September 2020 RFM Corner: Colin Wendt, M.D.

In late February, I sat in the on-call room of Harborview Medical Center after completing a psychiatric consult on a medical floor. Of all the clinical duties required by the UW Psychiatry Residency Program, call shifts at Harborview are notoriously challenging; the resident on call receives a steady stream of pages from psychiatric units, manages the consult-liaison service, and works in the psychiatric emergency department overnight. I decided to take a short break prior to completing my notes. I grabbed my phone to check the news, finding a headline that would drastically change all aspects of my personal and professional life: The New York Times reported “Washington State Declares Emergency Amid Coronavirus Death and Illnesses at Nursing Home”(1). The patient’s death was later publicly declared to have taken place at Harborview Medical Center (2). I sat in shock as the consult pager buzzed on the countertop. A quick glance at the pager worsened my growing anxiety—the medical intensive care unit was requesting my presence for a psychiatric evaluation.

The COVID-19 pandemic has affected every level of health care delivery in Washington State. UW Medicine estimated the financial impact from the pandemic to be $500 million within its health system, prompting temporary furloughs for thousands of staff (3, 4). For mental health care, changes have been substantial. Seven North, an inpatient psychiatric unit at UW Medical Center - Montlake, closed amid financial constraints caused by the pandemic. New beds were allocated at UW Medical Center - Northwest to target the patient population served by Seven North, but this change has reduced the number of inpatient geriatric psychiatry beds available at the Northwest campus. Plans are ongoing for a new, 150-bed behavioral health facility at the Northwest campus, however, this new facility is not currently ready for patient care (5).

Community resources have also been impacted by the COVID-19 crisis. Many shelters in the Seattle metropolitan area either stopped taking new clients or were repurposed early in the pandemic. Harborview Hall, for example, transitioned to an isolation and recovery center for individuals awaiting COVID-19 test results or those who tested positive but did not have shelter to quarantine (6). Several outpatient mental health facilities limited walk-in and face-to-face appointments for clients early in the pandemic, focusing efforts on telehealth communication in an attempt to promote social distancing. This created barriers in accessing care for those without telephone or computer access.

The COVID-19 crisis has also had an immense impact on our individual patients. The magnitude of this impact remains unknown and evolving. In a recent survey of U.S. adults, twice as many respondents in 2020 have seriously considered suicide in the past 30 days as compared to 2018 (7). It is estimated that upwards of two to three million Washingtonians will likely experience clinically significant behavioral health symptoms within the next 3-6 months (8). Much of this is fueled by economic hardships caused by the pandemic. In Washington State, five hundred thousand people lost their jobs in the month of April 2020 alone (9). Countless others have lost housing, transportation, and other essential services due to impacts caused by the virus. Further studies will be needed to quantify the impact of this crisis on the citizens of Washington State.

The COVID-19 pandemic has created unprecedented changes in training at the UW Psychiatry Residency Program. Individual sites worked to keep residents, other staff, and patients safe through initiating personal protective equipment requirements, implementing widespread use of COVID-19 testing for patients and staff, and adopting algorithms for the treatment of suspected or known COVID-19 positive patients with underlying psychiatric illness. With the support of chief residents and faculty members, telepsychiatry was widely adopted and implemented in outpatient psychiatry settings. Didactic lectures were transitioned to virtual learning. Applicants to psychiatry residency programs can expect all interviews to be conducted virtually (10).

Both the UW Department of Psychiatry and Behavioral Sciences and the UW Psychiatry Residency Program have taken actions to address the mental health impacts caused by the pandemic. Much effort has been placed in expanding access to care through behavioral health integration within primary care settings. UW medicine expanded its Psychiatry Consult Line to provide 24 hours, seven days a week staffing (11). Our residency program continues to offer several integrated behavioral health clinical opportunities, including rotations at sites using the Collaborative Care Model.

 As mental health practitioners in Washington State, there are ways we can advocate for our patients during the pandemic. Continue to provide excellent patient care, taking into account how the COVID-19 pandemic has affected our individual patients. Advocate for mental health resources within our healthcare institutions. If possible, contribute to community resources affected by the pandemic. Finally, contact local representatives to inform them how our patients have been affected by the COVID-19 crisis.

When the pager buzzes, the residents at UW Psychiatry Residency Program are ready to take the call. It is clear that our pagers are sounding at unprecedented rates as the demand for mental health services has increased during the COVID-19 pandemic and economic downturn. Mental health providers across Washington State have the capacity to support those struggling as a result of the pandemic through individual patient care, health systems, and state legislation. Our collective presence as mental health practitioners is needed now more than ever.

7) Czeisler, M.E.,et al. (2020).  Mental Health, Substance Use, and Suicidal Ideation During the COvid-19 Pandemic—United States, June 24-30, 2020.  Center for Disease Control and Prevention Morbidity and Mortality Weekly Report Vol. 69, No. 32.

About Colin Wendt

Dr. Colin Wendt is a third-year resident in the University of Washington Seattle Psychiatry Residency Program. Dr. Wendt hopes to complete a fellowship in child and adolescent psychiatry after completing general psychiatry residency training. Dr. Wendt completed medical school and undergraduate training at the University of Minnesota. Dr. Wendt’s clinical interests include behavioral health integration and medical education. Colin enjoys yoga, running, and hiking. In his free time, Colin leads yoga classes for kids.