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23 PATIENT & CAREGIVER EXPERIENCE 'More ill, more desperate': How hospitals are responding to changing mental health trends By Katie Adams, Lauren Jensik, Gabrielle Masson and Marissa Plescia I ncreased stress, isolation and burnout among patients and clinicians amid the COVID-19 pandemic shed light on a wide- spread lack of mental health resources. Many hospitals and health systems quickly pivoted their mental health strategies to meet this growing need. In November 2021, Becker's interviewed healthcare leaders across the country about what their organization is doing in response to current mental health trends. Editor's note: Responses were lightly edited for brevity. Question: What mental healthcare trends is your hospital seeing? How has demand changed since the pandemic started? Ben Weinstein, MD. Chair of the Department of Psychiatry and Behavioral Health at Houston Methodist: We have seen signifi- cant fluctuations in the demand for emergency psychiatric services. During COVID-19 surges, people stayed away from the emergen- cy departments and then flooded the EDs when the COVID-19 peak subsided. Just like in general healthcare, the delay in mental healthcare results in an increase in acuity. Patients are more ill and more desperate. Everyone in the community is impacted, especially healthcare workers. Jonathan Ripp, MD. Dean of Well-being and Resilience at the Icahn School of Medicine at Mount Sinai and Chief Wellness Officer at Mount Sinai Health System (New York City): We im- plemented a longitudinal assessment examining the psychological impact of the pandemic on front-line healthcare workers. Symptoms of depression, anxiety and post-traumatic stress affected nearly 2 in 5 workers at the start of the pandemic, but decreased to just over 1 in 5 seven months later. ough these mental health outcomes decreased, burnout remained high, affecting nearly half the workforce through- out. Despite these findings, we saw that more than 75 percent of our sample experienced post-traumatic growth seven months aer the first wave at the end of 2020. Olga Barg, MD. Associate Professor of Clinical Psychiatry at the Perelman School of Medicine at University of Pennsylvania (Philadelphia): Demands for mental health treatment have steadily increased during the pandemic. We are seeing higher-acuity patients in our ambulatory practices, emergency departments and on hospital services. Interruptions in community-based treatment resources early in the pandemic have added to the higher acuity of patients presenting for inpatient care, as well as creating added challenges of coordinating care on discharge. Inpatient psychiatric and addiction treatment units across the region face challenges to meet the growing treatment needs. Additionally, admissions and infection protocols for COVID-19 have reduced inpatient psychiatric bed availability, which can create lon- ger boarding times in medical emergency departments and medical hospital settings. e pandemic also created an increased need for mental health support for our employees who had to rapidly adapt to meet our community's healthcare needs. David Ginsberg, MD. Vice Chair of the Department of Psychi- atry at NYU Langone Health (New York City): Over the course of the pandemic, we have identified many contributing factors to an increase in both inpatient and ambulatory mental health needs, including contracting COVID-19; grief over loss of family members, friends or work colleagues; economic stressors; grieving the loss of certain freedoms; decreased exercise and movement; and family care obligations. Specifically, the increase in behavioral healthcare de- mand was most associated with illnesses such as depression, anxiety, profound grief and post-traumatic stress disorder. What has most changed since the pandemic began is the sheer number of people seeking care and diagnosed with these conditions. Itai Danovitch, MD. Chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center (Los Angeles): The trends at Cedars-Sinai mirror national trends. Nationally, there has been an increase in substance use disorders, depression, anxiety, suicidal ideation and other mental health conditions over the course of the pandemic. These issues are likely tied to stress, social isolation, difficulty accessing services, COVID-19 itself and other social determinants that have been exacerbated by the pandemic. Bryan King, MD, Vice President of Child Mental Health at UCSF Health, and Dan Becker, MD, Vice President of Adult Mental Health at UCSF Health (San Francisco): e pandemic has had pro- found mental health effects throughout the population. Numerous stressors have contributed to these effects, including direct impacts on health, economic stress, concerns about job and housing security, and increased child care responsibilities. Children and adolescents, in particular, have missed important social development opportuni- ties. And social isolation has compounded the loneliness experienced by many segments of our society, including senior citizens and those with severe mental illness and substance use disorders. e resulting increase in demand for mental health and substance use services, along with the constraints placed by the pandemic, has transformed how we deliver services. For each of the past several years, UCSF Health has seen marked annual increases in demand for mental health services across all hospitals and clinics. e pandemic has directed a spotlight on national challenges with mental healthcare delivery, including a longstanding crisis with respect to child and adolescent care. Access remains a critical issue for our health system despite leveraging tele- health, expanding outpatient access by nearly 30 percent, and more than doubling the number of child and adolescent psychiatrists and psychologists on our staff. James Potash, MD. Director of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins Hospital (Baltimore): Early on, the pandemic posed great challenges for us, as it did for every- one. ere was a reduction in the number of people coming into the psychiatric emergency service, but for those who did come in and needed admission, we had to set up a system to COVID test them. e people who did get admitted tended to be more psychiatrically ill than we were used to. Now the flow of psychiatric patients in the emergency department is back to normal, and the COVID processes are all ironed out. But our inpatient bed capacity remains reduced