Providing the best psychiatric care in a safe environment during the COVID-19 pandemic

Reviewed by Emily Henderson, B.Sc.November 4, 2020

The real heart of inpatient care for psychiatric patients is socialization, group therapy, shared meals, and standard two people per room. So COVID-19 has struck with accompanying public health warnings to isolate, socially distance and wear masks.

This prompted doctors and staff from the University of Texas Health Science Center at Houston (UTHealth) to move quickly to create a strategy for the UTHealth Harris County Psychiatric Center (UTHealth HCPC) that would provide the best psychiatric care in a safe environment in the midst of an epic pandemic. This strategy was published in the October issue of Psychiatric research.

“When COVID-19 started, we were left with the question of how to manage a highly infectious virus in an independent psychiatric hospital. There were no existing published guidelines on how to do this,” said first author Lokesh Shahani, MD, MPH. , assistant professor at the Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth and chief medical officer of UTHealth HCPC.

The largest inpatient psychiatric care provider in the Greater Houston area, the center is a 274-bed, safety net hospital providing care to approximately 9,000 patients annually. It is led by Executive Director Jair C. Soares, MD, PhD, senior author of the paper, and Pat R. Rutherford, Jr. Chair in Psychiatry at the Faillace Department of Psychiatry and Behavioral Sciences.

In mid-March, as Harris County cases increased, hospital executives realized that the chances of a patient infected with COVID-19 were growing rapidly.

Our mission is to treat community patients who have psychiatric conditions and we didn’t want to turn anyone away. The only way to do this was to create an isolated COVID-19 unit. “

Stephen Glazier, COO of UTHealth HCPC

To create the space, new patients were not admitted to that unit and the remaining patients were moved to other units as soon as the places became available. Glazier asked for volunteers willing to staff the unit day and night. Shahani, who is board certified in infectious disease and psychiatry, has decided to lead the infection control initiative.

“I am honored to work alongside our dedicated nursing staff who have come forward and volunteered to care for our COVID-19 patients,” said Shahani. “Staff safety was our top priority and we made sure everyone was trained in the proper use of PPE and had access to it.”

The team sought advice and leadership from co-author Luis Ostrosky, MD, professor of infectious diseases at McGovern Medical School and vice president of health quality at McGovern Medical School. “We had to keep the staff safe as well as the patients,” Shahani said. “Being part of UTHealth and being able to consult with Dr. Ostrosky has been invaluable to us.”

Ostrosky is the commander of the COVID-19 incident for UTHealth. “COVID-19 continues to challenge the way we work. The acquisition of knowledge and flexibility have been key to making changes and adapting to our new reality,” said Ostrosky. “From transporting patients by helicopter, to finding waiting rooms, to securing psychiatric care, UTHealth is here for the needs of our community.”

Complicating the process for the team were patients who refused to be tested for coronavirus or figured out why they had to wear a mask.

“In a medical hospital, patients may have a private room with an attached bathroom, which we do not have, and are tested for the virus. Psychiatric patients do not always consent to testing due to their severe mental illness, and 40% have refused the test, “Shahani said. “Wearing a face mask and adhering to hand hygiene are other necessary measures to keep people safe, but people with chronic severe mental illness don’t have the ability to always follow guidelines like that.”

The team decided to focus on screening for symptoms, fever, contact and travel history. They used extreme caution – anyone suspected of having the virus was isolated.

The first test for the new unit was carried out on April 17, when an asymptomatic patient requested isolation due to recent travel and exposure. Since then, over 100 patients have been treated in the COVID-19 unit, with 52% of them testing positive for the virus.

“We had community partners who needed a safe place to treat patients and we were able to step in and accept these patients,” said Shahani. “During the pandemic we have provided psychiatric care in safety.”

“We couldn’t be more proud of the exceptional team of very dedicated and compassionate doctors and staff we have at UTHealth HCPC,” Soares said. “They have come forward to help us continue to function at very high levels during this unprecedented crisis with the pandemic.”