Providing a safe environment for psychiatric patients during pandemic

November 04, 2020

The very heart of inpatient care for psychiatric patients is socialization, group therapy, shared meals, and a standard two people per room. Then COVID-19 hit with the accompanying public health warnings to isolate, socially distance, and wear masks.

That sent clinicians and staff from The University of Texas Health Science Center at Houston (UTHealth) moving quickly to create a strategy for the UTHealth Harris County Psychiatric Center (UTHealth HCPC) that provided the best psychiatric care within a safe environment in the middle of an epic pandemic. That strategy was published in the October issue of Psychiatry Research.

"When COVID-19 began, we were left with the question of how to manage a highly infectious virus in a freestanding psychiatric hospital. There was no existing published guideline on how to do this," said first author Lokesh Shahani, MD, MPH, assistant professor in the Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth and chief medical officer of UTHealth HCPC.

The largest provider of inpatient psychiatric care in the Greater Houston area, the center is a 274-bed, safety-net hospital that provides care to around 9,000 patients each year. It is led by Executive Director Jair C. Soares, MD, PhD, senior author of the paper, and Pat R. Rutherford, Jr. Chair in Psychiatry in the Faillace Department of Psychiatry and Behavioral Sciences.

By mid-March, with rising Harris County cases, hospital leaders realized that the chances of a patient arriving who was infected with COVID-19 were rapidly growing.

"Our mission is to treat patients in the community who have psychiatric conditions and we didn't want to turn anyone away," said Stephen Glazier, COO of the hospital. "The only way to do that was to create an isolated COVID-19 unit."

To create the space, new patients were not admitted to that unit and remaining patients were moved into other units as spots became available. Glazier asked for volunteers willing to staff the unit day and night. Shahani, who is board certified in infectious disease as well as psychiatry, decided to lead the infection control initiative.

"I am honored to work alongside our dedicated nursing staff who stepped up and volunteered to take care of our COVID-19 patients," Shahani said. "Staff safety was our priority and we made sure everyone was trained in appropriately using PPE and had access to the same."

The team turned for advice and leadership from co-author Luis Ostrosky, MD, professor of infectious diseases at McGovern Medical School, and vice chair of Healthcare Quality at McGovern Medical School. "We had to keep staff safe as well as patients," Shahani said. "Being a part of UTHealth and able to consult with Dr. Ostrosky was invaluable for us."

Ostrosky is the COVID-19 Incident Commander for UTHealth. "COVID-19 continues to challenge the way we work. Knowledge acquisition and flexibility have been key in making changes and adapting to our new reality," Ostrosky said. "From transporting patients in helicopters, to figuring out waiting rooms, to making psychiatric care safe, UTHealth is here for our community's needs."

Complicating the process for the team were patients who refused to be tested for the coronavirus or understand why they had to wear a mask.

"In a medical hospital, patients are able to have a private room with attached bathroom, which we don't have, and they are tested for the virus. Psychiatric patients don't always consent for testing because of their severe mental illness, and 40% refused testing," Shahani said. "Wearing a face mask and adhering to hand hygiene are other measures needed to keep people safe, but people with chronic severe mental illness don't have the ability to always follow guidelines such as that."

The team decided to focus on screening for symptoms, fever, contact, and travel history. They used extreme caution: anyone who was suspected of having the virus was isolated.

The first test for the new unit came April 17 when an asymptomatic patient required isolation because of recent travel and exposure. Since then, over 100 patients have been treated in the COVID-19 unit, with 52% of them testing positive for the virus.

"We've had community partners who needed a safe place to treat patients and we have been able to step in and accept these patients," Shahani said. "We have been safely delivering psychiatric care during the pandemic."

"We could not be any prouder of the outstanding team of very committed, compassionate clinicians and staff we have at UTHealth HCPC," Soares said. "They stepped up to help us continue to function at very high levels through this unprecedented crisis with the pandemic."
Scott Lane, PhD, professor, vice chair for research for the psychiatric department, and director of research for the hospital, was a co-author. Lane and Soares are members of The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences.

University of Texas Health Science Center at Houston

Related Psychiatry Articles from Brightsurf:

The Lancet Psychiatry: First UK-wide study describes brain complications in some patients with severe COVID-19
A study of 153 patients treated in UK hospitals during the acute phase of the COVID-19 pandemic describes a range of neurological and psychiatric complications that may be linked to the disease and is published today in The Lancet Psychiatry journal.

Revisiting the potential of using psychedelic drugs in psychiatry
Before they were banned about a half century ago, psychedelic drugs like LSD and psilocybin showed promise for treating conditions including alcoholism and some psychiatric disorders.

Psychiatry: Five clearly defined patterns
Psychiatrists led by Nikolaos Koutsouleris from Ludwig-Maximilians-Universitaet (LMU) in Munich have used a computer-based approach to assign psychotic patients diagnosed as bipolar or schizophrenic to five different subgroups.

The Lancet Psychiatry: Life-course-persistent antisocial behaviour may be associated with differences in brain structure
Individuals who exhibit life-course-persistent antisocial behaviour - for example, stealing, aggression and violence, bullying, lying, or repeated failure to take care of work or school responsibilities - may have thinner cortex and smaller surface area in regions of the brain previously implicated in studies of antisocial behaviour more broadly, compared to individuals without antisocial behaviour, according to an observational study of 672 participants published in The Lancet Psychiatry journal.

The Lancet Psychiatry: Abortion does not increase a woman's risk of attempting suicide
Policies based on the notion that undergoing an abortion causes or increases women's risk of suicide attempts are misinformed, according to the results of a 17-year-long observational study including more than half a million 18 to 36-year-old Danish women who had a first, first-trimester abortion, published in The Lancet Psychiatry journal.

How artificial intelligence can transform psychiatry
Scientists have developed a new mobile app that categorizes mental health status based on speech patterns.

The Lancet Psychiatry: Improved support after self-harm needed to reduce suicide risk
To reduce the high risk of suicide after hospital attendance for self-harm, improved clinical management is needed for all patients - including comprehensive assessment of the patients' mental state, needs, and risks, as well as implementation of risk reduction strategies, including safety planning.

The Lancet Psychiatry: Insufficient evidence that medicinal cannabinoids improve mental health
The most comprehensive analysis of medicinal cannabinoids and their impact on six mental health disorders -- combining 83 studies including 3,000 people -- suggests that the use of cannabinoids for mental health conditions cannot be justified based on the current evidence.

'Spin' found in over half of clinical trial abstracts published in top psychiatry journals
'Spin' -- exaggerating the clinical significance of a particular treatment without the statistics to back it up -- is apparent in more than half of clinical trial abstracts published in top psychology and psychiatry journals, finds a review of relevant research in BMJ Evidence Based Medicine.

The Lancet Psychiatry: Compensatory strategies to disguise autism spectrum disorder may delay diagnosis
For the first time, compensatory strategies used by people with autism have been investigated and collated in a qualitative study using an online survey of 136 adults, published in The Lancet Psychiatry journal.

Read More: Psychiatry News and Psychiatry Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to