A doctor’s diary from a pandemic: Mental illness

Almost every day I walk through the patient care areas of our hospital at Hennepin Healthcare and lately I’ve been visiting the staff and patients in our 6 psychiatry units. Since I’m an internist, meaning I care for people with medical illness, I usual focus on patients on the internal medicine floors. But walking through the psychiatry units reminded me of the unique place people who experience mental illness are in.

At our hospital, just about 1 in 4 patients in the hospital is in a psychiatric unit with a mental health diagnosis. Possibly that is more than you realized previously. They are representative of all of us: rich and poor, young and old, urban and rural, you name it. Mental illness is a reality for all of our community. Furthermore, our mental health system is fragmented and historically we have not adequately provided a system robust enough to provide the care people need and deserve. So this pandemic presents unique challenges.

The current COVID-19 pandemic presents is hard enough for all of us. It produces anxiety in people who previously had not experienced such things. But for those who are experiencing mood disorders, psychoses, and other severe mental health conditions, it can be especially troubling. Coping with everyday life can be challenging in the best of times for people experiencing mental health issues. During this pandemic it can be crisis-provoking.

But the staff in the psychiatry units at Hennepin (and every other hospital) are skilled and dedicated to patients with mental illness. Here’s some insider info . . . the psychiatry units are not like regular hospital hallways that you may have in your head. They are more like a dorm at a college, with rooms down the halls around a common area when patients and staff co-mingle, eat together, watch TV together, and help each other heal. They have rooms for group therapy which are vital to the healing process. They have a kitchen-area where people have access to snacks. The nursing desks are centrally located which allows for lots of interaction.

All of this is challenging to do when coronavirus is on the mind of everybody. How do you do social distancing in that setting? How do the doctors and nurses and therapists promote healing when part of healing is socialization and group activities? How do you calm frazzled nerves when someone in a common area coughs or sneezes? How do you do all this when the length of hospitalization is measured in many days or even weeks?

Over the years I have become rather close to some of my colleagues in psychiatry and I appreciate the skill set of a psychiatry nurse or doctor so much more than I did a few years ago. So I write this post to honor those who care for people with mental illness and in support of those among us who are experiencing mental illness. During this pandemic – but really any time – I hope we all will check up on our friends and neighbors who may be struggling and to reach out to them by phone or from across the yard from a safe distance and offer a word of support.

Check out Minnesota NAMI for online courses and support.

For more good resources on mental illness, including COVID-19 information, check out the National Alliance on Mental Illness.

Follow me on Twitter if you wish @DrDavidHilden

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The intersection of physical and mental health

“Despair” (public domain art)

A good part of my medical practice at Hennepin Healthcare is in mental health.  Although I’m a general internist, meaning I specialize in chronic diseases of adults, I have a special interest in the intersection of medical and mental illness.  Consequently, I spend a hefty portion of my days on the inpatient psychiatry units.  So when a piece came out in the New York Times this week, I was immediately drawn to it.  Written by Dr. Dhruv Khullar from New York-Presbyterian Hospital, it is entitled The Largest Health Care Disparity We Don’t Talk About.  I strongly encourage you to read it.

This is particularly of interest to me since I have also been part of a group of five medical systems across the country who have recently published our own experience in caring for people with mental illness. You can read our very brief paper at the Annals of Internal Medicine.

In this post I’ll talk a bit about my own experience in caring for patients with mental health conditions.  I’ll end with a few suggestions. Continue reading “The intersection of physical and mental health” Facebooktwitterredditpinterestlinkedinmail