With social distancing recommendations in place as a result of the COVID-19 pandemic, many mental health clinicians are turning to telehealth to meet with clients. But while connecting virtually is better than not connecting at all, delivering essential mental health care this way poses specific challenges and risks, especially regarding clients at risk for suicide.
Julie Goldstein Grumet, director of health and behavioral health initiatives for the Suicide Prevention Resource Center (SPRC) at EDC, has a message of support for clinicians.
“Providing suicide care during this time of COVID-19 is possible, and your care can remain safe and effective even using telehealth and without the need for hospitalization,” she says.
Recently, Goldstein Grumet moderated a webinar on using telehealth to care for patients at risk for suicide. The webinar featured three national experts on suicide prevention: Barbara Stanley, David Jobes, and Ursula Whiteside. Here are three practical tips for clinicians who are delivering care in a virtual environment.
1. Prioritize safety
In virtual settings, it is essential that clinicians take steps to prioritize patient safety, says Stanley, a professor of medical psychology at Columbia University. She recommends that clinicians ask for a client’s physical location at the beginning of each virtual meeting. In addition, clinicians should have a plan in place for re-establishing contact with a client in case the virtual session is interrupted.
“You need to develop a plan for how to stay on the phone, or in the video chat, while arranging for emergency rescue, if it’s needed,” says Stanley.
She suggests that all clinicians review and update patients’ safety plans, which list warning signs that a crisis may be developing, coping strategies, and a list of people to contact. Having a strong, updated safety plan is always an important part of suicide prevention—but it’s essential now, as a trip to the emergency department puts clients at increased risk of contracting COVID-19.
“[You want to help clients] stay safe without going to the ED, or to any other kind of medical facility,” Stanley says.
Finally, clinicians can also help patients use strategies designed to maintain a sense of calm in between virtual clinical visits. These may include using a mindfulness app, practicing deep breathing, spending time on hobbies, and not watching news coverage.
“It’s important to identify things that [clients] can do when they are alone,” says Stanley. “So we want to . . . identify things that can be done to distract them from suicidal thoughts and de-escalate the crisis.”
2. Keep it confidential
Clinicians should also take steps to maintain confidentiality, says Jobes, a professor of psychology at The Catholic University of America. He acknowledges that with most clinicians now working from home, creating a quiet, private space can be challenging.
“Clinicians . . . need to ensure that the room is secure, and that you don’t have intrusive siblings or parents or spouses listening to the sessions,” Jobes says. For example, putting a towel under the door of a home office space helps create as confidential an environment as possible.
Virtual spaces where clinicians meet and exchange materials with clients also need to be secure, protect patient confidentiality, and comply with HIPAA. Jobes advises clinicians to research different telehealth platforms, use online checklists, and communicate with colleagues about how they are maintaining patient confidentiality in a virtual clinic setting.
“People [have been] thrust into this ‘feeling incompetent’ mode, where they haven’t used telehealth or telepsychology, and they want to develop usual and customary practices around these kinds of care models,” Jobe says.
3. Be ready to address someone in crisis
Finally, clinicians should be prepared to support someone who is in suicidal crisis. This starts by asking patients directly about their thoughts of suicide.
“Assessing thoughts of suicide among all of your patients is critical,” says Goldstein Grumet. “Every patient, every visit.”
Whiteside, a clinical psychologist at the University of Washington and founder of NowMattersNow.org, says that clinicians should be explicit when they are offering counseling to someone in crisis in a virtual setting. It’s important to be directive because a patient’s cognitive process is very low when they are in acute suicidal crisis, she says.
Whiteside describes how she breaks one particular activity down into specific, discrete steps.
“I say, ‘Let’s walk into the kitchen. Bring the laptop into the kitchen. Set it on the counter. Open the door to the freezer. Do you have an ice pack in there? . . . Great. Let’s take that out. Let’s go back to the kitchen table and grab a couple towels on the way. Now what I’d like you to do is put that cold ice pack on the back of your neck, and with me in front of you . . . put [the ice pack] on your forehead, too. I’d like us to count together, we are going to do two minutes of paced breathing.’”
These interventions may be difficult for clinicians new to telehealth, but they can work. However clinicians are planning on supporting their clients during this decidedly different time, adds Whiteside, they should all heed the knowledge and experiences of people who have survived suicide.
“At the end of the day,” Whiteside says, “the people that have lived this experience say we should do these three things: not panic, be present, and offer hope.”