Opportunity, Not Obstacles: Pandemic Innovations in Psychiatry Are Here to Stay

From telepsychiatry to drive-up injection sites, new, inventive strategies for patient-centered care spurred by COVID-19 pandemic could drive lasting change

Each of us likely have our own memories of the day the COVID-19 pandemic turned our world upside down and changed the healthcare landscape forever. Clinicians across specialties and settings of care, including those of us in psychiatry, were compelled to innovate overnight in order to keep patients engaged in care throughout the uncertainty of the pandemic, regardless of the mounting challenges we faced.

Now, after more than a year of seeing these new aspects of care in practice and the positive impact they’ve had on our entire system, I recognize that many patients have come to prefer what's been put into place in response to the pandemic. As we reflect on the lessons of the pandemic, my hope is that the innovations driven by the necessity of a global crisis will have a lasting, positive impact on the entire health care ecosystem.

The Opportunity of Telehealth

While technology is an asset to many aspects of our work, very little can replace the value of in-person interaction with our patients. Nevertheless, as all our lives went virtual, health care had to transition as well. Once a National State of Emergency was declared, it was clear we needed to pivot to a new style of patient care. I immediately began to trial several telemedicine platforms to determine which would provide the best patient experience. This was no easy matter, as some of the services with more patient-friendly interface had more difficulty maintaining connections.

The ability to hold the connection was especially important because there are many people across the country who do not have adequate internet service or even hardware to engage in telemedicine. This lack of access to health care services, psychiatric or otherwise, can hinder an individual's overall wellbeing. We got creative and began to open our own space, safely, so patients could access reliable internet to see their other health care providers. Moving forward, I plan to continue to provide the opportunity to use our internet services to our patients.

I am invested in my patients’ mental health, but my training taught me to be a doctor first, psychiatrist second, and I believe in treating each patient holistically. Doing my part to protect my patients’ physical health is the priority and monitoring their weight and vital signs when practicing telepsychiatry was another complication to overcome. After some research, I partnered with a lab company that sends patients a glucometer, automated blood pressure cuff and scale to let them monitor their values from home on standardized equipment. They text the results to the lab each month and I can view the data from a secure web portal. By following the trends in these results, I can detect abnormalities even earlier than before when I might only collect that information a few times a year.

I also realized that seeing patients in their own element lets me get a clearer glimpse into aspects of their life that may not have been visible during in-office interactions. This provides me with added insight into their psychosocial environment, which is essential for assessing the patient as a whole. I look forward to continuing to serve patients with a hybrid in-person and virtual model even when social distancing and at-home measures have been lifted.

Patient-Centered Strategies to Improve Treatment Access

Beyond the platforms by which we deliver care, my treatment strategies also shifted due to the pandemic. For my patients with schizophrenia, I redoubled my efforts to offer them the opportunity to transition to long-acting injectables (LAIs). I consistently discuss with my patients their life and treatment goals and partner with them to align their treatment plan with those goals. LAIs support continuity of care and assure patients that they have received their therapy in a consistent way.

For those patients receiving LAIs, I had to determine how to administer them safely and make them accessible to patients. I came up with a solution to deliver LAIs administered via deltoid injections by a new drive-up system at my office. This made it easier to deliver the treatment my patients needed in a way that respected COVID-19 social distancing measures. For patients already receiving LAIs through gluteal injections, I transitioned them to deltoid injections when possible during times of surges to allow them to take advantage of the drive-thru system. When conditions improved, I resumed their original gluteal LAI.

The drive-through setup was a game changer for my practice and my patients, as it allowed me to safely see patients outside, deliver their medication and feel confident in their ability to stick with their treatment regimen, even during the stressful time of a global pandemic. My patients have loved the convenience of drive-through injections and anything that lowers the barrier to patients choosing LAIs is worth continuing.

What Lies Ahead for Mental Health Care

My experience providing care during the pandemic has taught me many things – people are resilient, adaptable, and able to embrace change. With each obstacle my patients and I faced due to the pandemic, I found that the solutions were actually opportunities I could have taken advantage of at any time in the past. I had simply missed out on them because I hadn’t felt the same urgency to invent new practices. I believe that being forced outside of our comfort zones by the pandemic was the best thing that could happen to the field of medicine.

As the philosopher Jiddu Krishnamurti wrote, “Tradition becomes our security, and when the mind is secure, it is in decay.” The innovations we all made through adversity over the last year will have a lasting, positive impact on the way we deliver care and the overall patient experience. And for that, I am thankful.

Craig Chepke, M.D., FAPA, is an Adjunct Associate Professor of Psychiatry for Atrium Health, an Adjunct Assistant Professor of Psychiatry for The University of North Carolina School of Medicine, Chapel Hill, and the Medical Director of Excel Psychiatric Associates, Huntersville, North Carolina.