Impact of COVID-19 on Provider Assessment and Treatment of Psychosis and Suicide Risk

Background and Purpose: The COVID-19 pandemic has led to substantial psychological impact in the United States and worldwide, and It is well established that epidemics and widespread outbreaks of disease are significantly associated with development and exacerbation of mental illness, increased psychological distress, and need for psychiatric and mental health care. While literature is growingly reporting on the pandemic and its impacts on mental health, less is currently known about its impact on mental health services and delivery from the perspective of mental health providers. The current study explored provider perspectives of mental health services and delivery in the 2020 COVID-19 context.

Methods: Data were collected as part of a National Institute of Mental Health (NIMH)-funded pilot effectiveness clinical trial (R34) aiming to modify and preliminarily test a cognitive-behavioral suicide prevention treatment for adults with psychosis. Adult providers (n=12) in community mental health were recruited through informational presentations given in virtual staff meetings. Quantitative and qualitative COVID-19 pandemic-related questions were included in a brief electronic survey completed by participants between November and December of 2020. Data were analyzed using SPSS27 and Dedoose.

Results: Providers (n=12) were on average 35.67 years of age (SD=6.387), most often identified as female (n= 8, 66.7%), and all (n=12) identified as White and non-Hispanic/Latino. Providers either had a social work license (LMSW or LCSW; n=9, 75%), limited social work license (LLMSW; n=2, 16.67%), or were a Master of Social Work Student in training (MSW student; n=1. 8.33%). All providers (n=12) endorsed having direct contact with clients with the majority in a mental health therapist, clinician, or case manager role (n=10, 83.3%). The average duration of work experience providing services in the mental health field was 5 years and 10 months (SD= 4 years and 1 month) with a range from 6 months to 14 years. Many providers noted increased workload (58%) and the majority shared challenges in remote engagement with clients (77.7%), treatment of psychosis (88.8%), and suicide assessment (77.7%). The following 3 themes of engagement challenges emerged: 1) logistic (e.g., technology barriers), 2) health concerns (e.g., concern of in-person health risk), and 3) ability to deliver services (e.g., engagement via phone or video is challenging). The following 3 themes of psychosis treatment challenges emerged: 1) assessment challenges (e.g., mental status hard to assess remotely), 2) symptomatology (e.g., symptoms may be a barrier to telehealth), and 3) service delivery challenges (e.g., some services not possible to deliver remotely). The following 2 themes of suicide assessment challenges emerged: 1) assessment challenges (e.g., hard to assess affect without seeing facial expressions) and 2) rapport challenges (e.g., hard to build rapport remotely).

Implications and Conclusions: It is essential to consider the COVID-19 pandemic’s impact on mental health service delivery to inform acceptable and feasible approaches to virtual engagement and care. Mixed-method findings lead to recommendations for troubleshooting client access to technology, providing additional training for providers related to virtual engagement and service delivery skills, and increasing support for provider workload increases with a focus on burnout prevention.