Behavioral health providers come in all different shapes and sizes, with business models varying greatly depending what population a provider serves. But currently, everyone in the industry shares a universal problem: figuring out how to best protect patients from COVID-19 while continuing to provide them with the essential behavioral health services they need.
Providers must make a number of procedural changes and plan with a not-if-but-when mindset, according to behavioral health experts at the Joint Commission, a nonprofit that accredits health care organizations across the country.
Communication, cleaning and physical distancing are key, Peter Vance — field director of behavioral health at the Joint Commission — explained on a recent webinar.
“You already want to have that plan in place,” he said. “What are you going to do and how are you going to change your waiting room situation and things like that?”
The first step in navigating patients through care during the coronavirus is communication.
That means calling them ahead of time to explain what protocols have changed and why, as well as what additional measures are being taken to keep them safe. It also means posting signage both inside and outside facilities to inform patients and staff members of procedural changes.
In some cases, keeping patients safe also means changing the way in which providers deliver care, adopting telehealth when possible and screening patients via telephone before they enter the waiting room.
However, telehealth may not be appropriate for everyone. And even if it is, providers may need to use a heavier touch.
“It’s going to be key to assess the clients that are more at-risk for relapse and decompensation, and then prioritize those people,” Vance said. “Maybe some of the higher risk folks need to come into the facility. Maybe some of the others can benefit from remaining at home and using phone and telehealth services.”
Providers also might consider increasing case management and publicizing the existence of local and national hotline resources for patients.
Clean, disinfect properly
Adopting more intensive and thorough cleaning practices is also especially important for behavioral health providers in light of COVID-19, Sylvia Garcia-Houchins, director of infection prevention and control at the Joint Commission’s division of health care improvement, said during the webinar.
While most people know to use good hand hygiene and disinfect surfaces, Garcia-Houchins offered providers more detailed, practical advice.
“In order to disinfect something, it must be cleaned [first],” she said. “Some organic matter — or dirt — will end up inactivating the disinfectant.”
As such, providers should be cleaning and then disinfecting surfaces and dishware as frequently as possible. Garcia-Houchins advises against the use of mixing cleaning products and says every day products can do the trick.
“Any alcohol solution with at least 70% alcohol should be effective against COVID-19,” she said.
If providers are unable to find cleaning supplies at the store, she recommended mixing ⅓ cup of bleach with one gallon of water or mixing 4 teaspoons of bleach with one quart of water. Uncovered solutions should be disposed of daily. Solutions kept in closed containers should be remade weekly.
Like hard surfaces, porous surfaces need to be cleaned regularly, but “in general, we’re not thinking this is a big source of transmission,” Garcia-Houchins said.
However, it’s important for providers with laundry services to take special precautions, making sure workers do not shake out laundry and routinely clean and disinfect laundry stations.
Providers should also be well equipped with the appropriate equipment — masks, tissues, hand hygiene products, ect. — so people can follow precautions appropriately.
Promote physical, not social distancing
Rather than social distancing, the Joint Commission is encouraging organizations to adopt physical distancing practices.
“It’s social distancing, but it’s physical distancing really,” Vance said. “You as a behavioral health care professional are continuing to make that [social] connection with them, and they are hoping to keep that connection with you.”
For outpatient facilities, that means adopting telehealth when possible, having patients wait outside or in their cars rather than the waiting room and limiting the number of people allowed in a room at a time.
For in-patient facilities, that means rearranging sleeping and eating arrangements if need be, as well as restricting or greatly limiting visitation.
“Things to consider are the grab-and-gos: [Food] pre-distributed in some kind of containers. Hand them to people and then have them sit … with some social distancing,” Garcia-Houchins said. “Think about how you arrange the area where people eat. Doing meal delivery is another great option.”
When in doubt, ask patients for creative ideas of their own.
Finally, it’s important for providers to have a plan in place in the event of a COVID-19 outbreak.
“If there are cases that occur in your situation, please work with your local public health department,” Garcia-Houchins said, encouraging providers to get in touch before there’s a problem. “They are going to be your best resource for assessing your situation and providing good information to your residents and to your staff.”