Addiction and Recovery Treatment during COVID

I am a mental health and addiction therapist and currently work at a hospital.  My experience with COVID-19 as a therapist has been somewhat different from others in my profession, as my site considers us essential, in-office employees.  We have been reporting to the office since March when COVID-19 precautions began, compared to some therapists who have converted to doing teletherapy strictly from home.  We have made some adaptations in our clinic and now offer audio-visual therapy from our site, though do still have some in-person patient interaction and have special PPE for this.  Also, due to working with dual-diagnosis and our patients being prescribed strong psychotropic and maintenance medications, we interact with our patients on a much more frequent basis than clients in traditional outpatient settings.   My organization first learned of COVID-19 a little before it was majorly publicized in the news, so I quickly realized it was going to be a major life event.  At first, I remember being anxious both personally and professionally, with the main concern being how to maintain the health and safety of myself and family members, balanced with concern for my coworkers and the patients we care for.  While this mild anxiety has persisted throughout the following months, there has also been frustration and a sense of being overworked.  There has been frustration due to some organizations not taking COVID-19 precautions as seriously as others, which ultimately create a ripple effect to our unit.  Additionally, since individual staff have different perspectives on COVID-19, discussions about creating ‘organizational flows of work’ become a debate and official guidelines take much time to be developed.  On a larger scale than our unit, there has been frustration from systematic changes from insurance companies and state officials that have taken place on timelines we cannot control with some answers we disagree with.  At the beginning of COVID-19, there were laws passed much more quickly to address insurance rates and HIPAA concerns via video therapy for strictly mental health therapy, compared to individuals who were in need of comorbid substance abuse and mental health treatment. For example, strictly mental health treatment reimbursement rates were much higher than comorbid treatment rates, and it took a large number of practitioners to complain about this issue before it was addressed.  Also, due to financial concerns from COVID-19, there have been many funding cuts where certain programs existed to provide treatment to under- or uninsured patients, and now these programs, and some patients, have been terminated from treatment.

There has been an increased demand for therapists during this time, which has been a difficult need to meet. Hospitals and other organizations see the demand for care and willingly accept more patients, which in a sense is good that people are reaching out for care; however, it is only logistically possible to see so many patients in a week for therapy sessions while maintaining appropriate paperwork for such cases in additional to other job responsibilities. Caseloads have been increasing, while staff have been resigning due to burnout rates and other factors, some directly related to COVID-19.  Furloughs have taken place with administrative and billing staff, and their workloads have been pushed onto counselors as well.  Additionally, I have observed organizations becoming very finance-focused.  It is a fair concern since organizations like a hospital are in general losing money from loss of elective surgeries, etc., however, there is stress that comes from asking providers to increase their amount of billable hours with the added confounds of taking on more work from furloughed employees and only actually being paid for 40 but having to work an extra 5-10 hours per week.  It’s been roughly 6 months since COVID-19 precautions first started, and my job is still affected on a daily basis. We have had to complete special health and safety training, clean our own unit several times per day, accept more patients, work more hours during the week and weekends, and take on more job responsibilities that aren’t normally in our job description.

In my workplace, I have been very fortunate that we all try to be as safe as possible with PPE and offering emotional support.  We have seen an increase in patient sickness and death, domestic violence/CPS and APS reports, drug or alcohol relapse, and overall increase in mental health symptom and severity.  Due to having increased caseloads, it has been difficult to meet some of the demand for increased session frequency; whereas before COVID-19, it was reasonable to offer extra ‘on the spot’ sessions when needed.  In addition, our site used to provide intensive outpatient therapy via psychoeducational and coping skills groups.  Since these are in-person, they were stopped.  We converted to doing some groups online, but the majority of our patient population does not have access to telehealth capabilities due to lack of technology or internet/cell data restrictions.  For those who can join, it is much harder to assess mental status and affect via video, particularly with having to say ‘can you hear me now’ or ‘can you please unmute yourself’ every few minutes. In addition, some of the common ‘tools in the toolbox’ are not possible suggestions at this time- such as, AA/NA meetings being closed, many inpatient centers and detoxes have not been accepting new patients, inability to participate in social gatherings (gym, library, mall, etc.).  As therapists, we have been giving each other emotional support and the space for venting as needed.  We are used to meeting throughout the week for peer consultation and often for lunch.  Our peer consultations are now taking place over ZOOM, and our lunch times are often taking place outside and 6-feet apart so we can still maintain some in-person interaction.

There have also been challenges in my personal life adjusting to COVID-19, as well.  For example, being the youngest and healthiest family member,  I assumed the role of doing all the grocery shopping and other trips outside of the house in effort to keep older family members healthy as much as possible.   Errands, even small ones, can add to that feeling of being overworked, especially after working a 50-hour week. Normal outlets like social events with friends, visiting others’ homes, going to the gym, etc., have changed, mostly by decreasing in frequency or taking place over video.  As a person who appreciates in-person interaction by profession, it is an adjustment communicating mostly over a screen.  Focusing on how to implement some space for self-care has been imperative, but this new time at home has allowed me to tackle some books collecting dust on the bookshelf and re-engage with my artistic side.  Another point of appreciation is the amount of time many people are spending outside, and connecting with their environment.  For myself, outside exercise, hikes, and park trips have been great activities for grounding and centering. 

All-in-all, I consider myself a positive and resilient person and have faired the adjustments to COVID-19 fairly well.  I recognize I do have a lot of privilege and good fortune, in that I have been able to maintain work and meet my own financial demands, have not lost any close friends or family to the virus, have supportive coworkers who try to make the best out of every situation, and have adequate resources such as safe housing, food, outdoors, technology, etc., in my life.  If any one, let alone several, of these factors were missing, my COVID-19 experience would be vastly different and worse.  Generally, I think COVID-19 has highlighted the overall need for mental health and substance abuse treatment, while also prompting some tough, yet much needed, conversations about practitioner responsibility, insurance-company and state-official influence on rates and laws, and healthcare access and treatment disparities.  There is much outstanding conversation that needs to take place, and I can say a positive impact from COVID-19 is that I’ve seen myself and many colleagues who have become more involved in policy change for mental health and substance abuse treatment than ever before.