Module 4: Mental Health in the Time of COVID-19

Assess how the COVID-19 pandemic affects the mental health of patients and identify basic tools for responding to these changes in the clinical setting.

Authors: Okechi Boms; Taylor Brown; Sun Fletcher; Colby Hyland; Katie Kester; Danny Linggonegoro; Catherine Mankiw; Katherine McDaniel, MSc; Larisa Shagababayeva

Editor: Catherine Mankiw

Reviewers: Jennifer Potter, MD; Fernando Rodriguez-Villa, MD; Nhi-Ha Trinh, MD, MPH; Aliya Feroe; King Fok, MSc; Sabra Katz-Wise, PhD

Introduction

The COVID-19 pandemic has already caused a significant psychological impact across the globe, and there is ongoing concern that mental health outcomes will continue to worsen in the coming months (Galea et al., JAMA 2020). The World Health Organization, National Alliance on Mental Illness, Centers for Disease Control and Prevention (CDC), and Substance Abuse and Mental Health Service Administration (SAMHSA) have all released guidelines for individuals to address the mental health consequences of the pandemic.

We are already seeing these consequences in the United States. In a tracking poll conducted by the Kaiser Family Foundation (KFF) from March 25th to 30th, 45% of Americans stated that the pandemic had affected their mental health, with 19% expressing the pandemic had a “major impact” (Kirzinger et al., KFF 2020). Compared to just two weeks prior, these results had increased from 32% and 14%, respectively (Hamel et al., KFF 2020). While the findings were prevalent across all groups, females as well as black and Hispanic Americans appear to be particularly affected.

How we as medical providers can respond to these increased mental healthcare needs during this time of crisis is an open question (Pfefferbaum & North, NEJM 2020). As medical students, we too can have an important role in the mental health response.

Module 4 of the curriculum will teach students about the mental health ramifications of the COVID-19 pandemic. We will first utilize our two longitudinal cases - Brian and Diane - to demonstrate how the biopsychosocial framework can illuminate the many stressors COVID-19 is currently inflicting on our patients. Second, we will address populations that may be particularly vulnerable to mental health sequelae and special considerations we must take when working with these patients. These include healthcare workers, elderly patients, pregnant women, patients with pre-existing mental health conditions, patients experiencing homelessness, individuals experiencing intimate partner violence, and several minority communities. And finally, we will outline the ways we can expect clinical care and mental healthcare delivery to change as a result of COVID-19. This section introduces a framework to help us evaluate the mental health resources available for our patients, an update on the use of telehealth during the crisis, and a set of trauma-informed precautions that should guide our patient encounters in the months ahead.

Learning Objectives

At the end of this module, medical students should be able to:

  • Describe the multidimensional factors that impact mental health during the COVID-19 pandemic.

  • Identify vulnerable patient populations, and critically evaluate and describe how to respond to the unique needs of each one.

  • Identify both health systems and community resources for individuals requiring mental health support.

  • Evaluate the current state of telehealth in the context of mental health delivery and describe barriers to its dissemination.

  • Practice trauma-informed care with patients as a universal precaution.

Note: This module is primarily aimed to help us as medical providers and future physicians understand the impact of the COVID-19 pandemic on the mental health of our patients. Our goal is to help you identify the complex ways that the crisis contributes to our population’s mental health and how your role in clinical settings may evolve to respond to these new mental health challenges. But before we can take care of our patients, it is important that we first take care of ourselves. Your own mental health and well-being as a trainee and medical provider are incredibly important in this time. For information on care of self and others, and tools to protect your own mental health in the setting of this traumatic exposure, please refer to Module 6.