It is difficult to identify any aspect of everyday life that the global COVID-19 pandemic has not, in some way, impacted or altered. As the healthcare community valiantly responds and adjusts to the myriad challenges associated with the novel coronavirus, individual patients have also been forced to rearrange in the midst of the public health crisis. For healthcare providers and patients, COVID-19 has upended many aspects of life that not long ago seemed rather stable and relatively predictable, such as education, travel, employment, entertainment, shopping, finances and social gatherings. A disruption of this magnitude has spurred innovation in the delivery of medical care.  At the same time, providers should be mindful of recent studies indicating nearly half (45%) of adult Americans report having their mental health negatively impacted due to COVID-19[1], demonstrating an increase in the need for behavioral and mental health treatment and services during the public health crisis.

As a result of the global pandemic and stay-at-home orders, many healthcare providers have turned to telemedicine and telehealth as a means to safely, and remotely, continue offering care to their patients.  A recent Merritt Hawkins report found that 48% of physicians are using telemedicine to treat patients through the COVID-19 pandemic, up from 18% in 2018.[2]  In fact, reporting from NYU Langone Health, which added over 1300 providers[3] to its telemedicine platform in March, demonstrates just how swiftly providers are adopting telehealth.

While most physician practices and healthcare facilities have policies and protocols in place for responding to behavioral or mental health warning signs when treating a patient in the clinic or facility setting, these same providers may not have similar policies and protocols for their telehealth practices—especially if the provider is new to providing care remotely.  Consequently, telehealth presents novel issues providers may not be adequately prepared to handle—especially for providers forced to employ telehealth in response to COVID-19.

While telehealth enhances practitioners’ ability to reach patients—particularly amid social distancing directives—virtual care also requires the provider to assess a patient’s condition without several tools and factors present in the clinical setting. Regardless of location or specialty, when assessing a patient’s condition, practitioners must be prepared to identify possible behavioral or mental health warning signs.   This may prove difficult in some telehealth encounters, as practitioners may have difficulty assessing a patient’s environment, social support or physical cues remotely, which is especially critical in the midst of unusual and extreme stressors associated with a global pandemic. Accordingly, practices and facilities should not assume that in-office policies and protocols would seamlessly transfer to telehealth visits.

This resource has basic information for practitioners to consider in reviewing or preparing policies and protocols regarding behavioral and/or mental health indications when treating patients remotely.

PLAN AHEAD: OBTAIN INFORMATION EARLY AND HAVE IT AVAILABLE

  • Practices should have policies and protocols in place before treating patients remotely. Staff should be educated as to the policies, protocols and their respective responsibilities related to the same.
  • Policies and protocols should allow the practitioner to obtain critical information and assess the patient prior to the telehealth visit.  For example, include questions and screening tools (e.g. PHQ-2 or PHQ-9) concerning the patient and his or her environment in patient intake forms.
  • Know where the patient is located (i.e., are they at home or in another location) and obtain a specific address.
  • Know patient’s living situation (i.e., do they live alone? With family? Roommates?).
  • Request and verify alternate contact information (e.g., cell phone number, landline, e-mail address) and establish a method to re-establish contact in case of service disruptions (e.g., if video drops, then re-establish contact via phone).
  • Request and verify the name and contact information of an emergency contact or other support person who can be contacted. If possible, this person should physically be able to check up on the patient. Obtain consent to contact this person directly.
  • Identify and verify local emergency services contact information and crisis numbers for the region or county where the patient is located.
  • Have all the contact information described above available and in front of the provider during the remote visit.

BE PREPARED: APPROPRIATE RESPONSE

  • Know your practice’s capacity to address or treat mental or behavioral health concerns. Identify the ability to treat certain conditions in-house and identify local providers specializing in mental or behavioral health and other potential referral sources.
  • During the visit, determine whether there is an imminent risk to the patient.  If there is not an imminent risk of harm to the patient, have resources, websites and local organizations available that may be helpful for the patient to explore. Consider additional steps the practice can take to support and/or monitor the patient’s status.

BE READY TO ACT: DEVELOP EMERGENCY PROTOCOLS

  • If a patient is in imminent danger, coordination with local emergency services and other resources might be necessary. A patient’s emergency contact or support person might also need to be contacted to help coordinate emergency services or periodically check in and monitor the patient.
  • If immediate attention is necessary, the primary practitioner might need to remain connected to and engaged with the patient until someone arrives at the patient’s location. Identify and work with Practice staff members who are trained to help with contacting third parties in emergency situations.

 

Contributing Author:

Sandra Van Wyk, M.D.

715 Chestnut Street
Bastrop, TX 78602

Phone: 512-360-8488
Fax: 956-253-2505

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THE SUICIDE PREVENTION LIFELINE: 1-800-273-8255

  • The Lifeline is made up of 170+ local – and state – funded crisis centers located across the United States. Calls to the Lifeline are routed to their closest center based on area code.  Counselors at these crisis centers are familiar with community health resources, and can therefore provide referrals to local services.

 

[1] https://www.kff.org/health-reform/report/kff-health-tracking-poll-early-april-2020/

[2] https://www.merritthawkins.com/uploadedFiles/Corona_Physician_Survey_Merritt_Hawkins_Report.pdf

[3] https://www.beckershospitalreview.com/telehealth/nyu-langone-health-adds-1-300-providers-to-telemedicine-platform.html