In the face of Covid-19, the U.S. needs to change how it deals with mental illness

Jeffrey Geller
STAT NEWS
Originally posted 29 May 20

Here are two excerpts:

Frontline physicians, nurses, and other health care workers are looking death in the face every day. Shift workers in economically treacherous situations are forced to risk their health for a paycheck. Millions of Americans have lost their jobs. Still more are separated from the people they love, their daily routines have been disrupted, and they are making anxious choices every day that affect their physical and mental health.

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Second, Covid-19 has laid bare the severe doctor shortage across the United States, and that shortage includes psychiatrists. While every kind of mental health professional is necessary and indeed critical to responding to the crisis, psychiatrists bring unique expertise in serving some of the most severely compromised patients in psychiatric units and hospitals, long-term care facilities, homeless shelters, and jails and prisons. Forgiving some of the debt that students amass during medical school would incentivize more individuals to serve in these capacities, as would lifting caps on federal funding for new residency slots.

Third, we needed more psychiatric beds in hospitals before Covid-19, and need even more now as physical distancing continues — yet some hospitals have decreased the number of psychiatric beds by converting them to beds for individuals with Covid-19. Patients in psychiatric units who contract Covid-19 need to be separated from other patients. We currently do not have enough beds to treat everyone for the length of time they need. Without federal funding for psychiatric beds, we will have an increase in deaths from the mental health sequelae of Covid-19.

The info is here.

Physician at Epicenter of COVID-19 Crisis Lost to Suicide

Dr. Lorna Breem

Marcia Frellick
MedScape.com
Originally published 28 April 20

Grief-laden posts are coursing through social media following the suicide on Sunday of emergency department physician Lorna M. Breen, MD, who had been immersed in treating COVID-19 patients at the epicenter of the disease in New York City.

Breen, 49, was the medical director of the ED at NewYork-Presbyterian Allen Hospital in Manhattan.

According to a New York Times report, her father, Dr Philip C. Breen, of Charlottesville, Virginia, said his daughter did not have a history of mental illness but had described wrenching scenes, including that patients "were dying before they could even be taken out of ambulances."

The report said Lorna Breen had also contracted the virus but had returned to work after recovering for about 10 days.

Her father told the Times that when he last spoke with her, she seemed "detached" and he knew something was wrong.

"The hospital sent her home again, before her family intervened to bring her to Charlottesville," the elder Breen told the newspaper.

The article indicated that Charlottesville police officers on Sunday responded to a call and Breen was taken to University of Virginia Hospital, where she died from self-inflicted injuries.

The info is here.

COVID-19 Is Making Moral Injury to Physicians Much Worse

Wendy Dean
Medscape.com
Originally published 1 April 20

Here is an excerpt:

Moral injury is also coming to the forefront as physicians consider rationing scarce resources with too little guidance. Which surgeries truly justify use of increasingly scarce PPE? A cardiac valve replacement? A lumpectomy? Repairing a torn ligament?

Each denial has profound impact on both the patients whose surgeries are delayed and the clinicians who decide their fates. Yet worse decisions may await clinicians. If, for example, New York City needs an additional 30,000 ventilators but receives only 500, physicians will be responsible for deciding which 29,500 patients will not be ventilated, virtually assuring their demise.

How will physicians make those decisions? How will they cope? The situation of finite resources will force an immediate pivot to assessing patients according to not only their individual needs but also to society's need for that patient's contribution. It will be a wrenching restructuring.

Here are the essential principles for mitigating the impact of moral injury in the context of COVID-19. (They are the same as recommendations in the time before COVID-19.)

1. Value physicians

a. Physicians are putting everything on the line. They're walking into a wildfire of a pandemic, wearing pajamas, with a peashooter in their holster. That takes a monumental amount of courage and deserves profound respect.

The info is here.

Is it Too Soon? The Ethics of Recovery from Grief

John Danaher
Philosophical Disquisitions
Originally published May 11, 2106

Here is an excerpt:

This raises an obvious and important question in the ethics of grief recovery. Is there a certain mourning period that should be observed following the death of a loved one? If you get back on your feet too quickly, does that say something negative about the relationship you had with the person who died (or about you)? To be more pointed: if I can re-immerse myself in my work a mere three weeks after my sister’s death, does that mean there is something wrong with me or something deficient in the relationship I had with her?

There is a philosophical literature offering answers to these questions, but from what I have read the majority of it does not deal with the ethics of recovering from a sibling’s death. Indeed, I haven’t found anything that deals directly with this issue. Instead, the majority of the literature deals with the ethics of recovery from the death of a spouse or intimate partner. What’s more, when they discuss that topic, they seem to have one scenario in mind: how soon is too soon when it comes to starting an intimate relationship with another person?

Analysing the ethical norms that should apply to that scenario is certainly of value, but it is hardly the only scenario worthy of consideration, and it is obviously somewhat distinct from the scenario that I am facing. I suspect that different norms apply to different relationships and this is likely to affect the ethics of recovery across those different relationship types.

The information is here.