What we know about COVID-19 makes it a formidable threat to physical health. But what we don’t know may prove just as dangerous. As we face new uncertainties such as fear of infection, working from home, temporary unemployment, home schooling of children, and restricted contact with friends and loved ones, we must safeguard mental health as well as physical health.
Across UTHealth, our experts are confronting the unknown to address the stress and anxiety caused by the pandemic—from surveying COVID-19’s impact on mental health in our communities to increasing access to behavioral health care to helping health professionals cope with the anxiety and stress of being on the frontline. The following spotlights show how our extraordinary health care professionals are protecting mental health in our communities during one of the greatest health challenges of our time.
A tool for trauma
Roughly half of all Americans are carrying a cup that is partially filled—they endured a traumatic event such as a violent assault, disaster, accident, or combat. Pour in the stress and anxiety from the COVID-19 pandemic, and these cups risk overflowing.
“For people who suffered a past trauma, COVID-19 is creating new psychological obstacles to overcome while intensifying the memories and emotions surrounding previous trauma,” says Ron Acierno, PhD. “Just as we must be prepared to address the medical impact of this pandemic, our society needs to be prepared to address the psychological impact of a crisis like this.”
Acierno leads the UTHealth Trauma and Resilience Center, where experts use evidence-based psychotherapy to help people overcome traumatic life experiences. To improve accessibility and meet the increasing needs of our community during the pandemic, the center switched to home-based telemental health care through UT Physicians as stay-at-home orders brought most businesses and organizations to a halt.
“Without prompt treatment, the psychological impacts of trauma can become lasting impairments,” explains Acierno. “Telemental health allows us to serve patients in their homes using videoconferencing, helping us to avoid interruptions in treatment and get patients care when they need it most.”
Stephanie Emhoff, PhD, was among the first to use telemental health to treat patients when the center began testing it in September 2019.
“Although the transition to seeing patients via telemental health happened rapidly when COVID-19 struck, it was seamless,” she says. “Even patients who were initially wary about the switch have been pleased by how accessible it has made care.”
In addition to cutting out the transportation time and parking costs associated with in-person appointments, the switch to telemental health has reduced patient wait times and enabled patients to schedule multiple UT Physicians visits per week if necessary.
“When the dust settles, I think we are going to find that this pandemic impacted virtually everyone,” says Emhoff. “Telemental health is here to stay, and it will become an invaluable tool in healing the psychological damage caused by COVID-19.”
Helping the helpers
During times of crisis, we look to our heroes to save the day. As we weather the COVID-19 pandemic, countless health professionals have donned personal protective equipment to safeguard our communities on the frontlines. While we depend on these heroes to halt the advance of the virus and heal us if we fall ill, who can they turn to for support?
“On top of the anxieties we are all facing during this challenging time, frontline health care providers are also contending with the stress of being exposed to patients with COVID-19 and the possibility of spreading it to loved ones,” says Bobby R. Nix, MD. “Add on the initial shortages in personal protective equipment, extended work hours, and unusual schedules, and new stressors materialize each day.”
In early April 2020, Nix led an initiative to create a dedicated mental health support phone line for UTHealth employees. Marsal Sanches, MD, PhD, and Thomas D. Meyer, PhD, joined Nix, and the trio opened up their schedules to provide mental health support to colleagues in need.
“Prior to the pandemic, there was a three-month average wait time to see a psychiatrist in Houston,” says Nix. “We wanted to provide immediate support, so we made it possible for colleagues to schedule next-day appointments via telemedicine.”
Through virtual visits, Nix and Sanches offer complete psychiatric care, and Meyer provides psychotherapy services.
Much like sponges, health care providers often absorb the trauma they are helping to heal, causing them to experience it vicariously. Without outlets to address these feelings, vicarious trauma can cause burnout and compassion fatigue.
A MINDFULNESS EXERCISE TO GROUND YOURSELF IN THE PRESENT DURING STRESSFUL TIMES
Jennifer B. Hughes, PhD, counsels colleagues and patients to acknowledge feelings of grief and fear and to use grounding techniques to return to the present moment.
“Grounding can be a quick and easy process that anyone can use by engaging their senses,” she says. “My go-to technique is called 5-4-3-2-1: Name five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste.”
Just as acknowledging emotions can provide an outlet for traumatic experiences, grounding techniques can help health professionals return mentally to the present to focus fully on caring for patients.
There’s an app for that
Extreme stress and anxiety can weaken the immune system’s ability to ward off infections— a vital capability during a health crisis.
UTHealth offers help directly on phones, laptops, and tablets through a digital cognitive behavioral therapy (DCBT) app. Developed by Magellan Health, the app offers research-proven therapy through online modules tailored to six specific areas: anxiety disorders, depression, chronic pain, obsessive-compulsive disorder, substance use, and sleep difficulties.
“The program forms part of a stepped-care process,” says Elizabeth Newlin, MD, who originally led the effort to create the app in response to the mental trauma caused by Hurricane Harvey. “It can help treat milder symptoms, and people who experience greater severity can seek additional intervention, including home telemental health.”
The DCBT app, available for free to all Houston and Harris County adults through December 2020, screens users to determine which modules best suit their needs and can track the progress of symptoms based on user input. If symptoms worsen, the program will prompt the person to call the UTHealth Trauma and Resilience Center or the National Suicide Prevention Lifeline— otherwise known as the Suicide Hotline.
As people continue to live isolated—at least physically—from many of their supportive relationships, the DCBT app can help provide ways to cope.
“Even for those of us who might be coping well, it’s always a good idea to detail a plan and identify resources in case you do need help in the future,” Newlin says. “It can be difficult to find help when suffering psychological distress, but the DCBT app can help shore up your coping capacity and ensure you’re well prepared for ongoing mental health demands related to the pandemic.”
Philanthropy and the mental health challenges of COVID-19
With the devastating physical health effects of COVID-19, it may be easy to overlook the anxiety and trauma the pandemic inflicts. As UTHealth investigates new treatments for the virus, it also works to solve the mental health challenges COVID-19 brings to our communities.
Philanthropic funds, such as the President’s Excellence Fund and the Graham Family Scholars Program, have sparked collaborative research projects to explore better treatments for COVID-19, predict who will have poor outcomes, and determine the disease’s long-term effects on mental health. The following projects illustrate some of the ways UTHealth experts are working together to address pandemic-related mental health issues.
Increasing access to mental health care and creating better outcomes
Lokesh Shahani, MD, and Gordon Shen, PhD, are evaluating the use of virtual technology to deliver health services in psychiatric hospitals across Texas during the pandemic. This could help improve the quality of behavioral health care in times of emergency.
“Extensive shutdowns and quarantines have exacerbated psychological distress for many people and created new mental health obstacles for others,” says Shahani. “Using telemental health, we have an opportunity to tailor care to the needs of patients while making it more accessible.”
Creating a better understanding to provide better care
Kevin O. Hwang, MD, and his team are surveying the physical and mental effects of the pandemic on patients who receive COVID-19 testing at UT Physicians clinics. The researchers aim to help health professionals optimize the care they provide.
“History warns us that the trauma and anxiety caused by a pandemic may persist long after the microbe is defeated,” says Hwang. “Our study will yield a deeper understanding of issues our patients face during and after the pandemic, which will allow UT Physicians to align personnel and resources to best meet the needs of our patients.”
The President’s Excellence Fund and the Research Accelerator Fund—the university’s crowdfunding initiative to tackle the most pressing health needs—will continue to give UTHealth leadership flexible resources to support high-impact projects that address the pandemic and future health challenges.
To join the response to COVID-19 by supporting the Research Accelerator Fund, visit go.uth.edu/raf.