- Care driven by the community is at high risk due to the potentially increased risk factors associated with patients with severe mental illness including poor hygiene, homelessness, and often congregated living
- Many new guidelines must be developed in order to both assist these patients but also keep psychiatrists safe from the high risk of potential illness
- For all in-home visits, patients must be properly screened prior to visitation and if any symptoms are present, appointments must be rescheduled


Ohio State University, Columbus

- This paper addresses the growing concern of psychiatric care during and after the COVID-19 pandemic and how the field must change in order to fit the everchanging landscape of our society as well as some more general concerns around patient ethics and new resident training
- Currently, the effects of the rapid switch to telemedicine on patient care at the beginning of the pandemic are unknown
- This paper covers a broad spectrum of topics which all revolve around examining the effects of COVID-19 on treatment in the field of psychology including, outpatient psychiatric care, inpatient psychiatric care, community driven psychiatric care, the ethical challenges present as the pandemic continues, and the concerns around training new residents during this time


COVID-19 Pandemic: Impact on psychiatric care in the United States

Bojdani, E., Rajagopalan, A., Chen, A., Gearin, P., Olcott, W., Shankar, V., Cloutier, A., Solomon, H., Naqvi, N. Z., Batty, N., Festin, F. E. D., Tahera, D., Chang, G., & DeLisi, L. E. (2020). Covid-19 pandemic: Impact on psychiatric care in the united states. Psychiatry Research, 289, 113069. https://doi.org/10.1016/j.psychres.2020.113069

URL: https://www.sciencedirect.com/science/article/pii/S0165178120312269?casa_token=VPD3KE0pDaMAAAAA:W9-Y-9nAQfZf6FnWdIq22sMNWM5fIBekb93Cd4S8Ok_85xRzye1bfWpC6jvnon4JlIUTr4g


- The number of professionals in the outpatient setting that are leveraging telehealth to their advantage is ever increasing
- This has additionally extended to the supervision of trainees
- This new modality of treatment is not universally accepted as there are still many patients with technological difficulties or poor internet connections where this treatment is insufficient or impossible
- Fear has been expressed by patients regarding starting a new medication trial due to the requirement of having to go out and get bloodwork
- Substance abuse cases are now being more handled by national and state guidelines as they are a lot harder to treat during the pandemic
- A specific example for substance abuse would be the loosening regulations for methadone clinics which are allowing more patients to be able to come get treatment
- The most at risk group for the outpatient setting is the elderly group who are at most risk of both COVID-19 and mood destabilization due to forced sheltered behavior


Outpatient Psychiatric Care

-  The adoption of a lot more rigid and standardized procedures must take place for inpatient care to continue be safe and effective
- These kinds of methods include higher levels of sanitation, disease precautions such as heightened disease testing, restriction of non-essential contact, workforce adjustments, and changes to the group therapy changes
- Changes which have already been implemented display a much more isolating inpatient experience for patients where both familial and physician contact is limited, leading for fear of development of latent issues during hospitalization


Inpatient Psychiatric Care

Community Driven Psychiatric Care

- Currently, due to lack of consensus for new guidelines, physicians are forced to make decisions for changes to psychiatric care based off studies presented during this time that may not be peer reviewed and therefore less credible
- Resource limitations on departments during this time are also seen as an ethical dilemma as physicians may not have what’s needed to properly treat a patient
- Psychiatric facilities are not set up to maintain infection control, so therefore, the risk of transmission in most psychiatric facilities is very high
- Withholding any potentially dangerous info that could put patient lives in risk that is associated with COVID-19 has been deemed severely unethical by the American Medical Association


The Ethical Challenges Present as the Pandemic Continues

- Psychiatric residencies across the country are now tasked with finding innovative ways to provide psychiatric care to COVID-19 infected patients
- This has manifested in some facilities looking at their program’s core values in an attempt to rebuild a new format of care during the COVID-19 pandemic


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