggling to help their loved one manage their mental health symptoms and medications.

Muskin, who, at 72 is at increased risk if he gets COVID-19, now sees his clients — outpatient and inpatient — remotely, from his home.

Meanwhile, a growing number of people in hospitals across the U.S. that are all but locked down are finding themselves in emotional, as well as physical, crisis.

Thousands of new COVID-19 patients are terrified and lonely. Their families cannot sit bedside to hold their hand, and overworked doctors and nurses have little time to offer comfort. In the most agonizing situations, families of the sickest face the possibility of death without a goodbye.

Muskin says his hospital is now requesting donations of iPads that can be sealed in Ziploc bags and deployed as part of the institution's improvised teletherapy practice. Sick patients can use them to connect with family and counselors on the outside; therapists and staff inside the hospital use them to reach out to families, to get and provide information and support on the patient's behalf.

Normally, privacy rules would strictly limit a doctor's ability to provide care over the phone, or online. As evidenced by recent hacking incidents using Zoom, there are also security concerns with those connections. Nevertheless, some federal and state laws and licensing restrictions have been lifted during the pandemic, partly out of concern for people who are facing an increase in anxiety, depression and the pressures of addiction.

"We want people to be aware of the flexibilities that will be in place now that will allow them to get care and treatment," says Elinore McCance-Katz, assistant secretary at the Department of Health and Human Services and head of the Substance Abuse and Mental Health Services Administration.

Services like Eden Health, which normally provides both in-person and online medical care, reports a 61% increase in patient calls through its app in recent weeks. Now its health providers are nearly providing all their care online.

"This is what's really sort of driving our health care system right now — the ability to provide telehealth," says Rachelle Scott, Eden's medical director of psychiatry.

Scott says many of her patients say they are feeling lonely, and that maintaining social distance is taking its toll; they crave human connection.

A webcam is not a perfect substitute for that, she says. Scott can only see what's in the small screen, and can't tell if her patients are jiggling a leg or have sweaty palms.

But there are also many advantages of remote therapy, she says. It's easier, more immediate — and, of course, there are currently no other alternatives.

Muskin, the New York psychiatrist, says he is plagued by some of the same worries he's trying to help others manage. In particular, he aches over the patients and hospital staff he left behind to keep fighting.

"It never occurred to me that colleagues would die," he says, yet some have.

"I feel guilty," Muskin says. "I spend a lot of evenings crying because I feel very guilty. And so I'm trying to do as much as I can."

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