MENTAL HEALTH Diane Whitney MD, FRCPC, BCETS NOSM Program Director - - PowerPoint PPT Presentation

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MENTAL HEALTH Diane Whitney MD, FRCPC, BCETS NOSM Program Director - - PowerPoint PPT Presentation

Oct 24, 2022 135 likes •495 views

COVID-19 & MENTAL HEALTH Diane Whitney MD, FRCPC, BCETS NOSM Program Director Psychiatry Residency Program Assistant Professor NOSM & University of Toronto, Adjunct Professor Western University Teaching Objectives : Understand the

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COVID-19 & MENTAL HEALTH

Diane Whitney MD, FRCPC, BCETS

NOSM Program Director Psychiatry Residency Program Assistant Professor NOSM & University of Toronto, Adjunct Professor Western University

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Teaching Objectives:

  • Understand the impact of COVID-19

& social isolation on mental health

  • Highlight findings from the scientific

literature with regards to the impact

  • f COVID-19 crisis on our health care

providers

  • Identify how to provide support

patients, medical colleagues & yourself

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Impact of COVID-19 & Social Isolation on Mental Health

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Anxiety & Uncertainty

  • This infectious disease outbreaks

cause significant anxiety & uncertainty

  • General population
  • Anxious / depressed, psychotic patients &
  • ther vulnerable patients
  • Health care / mental health providers

can play an important role in supporting well being of patients, families, health care providers & general public

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Educate about Common Adverse Responses

  • Common responses include

anxiety, insomnia, fear of illness, desire to increase drug & alcohol use

  • Children may experience regression,

acting out & social isolation

  • Educate regarding reduction of
  • verall stress
  • Inform patients & family where & when

to get help

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Managing COVID19 Anxiety

  • Acknowledge that some fear & anxiety is normal
  • Switch off technology & do some enjoyable

i.e. reading, exercise

  • Limit your news intake including from social media
  • Get news from reliable sources-WHO, Health Canada
  • Show compassion & check on your neighbour /

those at risk

  • Show respect-don’t buy excessively

– Hoarding behaviours are common in times of

  • uncertainty. Recognize it as your brain engaging

in the fight or flight response and try not to feed into it.

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Remember the Children

  • Children need to be reassured at age

appropriate level

  • Acknowledge fears
  • Explain the risk & what is being done to keep

the family safe

  • Reassure while being realistic
  • Discuss questions
  • Limit TV & Social Media time
  • Help adolescents understand social

distancing

– Not to share drinks, make up – Avoid smoking, vaping

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At Risk Mental Health Populations

People with Serious Mental Illness compromise 3-5% of pop

– Homelessness & grp living increase risk of infection & spread – Coexisting medical problems – Inpatient admission may increase risk – Physical isolation increases depression and SI

People with Addictions

– Support groups limited & only on line, – Limited access to technology – Closure of stores for access may lead to withdrawal – Risk of relapse with unstructured time, loss of supports, recreational activities

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At Risk Mental Health Populations

Persons in Violent Living Situation

Domestic Violence, child abuse, dependent adult abuse

  • Social isolation increases victimization
  • Program often not operating
  • Home bound victims less likely to be

identified

  • Many children, youth & adults may be

victimized during COVID-19

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Suicide Mortality & COVID-19

Consequences of social distancing may increase risk of suicide:

  • Economic stress
  • Social isolation versus physical distancing
  • Barriers to Mental Health Treatment
  • Decreased Access to Community & Religious

Support

  • National Anxiety
  • Elevated suicide rates among medical

professionals

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Recommend Health Promoting Behaviour

  • Eat a healthy & balanced diet
  • Reduce / eliminate alcohol, cigarettes,

recreational drug use

  • Practice good hygiene
  • Good sleep hygiene
  • Establish daily routine
  • Exercise few times per week / Yoga
  • Engage in a sense of

meaning/purpose or accomplishment

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When we are in a place of uncertainty, the most effective way to decrease worry and anxiety is to be fully present in the moment

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Pleasurable and Mastery Events

  • Bring us into the moment rather than focusing on

the anticipation of what the future may look like

  • Pleasurable Events

– things you do for the sake of bringing you joy

  • Mastery Events

– things you do to gain a sense of accomplishment

  • Make your lists and try to ensure there is a

combination of both pleasure and mastery in your week

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COVID Friendly Pleasurable and Mastery Activities

  • Family workouts, walking, biking
  • Baking
  • Playing board games, cards
  • Spring cleaning/Yard work
  • Try new recipes
  • Learn something new, i.e. language
  • Read books/listen to audiobooks
  • Write (emails, letters, autobiography, book, etc.)
  • Video games
  • Skype, Facetime, etc.
  • Take an online photography class
  • Research a topic of interest
  • Redecorate your room
  • Volunteer for a cause you support online
  • Do a jigsaw puzzle
  • Donate old clothes or items to charity
  • Lay in the sun
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Guide to living with worry and anxiety amidst global uncertainty

https://www.psychologytools.com/ass ets/covid- 19/guide_to_living_with_worry_and_a nxiety_amidst_global_uncertainty_en- gb.pdf

Walley, M., & Kaur, H. (2020). Living with worry and anxiety amidst global uncertainty. PsychologyTools.

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Face Covid by Russ Harris

  • https://www.baps.org.uk/content

/uploads/2020/03/FACE-COVID- by-Russ-Harris-pdf-pdf.pdf

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Encourage Provider Self-Care

  • Risk of severely stressing the

providers along with the system

  • Highlight basic needs including Sleep,

eating, hydrating & regular breaks

  • Adequate PPE supply
  • Providing support, finding

constructive solutions & staying connected to friends & family

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Challenges for Health Care Providers

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Difficult COVID Situations

  • Triage of Patients

– Who gets the last ventilator or who gets taken off a ventilator?

  • You are asked to be a medical

physician rather than a psychiatrist

  • Intubation, prescribing antibiotics
  • Colleagues are in isolation so the call

schedule is a “no go”

  • Risk to you, your family –going &

coming from hospital to home etc.

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Supporting the Health Care Workforce during COVID-19 Global Pandemic-

Adams & Wall, JAMA Mar 12, 2020

Pressures on Health Care Workforce

1. Potentially overwhelming burden of illness stressing a health care system already at capacity 2. Adverse effect on health care workers including infection 3. High risk clinical settings

– Precautions for respiratory illness & crowding – Fear /anxiety

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China Health Care Workers

  • 3300 health care workers infected
  • At least 22 died
  • Access to PPE & adequate cleaning

major concerns

  • In China mental health needs have

been apparently poorly handled

– Planning is not adequate – Community & mental health institutions decoupled – Shortage of various professionals – Mental health professionals are considered non essential

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Mental Health Impact on Health Care Workers

Lai et al. JAMA 2020;3(3)

  • 1257 health care workers in 34 hospitals

Jan 29 to Feb 3, 2020 in China

– Participation rate 68.7% – 64.7% aged 20 to 40 years – 76.7% women – 60.8% nurses & 39.2% physicians

  • PHQ-9, GAD -7, Insomnia severity index-7,

22 item Impact of Event Scale-revised

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Results – Health Care Workers

  • Those working in Wuhan, China had

more severe degrees on all measures

  • Especially nurses, women
  • Frontline health care workers engaged

in direct diagnosis, treatment and care

  • f patients were associated with higher

risk of symptoms:

  • Depression

OR 1.52

  • Anxiety

OR 1.57

  • Insomnia

OR 2.97

  • Distress

OR1.60

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ONTARIO COVID-19 MENTAL HEALTH NETWORK -FREE https://covid19therapists.co m

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Preventing & Addressing Mental Health Concerns

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Mitigating Psychological Effect on health care workers SARS Outbreak CMAJ Wu et al April 15, 2020

  • Clear & rapid hospital communication
  • Frequent communication
  • Transparent leadership at multiple levels
  • Direction about hospital processes &

appropriate supplies & equipment

  • Psychological support informally then

telephone lines & drop in centres

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Health Care Workers in Isolation / Quarantine

  • Workers self-isolation report

symptoms of PTSD, depression, stigmatization & fear of $ loss

  • Strong social support network offsets

feelings of isolation

  • Video calls / virtual meeting
  • Support & altruism i.e. medical

students delivering groceries

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Identifying & Addressing Mental Health Concerns

  • Educate people to understand

normal reactions to stress & how to manage stress so individuals are more resilient Goals

  • Improve short term performance & long

term mental health outcomes

  • Reduce barriers to care
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Road to Mental Readiness Program (R2MR) LOAD THE APP!

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Monitoring Behaviour

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Some supportive and crisis resources for you or clients

  • Health Sciences North Crisis Intervention Services 1-

800-841-1101

  • Thunder Bay Crisis Response 807-346-8282
  • 24 hour Crisis Line North Bay 705-474-1031
  • Kids Help Phone 1-800-668-6868
  • Transgender Crisis Line 1-877-330-6366
  • Crisis Services Canada 1-833-456-4566
  • First Nations and Inuit Hope for Wellness Help Line

1-855-242-3310

  • 1-855-892-9992 A Friendly Voice for Seniors
  • Stacey E. Roles & Associates Psychotherapy Services
  • Inc. 705-929-1612 or staceyrolestherapy.com