{"id":257176,"date":"2020-06-05T04:19:33","date_gmt":"2020-06-05T08:19:33","guid":{"rendered":"https:\/\/canadianinquirer.net\/v1\/?p=257176"},"modified":"2020-06-05T04:19:33","modified_gmt":"2020-06-05T08:19:33","slug":"in-hard-hit-areas-covids-ripple-effects-strain-mental-health-care-systems","status":"publish","type":"post","link":"https:\/\/canadianinquirer.net\/v1\/2020\/06\/05\/in-hard-hit-areas-covids-ripple-effects-strain-mental-health-care-systems\/","title":{"rendered":"In Hard-Hit Areas, COVID\u2019s Ripple Effects Strain Mental Health Care Systems"},"content":{"rendered":"
\"\"<\/a>
Marcell\u2019s depression was so profound, he said, he didn\u2019t want to move and was considering suicide. (Pexels photo)<\/figcaption><\/figure>\n

In late March, Marcell\u2019s girlfriend took him to the emergency room at Henry Ford Wyandotte Hospital, about 11 miles south of Detroit.<\/p>\n

\u201cI had [acute] paranoia and depression off the roof,\u201d said Marcell, 46, who asked to be identified only by his first name because he wanted to maintain confidentiality about some aspects of his illness.<\/p>\n

Marcell\u2019s depression was so profound, he said, he didn\u2019t want to move and was considering suicide.<\/p>\n

\u201cThings were getting overwhelming and really rough. I wanted to end it,\u201d he said.<\/p>\n

Marcell, diagnosed with schizoaffective disorder seven years ago, had been this route before but never during a pandemic. The Detroit area was a coronavirus hot spot, slamming hospitals, attracting concerns from federal public health officials and recording more than 1,000 deaths in Wayne County as of May 28. Michigan ranks fourth among states for deaths from COVID-19.<\/p>\n

The crisis enveloping the hospitals had a ripple effect on mental health programs and facilities. The emergency room was trying to get non-COVID patients out as soon as possible because the risk of infection in the hospital was high, said Jaime White, director of clinical development and crisis services for Hegira Health, a nonprofit group offering mental health and substance abuse treatment programs. But the options were limited.<\/p>\n

Still, the number of people waiting for beds at Detroit\u2019s crisis centers swelled. Twenty-three people in crisis had to instead be cared for in a hospital.<\/p>\n

This situation was hardly unique. Although mental health services continued largely uninterrupted in areas with low levels of the coronavirus, behavioral health care workers in areas hit hard by COVID-19 were overburdened. Mobile crisis teams, residential programs and call centers, especially in pandemic hot spots, had to reduce or close services. Some programs were plagued by shortages of staff and protective supplies for workers.<\/p>\n

At the same time, people battling mental health disorders became more stressed and anxious.<\/p>\n

\u201cFor people with preexisting mental health conditions, their routines and ability to access support is super important. Whenever additional barriers are placed on them, it could be challenging and can contribute to an increase in symptoms,\u201d said White.<\/p>\n

After eight hours in the emergency room, Marcell was transferred to\u00a0COPE<\/a>, a community outreach program for psychiatric emergencies for Wayne County Medicaid patients.<\/p>\n

\u201cWe try to get patients like him into the lowest care possible with the least restrictive environment,\u201d White said. \u201cThe quicker we could get him out, the better.\u201d<\/p>\n

Marcell was stabilized at COPE over the next three days, but his behavioral health care team couldn\u2019t get him a bed in one of two local residential crisis centers operated by Hegira. Social distancing orders had reduced the beds from 20 to 14, so Marcell was discharged home with a series of scheduled services and assigned a service provider to check on him.<\/p>\n

However, Marcell\u2019s symptoms \u2015 suicidal thoughts, depression, anxiety, auditory hallucinations, poor impulse control and judgment \u2015 persisted. He was not able to meet face-to-face with his scheduled psychiatrist due to the pandemic and lack of telehealth access. So, he returned to COPE three days later. This time, the staff was able to find him a bed immediately at a Hegira residential treatment program, Boulevard Crisis Residential in Detroit.<\/p>\n

Residents typically stay for six to eight days. Once they are stabilized, they are referred elsewhere for more treatment, if needed.<\/p>\n

Marcell ended up staying for more than 30 days. \u201cHe got caught in the pandemic here along with a few other people,\u201d said Sherron Powers, program manager. \u201cIt was a huge problem. There was nowhere for him to go.\u201d<\/p>\n

Marcell couldn\u2019t live with his girlfriend anymore. Homeless shelters were closed and substance abuse programs had no available beds.<\/p>\n

\u201cThe big problem here is that all crisis services are connected to each other. If any part of that system is disrupted you can\u2019t divert a patient properly,\u201d said Travis Atkinson, a behavioral consultant with TBD Solutions, which collaborated on a survey of providers with the American Association of Suicidology, the Crisis Residential Association and the National Association of Crisis Organization Directors.<\/p>\n

White said the crisis took a big toll on her operations. She stopped her mobile crisis team on March 14 because, she said, \u201cwe wanted to make sure that we were keeping our staff safe and our community safe.\u201d<\/p>\n

Her staff assessed hospital patients, including Marcell, by telephone with the help of a social worker from the emergency room.<\/p>\n

People like Marcell have struggled during the coronavirus crisis and continue to face hurdles because emergency preparedness measures didn\u2019t provide enough training, funds or thought about the acute mental health issues that could develop during a pandemic and its aftermath, said experts.<\/p>\n

\u201cThe system isn\u2019t set up to accommodate that kind of demand,\u201d said Dr. Brian Hepburn, a psychiatrist and executive director of the National Association of State Mental Health Program Directors.<\/p>\n

\u201cIn Detroit and other hard-hit states, if you didn\u2019t have enough protective equipment you can\u2019t expect people to take a risk. People going to work can\u2019t be thinking \u2018I\u2019m going to die,\u2019\u201d said Hepburn.<\/p>\n

For Marcell, \u201cit was bad timing to have a mental health crisis,\u201d said White, the director at Hegira.<\/p>\n

At one time Marcell, an African American man with a huge grin and a carefully trimmed goatee and mustache, had a family and a \u201cpretty good job,\u201d Marcell said. Then \u201cit got rough.\u201d He made some bad decisions and choices. He lost his job and got divorced. Then he began self-medicating with cocaine, marijuana and alcohol.<\/p>\n

By the time he reached the residential center in Detroit on April 1, he was at a low point. \u201cSchizoaffective disorder comes out more when you\u2019re kicked out of the house and it increases depression,\u201d said Powers, the program manager who along with White was authorized by Marcell to talk about his care. Marcell didn\u2019t always take his medications and his use of illicit drugs magnified his hallucinations, she said.<\/p>\n

While in the crisis center voluntarily, Marcell restarted his prescription medications and went to group and individual therapy. \u201cIt is a really good program,\u201d he said while at the center in early May. \u201cIt\u2019s been one of the best 30 days.\u201d<\/p>\n

Hepburn said the best mental health programs are flexible, which allows them more opportunities to respond to problems such as the pandemic. Not all programs would have been able to authorize such a long stay in residential care.<\/p>\n

Marcell was finally discharged on May 8 to a substance abuse addiction program. \u201cI felt good about having him do better and better. He had improved self-esteem to get the help he needed to get back to his regular life,\u201d Powers said.<\/p>\n

But Marcell left the addiction program after only four days.<\/p>\n

\u201cThe [recovery] process is so individualized and, oftentimes, we only see them at one point in their journey. But, recovering from mental health and substance use disorders is possible. It can just be a winding and difficult path for some,\u201d said White.<\/p>\n

Seeking Help<\/strong><\/p>\n

If you or someone you know is in immediate danger, call 911. Below are other resources for those needing help:<\/p>\n

\u2014 National Helpline: 1-800-662-HELP (4357) or https:\/\/findtreatment.samhsa.gov<\/a>.<\/p>\n

\u2014 National Suicide Prevention Lifeline: 1-800-273-TALK (8255).<\/p>\n

\u2014 Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746.<\/p>\n

<\/p>\n

Kaiser Health News<\/a>\u00a0is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.<\/i><\/p>\n","protected":false},"excerpt":{"rendered":"

In late March, Marcell\u2019s girlfriend took him to the emergency room at Henry Ford Wyandotte Hospital, about 11 miles south …<\/p>\n","protected":false},"author":44,"featured_media":257177,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[37],"tags":[],"class_list":["post-257176","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","mauthors-cheryl-platzman-weinstock","mauthors-kaiser-health-news"],"_links":{"self":[{"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/posts\/257176","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/users\/44"}],"replies":[{"embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/comments?post=257176"}],"version-history":[{"count":1,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/posts\/257176\/revisions"}],"predecessor-version":[{"id":257178,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/posts\/257176\/revisions\/257178"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/media\/257177"}],"wp:attachment":[{"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/media?parent=257176"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/categories?post=257176"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/tags?post=257176"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}