When the COVID-19 pandemic came to the forefront in the late winter of this year, the consistent messaging became about the importance of staying home to reduce the transmission of the virus. At the heart of the physical distancing restrictions was the idea that people would be safe in their homes.
What happens when there is no home? What if home is not safe? For those with no fixed address, the options can be bleak. For example, crowded conditions in some temporary housing alternatives could increase the risk of transmission. On the other end of the spectrum, people can live in houses with well-manicured lawns which hide the terror that lies within when an abuser is part of the family.
As a community outpatient psychiatrist offering long-term therapy, there is a range of scenarios that I have encountered clinically in relation to socioeconomic challenges and to trauma that have both predated and have been exacerbated by the pandemic. The pandemic pressed pause on lives, scuttling plans for workplace advancement that would allow people to afford living in a better neighborhood and plans for starting a new life outside of an abusive household. Escape in the form of outside, in-person interactions were often no longer an option. Mourning for respite and for what could have been were aspects of the psychiatric wave as people worked through different stages of grief.
Technology has helped create remote/virtual spaces for offering vital mental health care in the form of telephone/video visits. Sometimes the most powerful treatment that we can provide patients is to listen when it seems like the world is falling apart, especially if where one lives re-activates past traumas. Having that consistent connection to a psychiatrist can feel like a lifeline when the physical space around the patient is failing to make them feel secure. They do not need to suffer in silence.
Another part of psychiatric care during the pandemic means triaging what needs to happen now versus what can happen when fewer restrictions are in place. Being ready for what comes on the other side of the pandemic can feel like a guessing game with so many mixed messages in our 24-hour news cycles.
Increased spacing and mask wearing are just some of the new procedures that will likely be in place for the foreseeable future. Getting used to seeing less of our patients' facial expressions and vice-versa will be part of that, which could shift the rhythm of the physician-patient rapport. As we prepare to gradually reopen health care settings safely, we are treading on new territory, one step at a time.
Dr. Renata Villela