Reaching out in crisis with telehealth

Dr. Mike McBride was providing telehealth when telehealth wasn’t cool.

The Milwaukee VA psychiatrist, who is also an Iraq and Afghanistan Veteran, was the first provider here to use mental health telehealth in someone’s home about three years ago. McBride was treating a Veteran with severe post-traumatic stress who couldn’t leave the house because of other medical issues.

VA had been using telehealth between clinics and hospitals, but hadn’t yet tried it from the hospital to a Veteran’s home.

“There were concerns, early on, that this could cause further isolation, but by making this connection, for many of our Veterans, it helps them take steps to get outside the house and engage in life. That Veteran was eventually able to go into his yard, he was able to get a dog and take him for walks. It was great progress,” McBride said.

In the years since, VA medical centers across the nation have embraced telehealth for primary care, mental health, and many other subspecialties. In the last year, most of the Milwaukee VA’s psychiatrists, psychologists, therapists, and other doctors have embraced this emerging approach to patient care.

Overnight, coronavirus (COVID-19) changed medical care across the United States and made telehealth more of a necessity for everyone; however, VA was prepared. While all nonessential appointments have been canceled, mental health providers are still connecting with their patients through telehealth and encouraging Veterans to use video or even phone calls to keep in touch.

“We still have walk-in appointments for any Veterans who are feeling suicidal or have urgent concerns,” said Dr. Bert Berger, Mental Health division manager. “Anyone coming in still must go through the screening process, before they can be seen in the Emergency Department or our Mental Health Urgent Care.

“We also realize many of our Veterans can’t or don’t want to come out right now, and telehealth is a huge benefit because we’ve already been pushing that out as an alternative.”

Keely Cullen, a Mental Health therapist, said she has doubled the number of Veterans using telehealth or even a phone call since the COVID-19 outbreak.

“More people are checking into it,” she said. “For some of our patients, there is anxiety right now. They may be worrying about their future and if this is going to end. That anxiety makes you ruminate and overthink, and that causes physical symptoms – heart racing, higher blood pressure, sweating, feeling hot, or even a panic attack, which can feel like a heart attack.”

Others throughout the U.S. may feel the same things as they isolate because of quarantines and lockdowns.

“This sense of fear, sense of anxiety, this unknowing, being socially distant – these are some core symptoms some of our Veterans experience every day,” McBride said. “Many of the Veterans I work with have been calm. They’ve been there. They’ve experienced this. I told one Veteran our society is now going through something that we’ve gone through.”

The advice VA therapists give are the same things non-Veterans can use, said Cullen.

“I ask people, ‘What changes can you make in your environment?’ We look at the full picture. That becomes more difficult now. We look at how we can still be social during this self-isolation. There are free, virtual options out there now – virtual museum tours, online classes, those types of things.”

For some, it’s just a need to talk.

Dr. Gregory Simons, who works with Veterans at higher risk of suicide, calls his patients if they don’t check in.

“This is something we do every day in this office, regardless of the pandemic,” he said. “We make sure our Veterans are connected. They have my direct extension if they need anything from me. A key piece of depression is people isolate themselves or feel isolated, and now we’re telling them to isolate. We’re definitely keeping an eye on them and making sure they have regular contact with their providers.

“It’s important, at times like this, to stay busy. Find projects to do around the house. We can have this wonderful, technical connection through FaceTime, Skype, texting and online support.”

Simons said any Veteran in crisis should immediately call the Veterans Crisis Line at 1-800-273-8255, or come to the hospital or nearest Emergency Department, if they have an urgent need.

Patricia Watson, a psychologist at VA’s National Center for PTSD, listed the following tips Veterans and others can take to help ease stress and anxiety during the pandemic:

Stay Connected

• Seek support from family, friends, mentors, clergy and those who are in similar circumstances.
• Be flexible and creative in using phone, email, text messaging and video calls.

Cultivate Ways to be More Calm

• Realize that it is understandable to feel anxious and worried about what may happen.
• If you find that you are getting more stressed by watching the news, reduce your exposure, particularly prior to sleep.
• Practice slow, steady breathing and muscle relaxation, as well as any other actions that are calming for you (yoga, exercise, music, meditation).
• Try using the PTSD Coach mobile app, or PTSD Coach online for more stress reduction tools.

Improve Your Sense of Control and Ability to Endure

• Accept situations that cannot be changed and focus on what you can alter.
• Modify your definition of a “good day” to meet the current reality of the situation.
• Problem-solve and set achievable goals within the new circumstances in your life.

Remain Hopeful

• Consider the stressful situation in a broader context and keep a long-term perspective.
• Celebrate successes, find things to be grateful about and take satisfaction in completing tasks, even small ones.
• Give yourself small breaks from the stress of the situation by doing something you enjoy.
• Draw upon your spirituality, those who inspire you or your personal beliefs and values.

Here’s some advice from those who have been in similar situations:

• Recognize, acknowledge and accept the reality of the situation.
• Prepare to feel overwhelmed or overly distressed. Preparation can make you feel more in control if these feelings arise and help you move through them quickly.
• If you are having a hard time making decisions, talk to a trusted family member or friend.
• Be aware that there are also behaviors that DON’T help. Learn more about these negative coping methods that you should avoid.
• Talk to your health care provider if your stress seems overwhelming. Sign into MyHealtheVet and send a Secure Message.

To learn more about VA’s approach to providing continuous mental health to Veterans throughout the pandemic, visit www.mentalhealth.va.gov/coronavirus.