In light of the COVID-19 pandemic, people across the country are grappling with the question, “What and who is essential?” Instructions to reduce non-essential activity hit differently in crisis compared to our normal mindset that our day-planners are scheduled with only crucial tasks. When suddenly gyms, churches, and restaurants close their doors, one must reflect on what is truly indispensable.
This hits home in my field of psychiatry, where outpatient appointments are being rescheduled or canceled to reduce the risk of infection. Certainly, our goal is to continue care by adopting telemedicine capabilities as quickly as possible. However, for mental health patients already facing adversity, requiring tech know-how may create an unsurmountable bar for receiving mental health treatment.
In addition, with a growing influx of sick patients, health care workers are becoming ill more quickly than they can be replaced, and residency programs like psychiatry, dermatology, and ophthalmology are shunting their residents to general medicine and intensive care units. The definition of which specialties are “essential” has been forged by the crucible of this virus.
With all the realization over the past couple of decades on the importance of mental health care, this new reality falls flat. From the first day of entering my residency, I have been aware of the inaccessibility to mental health care, the long waits for clinic openings, and the ability to get a job nearly anywhere. For psychiatry services to now be considered elective is shocking and rather insulting- but also understandable.
Basic psychology includes the theory of Maslow’s hierarchy of needs, which basically states that a human must have their basic needs met (such as one’s physiological needs or the need for safety) before being motivated to achieve other needs (such as love, esteem, and self-actualization). It would make sense then that patients must be alive and treated for their respiratory distress, for instance, before they can be treated for depression or a substance use disorder.
However, that is only true for patients whose safety and physiological needs are not compromised by an unstable state of mind. For starters, patients in the middle of a manic episode may expose themselves to lethal situations, depressed patients contemplating suicide may lose their lives without help, and psychotic patients may harm themselves or others inadvertently without intervention. One doctor predicts a wave of patients with mental health emergencies coming to hospitals after weeks of being untreated or out of medicines.
For now, we must use the elementary principle of triaging and must practice flexibility. If patients cannot be cared for because there is a shortage of medicine residents, we must fill the gap. If a patient calls with a mental health emergency, we must use whatever methods available to come to their aid. What is certainly essential in this time, no matter one’s role, is adaption, compassion, and diligence.
Lauren Das is a psychiatry resident.
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