May 27, 2020—Oregon has been spared the worst of the ravages of the global COVID-19 pandemic. As of this writing, the state has one of the lower counts of overall deaths in the nation. But as in nearly all clinical settings the world over, both Oregon’s providers and the patients they serve have seen enormous changes to their daily lives, and to the ways they typically engage with the healthcare system. Many of these changes have produced—or are likely to produce, moving forward—negative effects on mental and behavioral health.
Two of the OMA's psychiatrist members weighed in with their assessments of how the ongoing crisis is affecting, and will continue to affect, patients' mental health. Dr. Mary McCarthy practices in Portland, formerly served on the Executive Committee of the Oregon Wellness Program, and currently serves as the 2019-20 president of the Medical Society of Metropolitan Portland (MSMP).
Dr. Kirk Wolfe is a child and adolescent psychiatrist practicing in Portland with a focus on school district work, agency work, and private practice. Dr. Wolfe holds the rank of Clinical Assistant Professor at the Division of Child Psychiatry at Oregon Health & Science University. He serves on the boards and executive committees of several state organizations, including the Children's System Advisory Committee, Oregon Alliance to Prevent Suicide, Oregon Council of Child & Adolescent Psychiatry, and Oregon Psychiatric Physicians Association. The OMA honored Dr. Wolfe with its 2018 Doctor-Citizen of the Year Award for his efforts to address mental and behavioral health in children and adolescents.
Both Drs. McCarthy and Wolfe are OMA Trustees.
The Pandemic’s Toll on Mental Health
Dr. Wolfe enumerates the ways the pandemic has affected mental health: increased stress, alterations in life routines, rising unemployment, and loss of revenue, to name a few.
“This stress will make the lives of more Oregonians of all ages that much more difficult, with the development or worsening of anxiety, depression, substance use disorders and suicidality,” notes Dr. Wolfe.
Dr. Wolfe says he predicts a sharp increase in the number of Oregonians grappling with these issues “will be exacerbated by our state's shortages of all types of mental health professionals, and health professionals in general.”
Dr. McCarthy concurs, and says she is already seeing the signs.
“In my own practice I have seen patients with an increase in obsessive compulsive behaviors, as well as concerns surrounding cleanliness and excessive fears about going outside for fear of getting ill,” she says. “Isolation for lengthy period is worsening some patients’ depression.”
The massive changes in the way Americans interact can have an especially dramatic effect on a vulnerable population: children and adolescents. Dr. Wolfe notes that the brain continues to develop into the twenties, and that disruptions to lifestyle can disrupt that process as well.
“The sudden changes and ramifications with the pandemic have dramatically reduced support and opportunities for children, adolescents and young adults, and their families, which can negatively impact youth brain development and overall health,” he explains.
“With early recognition and intervention to address those negative changes and enhance protective factors, healthy youth development can get back on track.”
A Challenge for Clinicians
Despite the general sentiment of support for America’s healthcare professionals throughout the crisis, Oregon physicians, physician assistants, and other healthcare workers are not immune to mental health effects of the pandemic’s changes to their way of life.
“The reduction in income because of inability to do many procedures has been stressful for many clinicians,” notes Dr. McCarthy, who adds, “Reopening offices has presented challenges for sanitation and new rules to operate under.”
Even the workarounds to new best practices can present their own challenges, says Dr. McCarthy. She points to the stressors surrounding telemedicine as an example.
“For some patients this works okay, but some don’t do well with this model,” she says. Along the same lines, Dr. McCarthy adds, “Reopening offices has presented challenges for sanitation and new rules to operate under.”
Coupling these stressors with overwork, fatigue, operating outside their specialties, and fear for their families, their staff members, and themselves creates a recipe for bad mental health outcomes. Physicians and physician assistants are poised for problems.
“Increased anxiety, depression, and sleep disorders are common” in clinicians, says Dr. McCarthy. “Other psychiatrists and psychologists I’ve spoken with anticipate some clinicians may develop PTSD symptoms over time as this pandemic continues.”
The outlook may look grim, but Dr. Wolfe offers some words of wisdom in how to view pandemic effects holistically.
“Moving forward, we need to judiciously and decisively get our local communities and state back on track from an economic and other-health perspective,” Dr. Wolfe says. "It is critical we safely and urgently take steps to address the impact on our economy, and the fear and isolation that has developed within many of our families, schools, workplaces, and communities.”