Psychiatry embraces technology to transform care during COVID-19

Adjusting to the realities of the COVID-19 pandemic required every unit and department to adapt and restructure the way they provide services to patients – in many cases overnight. Yale New Haven Psychiatric Hospital was no exception.

Before March 15, very few services were provided through telehealth at YNHPH. As COVID-19 began to spread, stay-at-home and social distancing recommendations prompted YNHPH staff to turn to telehealth to provide counseling, medication-assisted treatment, group therapy and other forms of care.

Now, after working to deploy hardware and software solutions that connect and protect patients, families, physicians and care teams, “We’ve shifted to nearly 95 percent of ambulatory visits by telehealth,” said Frank Fortunati, MD, JD, medical director, YNHPH.

“We’ve done things we didn’t think were possible,” said Gale Lemieux, assistant director of business affairs, YNHPH. “It took quite the effort, but within three weeks we had shifted almost entirely to a virtual model of care using iPads, FaceTime, MyChart and Zoom for evaluations, group therapy, all of it.”

Staff have made a concerted effort to encourage patients to register for Yale New Haven’s MyChart online patient portal before leaving the hospital so they can stay connected after discharge, Lemieux said. For the small percentage of patients without access to technology needed for MyChart or Zoom therapy sessions, staff do outreach telephone calls.

According to Dr. Fortunati, the shift to telehealth has worked better than anticipated. One noticeable benefit is a dramatic reduction in missed appointments in the ambulatory settings, because patients don’t have to deal with transportation issues. Telehealth has also helped staff be more efficient and effective in sharing expertise among multiple providers, he said.

Most patients are receptive to the changes, but telehealth does have its limitations for others. “The reliance on technology is a concern for patients with certain underlying issues that make it difficult for us to build a rapport,” Dr. Fortunati said. “That’s an issue because our ability to build rapport with our patients is at the heart of psychiatry.”

Other concerns included the temporary absence of milieu observers, who normally work on inpatient units, observing how patients interact with one another. “Watching interactions provides valuable information,” Dr. Fortunati said. “We have to adjust to that.”

Despite some bumps in adapting to the telehealth model, YNHPH continues to use it as COVID-19 cases subside.

“I’m very proud of our team, and how successfully we’ve moved to incorporate telehealth,” Dr. Fortunati said. “It’s working better than I would have hoped.” According to Lemieux, telehealth will likely play an even larger role in the coming months.

“We are anticipating a resurgence of interpersonal issues related to panic, anxiety and depression leading to an increased need for our services,” she said. “We’re examining the best practices that we can take out of this experience and positioning ourselves for that wave. Increased capabilities with telehealth will change how we provide care, to a certain extent.”