American Mental Healthcare Facilities are Woefully Unprepared for Coronavirus

Protecting Against Coronavirus 3-30-20

My Coronavirus Gear

I work as a counselor at an acute mental healthcare facility in the Southeastern United States. I love what I do, but what I’ve observed during the past one month is that acute mental healthcare in the United States is woefully unprepared to tackle the coronavirus. Mental healthcare is something that we’re not hearing much of anything about during this crisis because of the focus on medical care, though protective precautions for patients and employees in the mental healthcare industry – particularly acute, long-term, and residential facilities – must be addressed and improved.

On Friday, March 6, 2020, I began wearing my own N95 masks – that I bought from eBay sellers – to work. I paid a high price for the masks, but it was worth it. I was the first employee (to my knowledge) to wear any type of mask at my place of employment, due to my own coronavirus precautions. Beginning on Friday, March 20, 2020, I also added cotton gloves to my arsenal of gear, also purchased from a vendor on eBay. Keep in mind that I’m not sick, and I’m doing whatever possible to stay that way with having to go to work.

Medical and healthcare policies toward protecting patients and staff from potential coronavirus exposure and infection need improvement in American mental health facilities. Only last week did my facility begin requiring employees to get temperature checks before entering any units. Each person is on their honor to now do their own temperature check and log the correct temperature. No medically-qualified staff are present when this occurs, nor to confirm the results. It may also be a good idea to have staff check their temperatures prior to leaving work, as well, though that has not yet been required.

Patients coming into my facility from other hospitals are generally already wearing masks that they’ve gotten from the previous facility. Only last week did my hospital begin supplying surgical masks to those patients and staff who ask for them. My understanding is that there is a low supply. More and more staff during the course of the past one month are wearing masks, including a few wearing N95 masks, and the majority wearing surgical masks. I would estimate, however, that not even one-quarter of the staff who work at my hospital during the day are wearing masks.

Yesterday, I wore an N95 mask for 14 hours. I wore it for 8.5 hours at work, and also for the rest of the day, including at home. I would ordinarily only wear the mask while at work, but yesterday, I was exposed to a staff member who was exposed to a patient at his other hospital who is in serious, if not critical, condition due to the coronavirus. I did inform two supervisors about it, and I wiped my department office down with Lysol since this colleague was also using my desk. Today, my work colleague got tested. When I checked-in with him, he stated to me that he has to wait 5-7 days for results and stay quarantined for 14 days. There was also a patient on the unit I was assigned to who was sent out to a medical hospital, yesterday, due to potential coronavirus symptoms. So, while I wasn’t exposed to that patient, I was exposed to staff who were exposed to that patient. Thankfully, I wear my mask and gloves at work for everything except eating and drinking, so I hope I’m safe from being infected.

Today, I’ve already worn the same N95 mask for 12 hours that I wore yesterday. I’m taking precautions to protect my family in case I have the coronavirus. I also washed in the laundry today three pairs of cotton gloves that I’ve been wearing – while also continuing to wear another pair. I figure that if I have coronavirus symptoms, they’ll start to appear within about three days, from what I’ve read. By Wednesday evening, I should know one way or the other.

Of course, I’m also doing social distancing, both at work and at home, while also wearing my mask and gloves. I’m also doing my laundry after work, as well as running the dishwasher to keep dishes clean. In the shower, I’m using latex gloves and I’m not keeping my soap in the soap dish, so no one else uses it. I’m also wearing latex gloves while cooking for my family. Hopefully, all of this will help prevent this ravaging virus from infecting me and my family!

I’ve been saying for weeks at work that everyone – including patients and staff – needs to wear masks. At my facility, that has not been encouraged to say the least, though I hope it will be in the near future for everyone’s protection. Everyone in facilities throughout the United States needs to wear masks, and if they’re not already wearing gloves, to wash their hands often and sanitize their areas as much as possible. We don’t know everything there is to know about this virus, though what we do know is scary and tragic. Too many people have already been lost to this horrible pandemic. People in the United States – and around the world – need to take coronavirus much more seriously, including mental healthcare professionals – for our own welfare as well as that of everyone we treat!

 

Challenges in Mental Health Care: The Sickness v. Wellness Perspective (By: Michele Babcock-Nice)

Mental health care is a challenging, but rewarding field.  There are many positive sides of mental health care, and also areas that need improvement.  One of the biggest rewards of mental health care is observing and experiencing progress, recovery, and a return to wellness of clients.  Healing, recovery, and a return to wellness of clients in mental health settings requires patience, understanding, respect, and sensitivity.  Agency and organizational stability is also needed for clients in order that they receive optimal care.  While each agency and/or organization has its own culture, a culture in which workers live in fear of becoming a statistic in extremely high turnover is unhealthy in itself.

As an individual working toward licensure in the mental health profession, I am one whose perspective is from a position of wellness.  First and foremost, one must view a person as a person.  To perceive and treat a person with respect, kindness, nonjudgment, and impartiality are requirements in supporting and empowering the wellness, healing, and recovery of clients.  In the counseling profession, one based on a view of wellness in people, there exists a positive and supportive hope for the overall optimal health of the individual.

This view is different from many other mental health professions in which the general view of the client is one of sickness.  Certainly, approaching an individual with a perspective of what can be improved is helpful, and for insurance purposes involving payment for services rendered, a diagnosis of the client is required, however it is my perspective that viewing the client from a wellness standpoint is much more healthy for all involved rather than judging a person as being sick.

Those who view and describe an individual as a “sick person” have already negatively judged him or her.  They have not viewed the person as a person, but as an “ill person.”  Such a perspective held by such individuals causes them to treat the client differently, as one who needs more and more treatment, more and more medication, more and more confinement.  In these situations, the positive view of wellness is gone, and is replaced by a judgment that the “sick person” is unable to become well.

While clients have challenges to achieving and maintaining wellness, it becomes even more of a challenge when many in the mental health field view clients as sick, and only they as the professionals who hold those views have the power and expertise to make them well – or they have already judged that they will never become well.  A professional who approaches a client from a perspective of wellness (a perspective that is in the minority), therefore, faces even more challenges, not only for themselves but also for their clients when others view them as sick and unable to become well.  A person is still a person, regardless of their diagnosis or disorder.  A person is still a person, and has the capability of becoming well.  A hopeful perspective toward client wellness must exist in the mental health profession – rather than client sickness – in order that clients are supported and empowered to experience that wellness.

A further challenge in agencies and/or organizations in which a “sickness” perspective prevails is that experienced clinicians fall into the trap of believing that their views and judgments about clients are the best – that they are the experts.  Certainly, the experience of a veteran clinician is extremely valuable in treating clients, however experienced clinicians who believe that only their views, judgments, and culture of sickness are the most helpful approaches create a potentially dangerous situations for their clients.  Clinicians of all levels of experience must be open-minded to considering and perceiving different views – including those from a wellness perspective – so that their clients receive optimal care and so that they profession, itself, can grow and develop in a healthy way.

Clinicians who view clients from a perspective of illness and negative judgment place their clients at risk for further illness.  Clinicians who are set in their ways of expertise toward mental health treatment, and who are unable to be open-minded toward viewing different perspectives regarding it have already erected walls around themselves that are harmful for themselves, their clients, the culture of their agency/organization, and the field of mental health.

What clinicians must always place as a primary priority is that people are people.  As such, people should be treated with dignity, understanding, kindness, respect, and sensitivity.  If a perspective of client wellness is lacking or absent, clients will likely experience a more difficult road to recovery and may not achieve wellness.  What is healthier – being an “expert” clinician whose views of client illness cause him or her to be closed to considering a client’s optimal recovery, or being a clinician who treats a person as a person, and who applies a wellness perspective that supports rather than negatively judges the client?  You be the judge.

Poorest People Still Left Behind in American Healthcare Coverage, Including Medicaid (By: Michele Babcock-Nice)

I am a person who is an advocate for universal healthcare coverage in the United States.  When President Barack Obama persistently pushed for the achievement of universal healthcare in the United States, I was definitely a supporter.  I think it is wonderful that people who so desperately need healthcare coverage in the United States are now able to receive it, in many areas of the country.

I, however, still do not have healthcare coverage.  Why?  My income falls below the federal government’s poverty level guidelines for who is eligible to receive universal healthcare.  And, my state, Georgia, has not expanded Medicaid for individuals and/or families who would otherwise be eligible to receive Medicaid due to income guidelines.

So, while there is universal healthcare coverage that is available in the United States, it is not available to me.  I have not had healthcare insurance coverage for about 4.5 years since becoming divorced.  Prior to that, I had healthcare coverage either through my employer and/or my spouse.  In 2009, I was employed with a company that guaranteed healthcare insurance coverage after working for several months; I was laid off before that time came.

For the past 4.5 years, I have paid out-of-pocket for all of my medical and healthcare-related expenses.  I have paid out-of-pocket for visits to my regular doctor, gynecologist, dentist, and optometrist.  I have also paid out-of-pocket for all of my prescriptions, laboratory work, and all other healthcare-related services and appointments.

Last year, after going five years without having an eye exam, I finally had one and got new glasses, with monies withdrawn from my retirement account.  This year, I have noticed further changes in my eyesight, but cannot afford to get my eyes checked, or get new glasses again, with having to pay out-of-pocket.

Typically, my gynecologist and dentist appointments cost me much more than any of my regular doctor appointments.  It has been several years since I went to my OBGYN, and my last mammogram was about five years ago.

Thankfully, most medical practitioners provide some sort of discount for people who pay out-of-pocket.  Such a discount is helpful, though there is a wide range in discount percentages, usually 5%-20%, as I’ve experienced.

When I lived in New York State, from the time I graduated from the University at Buffalo (December 1992), and was removed from my parents’ coverage, until I became employed full-time as a teacher in Georgia (August 2000), I did not have healthcare coverage.  Either my employers did not offer healthcare coverage, or they required at least one’s year’s employment with them before they provided it.  In the places in which I worked part-time, and/or left employment to obtain other employment within one year (typically, for a higher salary and the opportunity for better benefits), I did not have healthcare coverage.

To date, that makes a total of 12.5 years of my life that I have not had healthcare coverage.  After reading a newspaper article related to a lack of healthcare coverage in Georgia for individuals who do not qualify for Medicaid, I realized that I am not alone.  Misty Williams wrote “Ga.’s Medicaid call affects thousands,” being published in the April 6, 2014 issue of The Atlanta Journal Constitution.

In her article, Williams stated, “Statewide, more than 400,000 of Georgia’s poorest, most vulnerable citizens have been left behind by the health care law that was supposed to benefit them the most.”  Because Georgia has not expanded Medicaid (and has, therefore, caused me to be ineligible for coverage, unless I am pregnant), all of these people are still without healthcare coverage.

Throughout the United States, there are 5.7 million people without healthcare coverage – because their states have not expanded Medicaid.  All of the seven states in the Deep South are included in the 24 (nearly half of the US!) states that have not expanded Medicaid.  A WhiteHouse.gov website put’s Georgia’s number of people without coverage at 478,000 – ranked third behind only Texas and Florida – for all those without healthcare coverage due to Medicaid not being expanded to cover them.

If I was younger and perhaps had more faith that an issue such as this would change, I would likely be highly upset about it.  But, now that I am older and somewhat wiser, it really comes as no surprise to me, and is actually a disappointment that people such as myself, who are in the greatest need of healthcare coverage, still do not have it – because they are too poor!

When I am driving on the road, I hope and pray that I am not involved in a serious vehicle collision that causes me bodily harm.  I hope and pray, and do my best to stay healthy, so that I do not acquire a serious illness or disease.  I am cautious and careful about what I eat and who I date, as well as about cleanliness and personal hygiene.

I try to stay as healthy and as well as possible in order to avoid being hospitalized for some situation or condition that could cause bankruptcy.  Sometimes, even with the best of intentions, situations cannot be avoided, and so, I continue to be aware, healthy, and do the best I can.  What I would really like is gainful, stable, and enjoyable full-time employment so that I can obtain and maintain healthcare coverage.

Lawmakers in Georgia – and in other states that have not expanded Medicaid – have truly let down those people such as myself who are so poor that they do not qualify for universal healthcare coverage, including Medicaid.  I thought that the idea behind establishing universal healthcare coverage was so that it would be universal.  Unfortunately, in states such as Georgia, I have seen that it is really not universal.

The Affordable Care Act has, therefore, made absolutely no positive difference in my life to date – because my state has not expanded Medicaid and I am too poor to be eligible to receive Medicaid.  I continue to pay out-of-pocket and do not have any healthcare coverage.  When the poorest of the poor are overlooked and ineligible for even the most minimal healthcare coverage that is supposed to be provided to those who are poor – Medicaid – there is definitely something very wrong with this situation. 😦

References:

24 states are refusing to expand Medicaid (April 3, 2014). Here’s what that means for their residents. WhiteHouse.gov.  Washington, DC: The White House. Retrieved on April 18, 2014 from http://www.whitehouse.gov/share/medicaid-map?utm_source=twitter&utm_medium=social&utm_content=110613p1&utm_campaign=healthcare

Is my state expanding Medicaid coverage? (2014).  Healthcare.gov.  Baltimore, MD: U.S. Centers for Medicare and Medicaid Services.  Retrieved on April 18, 2014 from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/

Williams, Misty (April 6, 2014).  Ga.’s Medicaid call affects thousands.  Atlanta, Georgia: The Atlanta Journal Constitution, Vol. 66, No. 96.