To be honest, we are all experiencing anxiety during these turbulent times. Even for people who usually have healthy lifestyles and are well adjusted in life, and even for people who are not anxious at baseline, there’s an undercurrent of anxiety. We worry about our personal health, the health of our family, and the health of our community. We wonder when the health of our community will improve so we can return to life as usual. I used to love going to music concerts in crowded venues, but now I get stressed when someone invades my space in the grocery store.
For people who are suffering with a mental disorder, symptoms can be exacerbated with the heightened anxiety in our culture. This anxiety has impacted our community fabric and the behavioral health support continuum. It has impacted how we function, as well as the resources and availability for support. The people who usually come in contact with people who have an exacerbated mental disorder may include law enforcement, EMS, hospitals, mental health clinics, social service agencies, outpatient providers, etc., and yet many providers have restricted access or shifted to telehealth. Although emergency departments are set up to triage someone safely who may need inpatient hospitalization, there was an early fear communicated by the media about avoiding the emergency departments to avoid COVID.
How can someone who is tormented by their mental illness and at the lowest point in their life get help with all these inherent barriers? Collectively, we need to remain cognizant of these people who are part of our community and we need to support access to care by understanding our access points have changed.
For the resourceful and lucky people who are able to access inpatient level of care when they are in imminent danger of harming themselves or others, higher anxiety may lead to higher agitation. High agitation, sitting on top of other comorbid conditions, may be associated with unwanted clinical indicators like aggression, property destruction, seclusion/restraint rates and more dysfunction with interpersonal relationships. The more dysfunction with interpersonal relationships, the higher incidence of depression and substance abuse.
Given the fears and high anxiety associated with being physically close to others, even with a mask, we have to recognize that anxiety in the behavioral health design process. Going forward, it doesn’t seem right to design group room space where patients can rub elbows, or bump into each other while eating their meals, or walking in hallways. Designing space and understanding patient flow in light of this additional variable of physical distancing and anxiety will definitely be important. We have always wanted our spaces for inpatient units to be warm and therapeutic – not adding another mountain of anxiety on top of all our normal challenges, nuances, and operations.
We can do this. We all need to protect this vulnerable population.
