Adjusting to a new normal: Emergency department psychiatry in Australia during COVID-19

By: 

MHIN Team

Posted: 18th May 2020

Dr Tanni Chowdhury is an emergency department psychiatrist (Registrar) in Perth, Australia. She works at Joondalup Health Campus (JHC), which is part of Ramsay Health Care, and is one of the largest hospitals in Western Australia with 722 beds and bays. As well as being a large medical and surgical hospital, JHC provides public services for mental health patients in inpatient and emergency department settings. In this post, Dr Chowdhury shares the challenges of working on the front-lines and considerations for addressing rising mental health problems during and after the pandemic. 

In my experience as a front-line mental health clinician, this pandemic has probably been the most challenging time for our patients and also for health professionals. COVID-19 has given rise to a huge wave of mental health conditions. In the emergency department (ED), I have seen increases in anxiety, distress, insomnia, alcohol use, worsening OCD traits and suicidal ideation. 

This pandemic has affected peoples’ lives at many levels, including work restrictions, unemployment and financial stress. Physical distancing has forced people to change their behaviour with borders closing in and outside the country. Every time people turn on the TV or look at social media, there is no escape from negative news with daily death tolls and economic loss.

As a health care worker, I have felt overwhelmed at times from major changes to the “normal” emergency department 10-hour shift. We have all needed to learn new routines of changing work clothes, procedures for putting on and taking off Personal Protective Equipment (PPE) and stringent hand hygiene. There have been major changes in hospital function in terms of patient flow along with many new policies to learn. As a mental health team, we are working side by side with teams treating COVID-19 in the ED and inpatient settings. In accordance with physical distancing policies, we now must try to build rapport with patients and their families at a distance of 1.5m with limits on the number of people in a room. Hospital inpatients have limits on visitors to decrease the possibility of infection in units.

Possibly as a result of fears of infection and physical distancing guidelines, patients have actually decreased presentations to the ED and to general practitioners. Despite this, we do know of significant community mental health impacts from pent-up anxiety, grief, loss, family stress and domestic violence. A rise in presentations is likely after COVID-19 is under better control. 

As a part of our current activities to help existing patients in the community, we are incorporating phone consultations and counselling, mental health phone check-ins and medication alerts. We are also trying to organise small group therapies as well as mindfulness, meditation, yoga, art, music and sports (table tennis) sessions for our patients. To increase morale, our teammates highlight positive news, such as COVID-19 recovery stories, support from the government and health care system to boost the economy, small initiatives to save local businesses and positive messages from celebrities. 

Arts and music activities

Our hospital is implementing tele-health interviews and follow-up with patients suspected or confirmed to have COVID-19. Benefits of this include decreased use of critical PPE and saving time that mental health clinicians would spend safely putting on and taking off PPE. We are also providing information to our mental health general patients in ED regarding available help in the community, which is crucial during the difficult period of lockdown.

Community resources

Even in emergency settings, our amazing social workers are helping people access available help, focusing on vulnerable groups like youth and immigrants with mental health conditions. Mental health nurses are doing an extraordinary job with anxious and vulnerable patients who need constant reassurance and redirection to remain settled during the chaos.

COVID-19 has impacted on every sector of society. Health workers, however, can be left without the ability to decompress or vent after work. They don’t want to discuss concerns with other staff for fear of causing panic – and also don’t want to burden their families and children. Ramsay Health Care has supported our hospital with a number of innovative approaches to support health care workers. Activities include webinars to share lessons from overseas and develop a number of self-care strategies, for example, mindfulness practices.

In times of limited resources, hospitals need to prevent attrition and burnout from stress and mental health conditions. Our hospital has a new staff wellness program that provides a safe place for staff to talk about their difficult experiences without fear of judgment. Staff can reach out digitally via phone, text or email and contact can be made using a number of conferencing services. We believe that such services might also be useful for other essential workers like food industries, pharmacists, police and retailers who are also on the front-lines of this pandemic.

Australia has greatly benefited from the sharing of experiences and medical information by other countries like the UK, USA, Italy and France. This has allowed us to learn and better prepare for the pandemic. Joondalup Health Campus received thirty international COVID-19 patients from the cruise ship Artania. 

One key aspect of this crisis is that the front-line professionals helping others are themselves at high risk of becoming ill (both physically and mentally) and possibly losing their own lives. This crisis has underscored more than ever that with COVID-19, we are all in this together – and that worldwide, we must act together to address the pandemic.

Key resources:

• Basic Psychosocial Skills: A Guide for COVID-19 Responders (IASC) [Link]
• Basic psychological support for staff health during COVID-19 (ICRC) [Link]
• Mental Health & Psychosocial Support for Staff, Volunteers and Communities (IFRC) [Link]
• Briefing note: Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak (IASC)​ [Link]​