This page contains a shortlisted entry by Anitha Howard for the RCPsych Future Archives Competition.
Being a psychiatrist in a pandemic
When the WHO declared a pandemic on the 11th of March 2020, I found myself wondering what my role as a psychiatrist would be especially as I am employed by an acute trust with all the wards you would expect in a busy general hospital including ICUs and CCUs.
"Are you really a keyworker?"
I felt uneasy reading doctors’ accounts on Twitter of being deployed to ICUs, after reading manuals on how to use a ventilator as healthcare professionals fell ill with the virus. Would this be me in a few weeks’ time? Would psychiatrists expect to be deployed on medical wards? Would my own trust feel psychiatry was a luxury at the height of the pandemic?
As a psychiatrist, I often have to justify why I am a real doctor, so it wasn’t a surprise when my son’s primary school asked for more evidence when I needed a keyworker place. An email from my line manager, an A and E doctor, in support of my school place reminded me, why psychiatry was still important to other specialities. This was reinforced when my trust did not deploy doctors to cover gaps on medical wards much to my relief. We received PPE as soon as it was available including goggles and face shields and even at the peak of the pandemic with no hesitation.
"I don’t want to die just because I have to come into work?"
In those early days, so many of us were scared of the consequences of catching the virus. My management role meant completing risk assessments that seemed to change almost weekly as more and more people were deemed more susceptible. The stress was unbearable as it felt like I was moving staff around like chess pieces trying to keep them safe while trying to ensure services were provided while trying to contain my own anxieties as a slightly overweight, Asian women rapidly approaching middle age.
"They are definitely not clapping for us?"
Every Thursday people started clapping for the NHS and while it felt good clapping for other people, it never felt that those claps were meant for me. A psychiatrist wasn’t really on the frontline?
Our department, like many other mental health services, thought the pandemic would be under control within a few weeks, so it made sense to reduce services especially in those early days when the focus was to reduce transmission. I 'consulted' with our patients over the telephone and soon realised how much I relied on non-verbal communication and body language. Sometimes patients or carers just needed to chat and there were times, I was only the person who they had spoken to that day or even that week. But it wasn’t the same, for the patient, the carer and for me.
GPs in our area helped by managing as much as they could in primary care, contacting us when they needed advice or referring patients to secondary care only when they could no longer manage people. My dread resurfaced, the reduced workload we all craved in normal times didn’t feel right. Would mental health services be deemed reductant once this was all over?
"You can die from covid but you can’t die from depression."
My friends wondered why I had to work when the people I dealt with were not physically unwell and could just wait till the pandemic was over but as the months progressed the trickle of referrals, the calls from the GPs and the emergencies started to increase each week. The wave of referrals we were expecting after the first wave turned into a tsunami proving mental health couldn’t just wait.
"Let me try the kitchen, I think there is more internet there."
A year on from the start of the pandemic, I find myself busier than I have been. Pandemic referrals are different complicated or caused by isolation, bereavement, not being able to see loved ones in care homes, anxiety, delirium and grief from losing a year of living that can never be returned.
Seeing patients is no longer simple. Patients can no longer see or hear me- not because of sensory deficits but because of masks and, face shields. My patients and their relatives have become adept at using video conferencing and I am now an expert on which parts of my catchment area have good bandwidth and build time into my appointments to take into account the poor internet connection in rural areas. I now enter a testing pod when I visit a care home and no longer gag or sneeze when I swab my nasal and throat for my weekly covid test. I interact with my colleagues and team members over a screen but it isn’t the same without cake or biscuits. Bumping into a work colleague while maintaining social distancing in the car park is now a social occasion.
Surprisingly, during the pandemic there has been a number of ‘interventions’ for mental health as well such as funding to replace old dormitory-style inpatients, funding to help improve discharges and funding for community transformation for mental health continues unchanged. There is an awareness that there will be an increase in mental health problems and how this can be addressed and is widely discussed in the media.
Psychiatry has played an important part in dealing with the pandemic and will still be dealing with the aftermath, when life returns to a new version of normality, for some time to come. I hope in the next pandemic there will be no doubt that a psychiatrist is a frontline keyworker but maybe this has already happened - my son’s new school gave him a keyworker place as soon as I asked.
I have been a consultant in old age psychiatry for 15 years in the North East of England and am employed by an acute medical trust which works well for older people. I work in the community and manage older people with functional illness and dementias. I also have a managerial role which I took up a few months before the pandemic hit.