In The News

Joint Statement: Care of Patients with Behavioral Health Emergencies and Suspected or Confirmed COVID-19

Posted: April 6, 2020 | Download as PDF
Joint statement by the American Association for Emergency Psychiatry, American College of Emergency Physicians, American Psychiatric Association, Coalition on Psychiatric Emergencies, Crisis Residential Association, and the Emergency Nurses Association. 
As with environmental disasters and other crisis events, pandemics may exceed people’s usual coping skills and capacity which, in turn, may lead to problems with anxiety, depression, increased use of substances, as well as exacerbation of underlying psychiatric disorders. Factors including, but not limited to, social and physical isolation, uncertainty, fear, evolving facts, changes in how individuals access outpatient care and public health recommendations contribute to this stress. This impacts people with and without pre-existing psychiatric illnesses and can contribute to a number of challenges for our already taxed emergency and crisis healthcare system. The most severely ill people with psychiatric illness have high rates of baseline medical comorbidity, reduced access to primary care medical resources, and may lack resources to participate in telehealth services. As a result, this group may have an elevated vulnerability to COVID and have limitations in accessing services other than emergency and crisis settings(1). For care of the behavioral health patient with suspected or confirmed COVID-19: 
  1. Encourage preparedness by supporting education and training on the treatment of psychiatric disorders and best-practices for the care of the behavioral health patient.
  2. Staff must have access to appropriate, adequate personal protective equipment (PPE).
  3. Encourage the use of existing, available behavioral health crisis services to mitigate unnecessary visits to the emergency department for psychiatric emergencies or for diverting people from psychiatric hospitals whenever possible.
  4. Support medical screening via telehealth/telephonic and clinical pre-admission screenings and assessments by qualified, licensed professionals. Additionally, we advocate for expanded use of telehealth, including prescribing of controlled substances for opioid use disorder via telemedicine, for patient and provider safety in line with infectious disease recommendations (i.e. social distancing). Encourage novel use of telehealth in high-risk environments for diversion and mitigation of unnecessary ED visits.
  5. Recognize that patients who present with psychiatric complaints may also have co-occurring medical disorders that should have a proper medical evaluation. Use pre-existing, evidence-based recommendations and screening algorithms in order to perform appropriate and directed medical evaluations. Encourage providers to identify alternate methods and modalities to make those assessments in the current COVID environment.
  6. Understand that people will present in acute psychiatric crisis who are at risk of, have symptoms consistent with or have tested positive for COVID-19, who will not meet medical admission criteria but will meet criteria for further psychiatric care. Mental health and substance use care, based on the needs of the individual, must remain available.
  7. Discourage the use of restraints while keeping people in the least restrictive setting possible that corresponds to their condition or presenting symptoms.
  8. Ensure that medical personnel is evaluating for signs of domestic violence in children, partners and spouses, the elderly, those with intellectual and developmental disabilities, and other vulnerable populations, as the implementation of social distancing and home-based self-quarantine could increase those risks.
  9. Encourage staff to formulate aftercare services that are based on existing resources and partnerships in the community.
  10. Provide individuals at risk of suicide with local and national resources of people to talk to if they are feeling suicidal (local crisis call center number, National Suicide Prevention Lifeline, Trans LifeLine, The Trevor Project, and Crisis Text Line).
  11. Encourage the creation and use of Psychiatric Advanced Directives by patients, wherever local jurisdictions permit, that will help provide treatment guidance for providers by patients before their symptoms worsen to the point of impairment in psychiatric medical decision making.
  12. Encourage and promote self-care amongst those providing care to our patients and their families. Acknowledge that healthcare workers will be committed to assisting all shortages/vacancies during these times of crisis and that it is just as important to maintain one’s individual health and wellness for the overall stability of the patients and the care delivery system. In addition to using one’s own internal coping skills and resources, staff should be made aware of all other local, state, and regional options for care.
  13. Ensure that there is adequate funding, governmental, non-governmental and private, to support all activities noted above and ensure that all insurance agencies, public and private, provide appropriate and reasonable reimbursement for the care and treatment of patients with behavioral emergencies.

 1 Osborn, David P J. 2001. “The Poor Physical Health of People with Mental Illness.” Western Journal of Medicine 175 (5): 329–32.

 

Maywood Hosts Pioneering National Conference On Suicide Prevention

Posted: Oct. 5, 2018
Michael Romain, Village Free Press

According to the Centers for Disease control, the rate of suicide in the United States has increased by more than 25 percent since 2009, which made it the 10th leading cause of death in 2016. 

Last week, Maywood was ground zero in the national effort to stem the rate of suicide when the Illinois Suicide Prevention Alliance held its annual summit at the Center for Translational Research and Education on the Loyola Health Services Campus, 2160 S. 1st Ave. in Maywood.

Read the full story here.

 

Step-by-step safety plans, follow-ups can help prevent repeat suicide attempts

Posted: Sept. 18, 2018
Kate Thayer, Chicago Tribune
 
After struggling with depression and self-harm through most of her teenage years, Alyse Ruriani attempted suicide at age 17. While her parents and a hospital stay saved her life that day, she said she has survived ever since with therapy and also by using a so-called safety plan — a step-by-step tool she can turn to in crisis.
 
Ruriani, now a 23-year-old Chicago graduate student studying art therapy at the School of the Art Institute of Chicago, has used her safety plan to identify when she’s headed into a depression and how to keep suicidal thoughts at bay.
 
As she moves through the steps of the plan, “usually that intense feeling subsides,” Ruriani said. “I’m still depressed … but I’m not in a crisis mode that I’m afraid I might attempt (suicide).”
 
Research shows this type of safety planning, combined with prompt follow-up from medical professionals, can help save lives, particularly for those who come to the emergency room after suicide attempts or expressing suicidal thoughts. But while many local hospitals have procedures in place to address the needs of suicidal patients who come to the ER, administrators acknowledged that consistent follow-up can be difficult.
 
Read the full story here.

 

Follow AAEP's New Sites On Social Media

Posted: Aug. 16, 2018

With a transition to a new management company, AAEP is re-establishing and improving its social-media sites. If you've liked our pages in the past or if you've never followed us, could you please take a moment to like our new pages? 

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Pittsburgh Doctor Honored With Exemplary Psychiatrist Award From the

Posted: Aug. 7, 2018
National Alliance on Mental Illness

Pittsburgh - The National Alliance on Mental Illness (NAMI) has awarded John Rozel, MD, MSL, with a 2018 Exemplary Psychiatrist Award. Dr. Rozel is the medical director of resolve Crisis Services, a program of Western Psychiatric Institute and Clinic of UPMC. Dr. Rozel, who is board certified in general, child, and forensic psychiatry, has more than 25 years of experience in emergency mental health.

“If you’re in crisis, you want Dr. Rozel in your corner,” said Christine Michaels, Chief Executive Officer of NAMI Keystone Pennsylvania. “He’s so knowledgeable as a clinician, but he also knows community resources better than anyone.”

NAMI’s Exemplary Psychiatrist Awards program allows state organizations, affiliates, and members across the country to publicly honor the extraordinary contributions that psychiatrists make to improve the lives of people affected by mental illness. Dr. Rozel was nominated by NAMI Keystone Pennsylvania, the state NAMI organization in Pennsylvania, which is located in Pittsburgh.

 
Read the full story here.