Facing the COVID Crisis

July 16, 2021

In early spring 2020, McLean President and Psychiatrist in Chief Scott L. Rauch, MD, predicted that across the country, the COVID-19 medical surge would be closely followed by a second life-threatening surge—one focused on the need for urgent psychiatric care.

By mid-May, the demand for psychiatric beds across Massachusetts was overwhelming, causing McLean’s leadership to take action in concert with leadership across the Mass General Brigham (MGB) system.

“After thoughtful consideration, we chose to launch a 20-bed adult inpatient program on our Belmont campus and an additional four beds at our Middleborough site,” said Rauch, who also serves as chair of System Behavioral and Mental Health (SBMH) for MGB.

“We felt it was our obligation to the people we serve to do everything we could to increase capacity and enhance access as we sought to address the needs of our communities in Eastern Massachusetts and beyond.”
– Dr. Scott L. Rauch

The new inpatient program, known as the North Belknap Inpatient Program (NB1), is the first major inpatient bed expansion for McLean since 2016 and the first new inpatient program since 1987. NB1 opened its doors in October 2020, while the additional beds at McLean SouthEast (MSE) in Middleborough began accepting patients in January 2021.

“We are thrilled to offer expanded services for adults who need inpatient care for a variety of psychiatric disorders,” said Linda M. Flaherty, RN, PMHCNS-BC, senior vice president, Patient Care Services at McLean. “Both NB1 and MSE serve an array of patients and families and will be tremendously beneficial in reducing the stress that we are currently seeing in emergency rooms across MGB and the state.”

Mental Health in a Pandemic

Although McLean’s admissions dropped significantly during the initial COVID-19 medical surge, Rauch and the hospital leadership team viewed that as the quiet before the storm.

“The reduction in patients seeking psychiatric care during the height of COVID correlates to people’s fear of going to emergency rooms (ERs)—the primary referral source for our inpatient programs,” explained Susan M. Szulewski, MD, associate chief medical officer for McLean.

“People were afraid to go anywhere they would encounter other people and potentially expose themselves to COVID. Hospitals were the perceived place to avoid, so unless it was a dire emergency, people stayed home and got sicker and sicker. We knew that once the medical surge subsided and people began to feel physically safer, we were going to experience a mental health surge.”

Both Rauch’s and Szulewski’s predictions were accurate. Immediately following the medical surge, patients needing urgent psychiatric care began arriving in emergency rooms across the state in unprecedented numbers. Despite the increased number of beds on NB1 and MSE, McLean continues to operate at capacity, while demand for psychiatric services continues to exceed supply, according to Szulewski.

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To help manage the demand, McLean’s Director of Psychiatric Admissions Wendy Currie, LICSW, along with Szulewski and other clinical leaders from McLean and from across the system, meet each morning to coordinate the assignment of patients from ERs. This allows for patients in ERs to be moved as quickly and efficiently as possible to appropriate beds within the system.

This daily meeting, organized by Joy B. Rosen, vice president for SBMH, and Christine F. Spring, senior program director for SBMH, has vastly improved communication and collaborations, benefiting the hospitals and patients.

“By distributing patients throughout the MGB system—a process known as level-loading—we are able to ensure that each patient is receiving high-quality care quickly, without overburdening one hospital,” said Rauch. “This is a great example of how being part of a system like MGB benefits patients and families, enabling McLean and all of MGB to better meet our mission.”

Szulewski elaborated on the process, noting that each patient’s needs are assessed by the team, and from there, it is determined which hospital is the best fit.

“All of these calls are done with the mindset of determining what is best for the patient,” said Szulewski.

Why Is the Demand So High?

The demand that McLean, the MGB system, and the entire state is seeing is part of a national trend in mental health post-COVID, explained Szulewski.

  • Last June, the CDC released a report noting that about 25% of adults in the United States reported symptoms of anxiety disorder—triple the rate reported in 2019
  • According to the same report, one in four young adults ages 18 to 24 had seriously considered suicide in the past month
  • Beyond that, more than half of U.S. adults who participated in a recent poll said their mental health had been “negatively impacted, due to worry and stress over the coronavirus”

Rauch attributes the large-scale increase in psychiatric distress to several factors, including fear of infection, the stress of disruption in our daily lives, the global economic crisis, and tremendous loss and grief around us, as well as a diminished sense of community, social contact, and other sources of joy and resilience.

“The trauma from COVID-19 is in many ways more profound and vast than anything we have seen before in our lifetimes,” Rauch said. “It’s at a larger scale than 9/11 or Katrina. This crisis is protracted now for many months and extends throughout the nation, as well as around the globe.”

What Is Next?

With the increased need for psychiatric services, Rauch and the McLean leadership team continue to explore innovative ways to meet the demand of patients and families. This includes McLean’s development of a new 68-bed inpatient program in southeastern Massachusetts expected to open in 2021. While increasing the physical capacity of the hospital is beneficial, so is the adoption of telemedicine as an innovative way to expand ambulatory services safely.

On January 1, 2021, Massachusetts Governor Charlie Baker signed a telehealth bill that paves the way for telemedicine to be part of everyday care well after the pandemic ends. This new law mandates permanent payment parity for telehealth services and established parity for primary care and chronic care management for the next two years.

More than half of U.S. adults who participated in a recent poll said their mental health had been “negatively impacted, due to worry and stress over the coronavirus.”
– Kaiser Family Foundation poll

“I’ve thought for a long time that because as a country we underinvest in primary care and behavioral health services, a lot of people who could be treated in the community end up in the hospital, and we will basically have a chance here to study this question,” Baker said in a statement to the press. “I think we’ll discover that by investing more or giving people more options to access care and supports, they will stay healthier and spend less time in the hospital.”

Rauch agreed with Baker’s assessment and is hopeful that the trends McLean, MGB, and others have seen in telemedicine since the beginning of the pandemic reflect the appetite for this kind of service in the future.

“Over the summer we saw up to a 30% increase in our outpatient encounters thanks to the convenience of ‘virtual visits’ through telehealth methods. While it will never entirely replace the need for in-person therapies, ‘tech-enabled care’ promises to revolutionize the field, enhancing access, effectiveness, and cost efficiency,” said Rauch.

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