The world of mental illness has shifted dramatically with the Covid-19 epidemic as things we never fathomed would be reality became reality. The effect on mental health has been monumental and has caused â€œmajor emotional distressâ€ (Bojdani, 2020). The combination of no known treatments for the virus as well as limited access to vaccines leads to extensive fears of developing an infection or giving the infection to others (Bojdani, 2020). The emotional negativity coming from adjusting to such fear is frequent and can extend into â€œanxiety, depression, and post-traumatic stress syndromeâ€ (Bojdani, 2020).
Patients who already suffer from mental illness were especially vulnerable in â€œsomatic, cognitive, behavioral, and psychosocialâ€ ways but also were at risk for gaps in mental health treatment (Bojdani, 2020). Access to much-needed psychiatric and substance abuse treatment was already a significant barrier for the mentally ill and addicted population but the pandemic only served to worsen this barrier (Slavova, Rock, Bush, Quesinberry, & Walsh, 2020). This resulted from an even fewer number of available mental health providers as they are swarmed with new-onset mental illness patients on top of the previously overloaded population of providers (Slavova, Rock, Bush, Quesinberry, & Walsh, 2020).
Among drug users, the number of overdoses in the emergency rooms and overdoses who refused to go to the Emergency Rooms increased dramatically (Slavova, Rock, Bush, Quesinberry, & Walsh, 2020). Experts have attributed this to various causative factors, such as increased likelihood to use drugs alone and therefore no one being there to notify emergency services as well as a decreased desire to be in the emergency room for fear of exposure to Covid-19 (Slavova, Rock, Bush, Quesinberry, & Walsh, 2020). Researchers speculate that there are many additional factors in regard to drug distribution that have affected drug use but these are challenging to identify specifically (Slavova, Rock, Bush, Quesinberry, & Walsh, 2020).
The provision of mental health changed during the pandemic in every setting. Those in inpatient settings faced limited admission with tighter criteria for admission criteria (specifically for certain self-admission substance use treatment) (Sheek-Hussein, Abu-Zidan, & Stip, 2021). In group therapy, the ability to socialize or dine together while inpatient, and in some cases direct access to their providers was significantly limited if not obsolete (Sheek-Hussein, Abu-Zidan, & Stip, 2021). Doctors are also emerging from medical schools without adequate psychiatric training as many were removed from their psychiatric rotation to assist in other more pertinent areas during the pandemic (Sheek-Hussein, Abu-Zidan, & Stip, 2021).
As many restrictions were temporarily lifted, it was the PMHNPs who lead the profession in the switch to telehealth treatment while also increasing their hours during the initial stages of the pandemic to meet the increased need for mental health care (Oâ€™Reilly-Jacob, Tierney, Freeman, & Perloff, 2022). Fifty-two percent of nurse practitioners felt that the temporary lift of restrictive practice regulations decreased the weight of collaborative rules and bettered their practices (Oâ€™Reilly-Jacob, Tierney, Freeman, & Perloff, 2022). As NPs have done throughout history, they rose to challenge, and with the lift on many restrictions, they now have the freedom of expanded practice locations geographically with expanded means of delivering effective care at lower cost in order to once again take the front lines in mental health crises (Oâ€™Reilly-Jacob, Tierney, Freeman, & Perloff, 2022).
If anything, the Covid-19 pandemic has given a glimpse at how minimally mental health care is : included in current disaster planning (Sheek-Hussein, Abu-Zidan, & Stip, 2021). The insight we have learned is creating an outcry among disaster management specialists who instruct that further planning should include â€œthe full scope of the disaster including preparedness, mitigation, response, and recoveryâ€(Sheek-Hussein, Abu-Zidan, & Stip, 2021). NPs in psychiatric care is at the forefront of this movement.
Bojdani, E., Rajagopalan, A., Chen, A., Gearin, P., Olcott, W., Shankar, V., … & DeLisi, L. E. (2020). COVID-19 pandemic: impact on psychiatric care in the United States. Psychiatry Research, 289, 113069. doi: 10.1016/j.psychres.2020.113069.
Oâ€™Reilly-Jacob, M., Tierney, M., Freeman, P., & Perloff, J. (2022). Emergency removal of supervision requirements for psychiatric mental health nurse practitioners: A mixed-methods survey. Psychiatric Services, appi-ps. doi:10.1176/appi.ps.202100725.
Sheek-Hussein, M., Abu-Zidan, F.M. & Stip, E. (2021). Disaster management of the psychological impact of the COVID-19 pandemic. Int J Emerg Med, 14(19). doi:10.1186/ s12245-021-00342-z.
Slavova, S., Rock, P., Bush, H. M., Quesinberry, D., & Walsh, S. L. (2020). Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug Alcohol Depend, 214:108176. doi: 10.1016/j.drugalcdep.2020.108176.