Out of the Darkness: A Roundtable Discussion About Mental Health

The isolation and the uncertainty of the early months of the coronavirus pandemic have had lasting effects on the mental health of adults, teens and small children, and some of those impacts are yet to be fully realized.

The pandemic and its associated shutdowns limited in-person access to mental health services but also created new opportunities to attain care as doctor’s offices and other health facilities instituted and expanded remote access to counselors, therapists, psychologists and psychiatrists. To explore all the ways in which the East End’s mental health care providers have risen to the occasion to meet the growing need, The Express News Group hosted “Out of the Darkness,” a discussion with mental health clinicians and other professionals, on October 20 as part of its Innovating Health Care on the East End series.

“Beyond the economic difficulties created by COVID-19 in recent years, there’s also been a slow and steady drumbeat of impact on individual lives,” said Express News Group Co-Publisher Gavin Menu as he welcomed guests to the event on Zoom. “Men, women, children were isolated, struggling to survive the crisis and in many cases battling new mental health challenges.”

Joseph Shaw, the executive editor of The Express News Group, moderated the discussion with the six panelists from the Stony Brook, Northwell Health and Weill Cornell health care systems.

“There’s no question that there was fallout in the entire population from the pandemic, and it’s changed so many things, and, certainly, health care is one of them,” Shaw said. “So I want to do a little bit of a deeper dive into how it may have changed things, specifically when we’re talking about diagnosing and treating mental health issues.”

Dr. Douglas Hoverkamp, the director of the department of psychiatry at Stony Brook Eastern Long Island Hospital, pointed to a service that would come up frequently during the discussion: telehealth, or telemedicine.

“Telehealth has been an avenue to get treatment out to a population that otherwise would be unable to get it due to transportation issues, health issues, etc.,” Hoverkamp said.

Susan Wilner, a licensed clinical social worker and the assistant director of behavioral health service for Stony Brook Medicine, recalled back in 2005 working on a grant for telemedicine. “It didn’t take off well because nobody thought it was a great idea,” she said.

But fast forward to a little bit before the pandemic, and Stony Brook University Hospital realized it could support its sister hospitals with tele-psychiatric evaluations, she said. It was set up to support patients who are having a psychiatric emergency and did not have the ability to access psychiatrist services other than going to Stony Brook in person.

“And then the pandemic — and then it was like, all of a sudden, everybody needed to do telemedicine immediately,” Wilner said. “And that was the only way we were able to treat a lot of the patients that we have. So it just took off.”

People have now seen that telemedicine can often provide the same quality care, she noted.

“It’s not always appropriate, but when it can be used it really is very helpful to those who are in areas that don’t have specialty services, or they don’t have access to transportation,” Wilner said. “... It’s really become now the way we just practice medicine. Whereas before, it was sort of something we just thought about. Now it’s really how we practice medicine and how we reach people, and I think that’s a good thing.”

Janet Jackowski, the vice president of behavioral health and social services at Stony Brook Eastern Long Island Hospital, said it was initially challenging for therapists when they couldn’t see patients one-on-one in the same room. “There were some things missing, but I think a lot of therapists, particularly in our outpatient clinics, have become very comfortable with it, and it has afforded us that ability to reach patients that aren’t able to get to the clinic or that wouldn’t be able to get to an office.”

Wilner added that telemedicine has afforded hospitals the ability to bring in all kinds of specialty care that they couldn’t before.

Katherine Karan, the obstetrics nurse manager at Peconic Bay Medical Center, specializes in mental health issues during pregnancy. She noted that delivering a baby in the hospital while visitors were limited or prohibited and while sickness was a concern turned into anxiety and fear.

“The need for support groups for perinatal mood and anxiety disorders just exploded during the pandemic, and regular support groups that we would have, we could no longer have because we couldn’t do anything in person,” Karan said. “So the use of online platforms got brought in, which has turned into the norm for us.”

She said there have been improvements recently because mothers have been able to get the support that they need, including joining support groups.

“They say perinatal mood and anxiety disorder is within the first year of life, and that’s no longer true with the pandemic,” Karan said. “A lot of moms are still having it up until two years, maybe a little bit more.”

Dr. Lloyd Simon, the director of addiction services at Stony Brook Eastern Long Island Hospital, saw addiction issues rise during the pandemic. He called it “the epidemic within the pandemic.”

“Take people who are really frail from whatever — whether it’s a mental health or substance abuse issue — and isolate them and cut out all their support, and one of the common things we saw was relapse,” Simon said.

Physicians treating patients for addiction, especially doctors prescribing suboxone and other medications for opioid use disorder, could not carry on their work during the outset of the pandemic. Simon’s own primary care office shut down for six weeks before work could resume by phone and video, he said, and eventually opioid use disorder treatment started up again the same way.

“There were barriers also because we weren’t even sure it was legal at the beginning,” Simon said. “We needed New York State, federal authorities, DEA, all to say this is OK. We were doing it, but we weren’t sure of the legality. We were sure that it was ethically the right thing to do, but we weren’t sure of the legality.”

In time, it was clarified that doctors could legally see a patient using telemedicine for the very first time and prescribe medication, without an in-person visit. “And that was a new concept for most of us,” Simon said.

Another development is emergency departments can see patients with opioid use disorder who don’t need to be or don’t want to be admitted to the hospital and can prescribe a couple of days of medication of suboxone, he said.

“The word ‘innovation’ in our current cultural moment usually involves something with computers and technology,” noted Dr. Guy Maytal, a psychiatrist with Weill Cornell Medicine. “But that’s a somewhat narrow definition as a word. Innovation could also be the way people interact in new and interesting ways.”

He saw a group of people who were otherwise uncomfortable or avoidant of technology learn to adopt telemedicine out of necessity. It could be that they come from an impoverished background or they are older and preferred to be seen by a doctor in person, but left no other choice during the pandemic, they had to figure out how to use telehealth services, he explained.

Maytal also observed that communities that have traditionally avoided mental health care are now open to it, as it has become “so much more a part of the conversation, that it’s something acceptable, necessary, helpful.” People who would never walk into a psychiatric facility are much more willing to get on Zoom or another video platform and talk from the comfort of their own living room, he said.

Seeing into patients’ homes over video software has also aided his work. He said he’s met patients’ pets and children and learned whether the patients live in a house of clutter and chaos or one that’s well organized. “That’s made an enormous difference in kind of a depth of understanding of people’s lives,” he said.

Hoverkamp echoed the sentiment that the pandemic destigmatized conversations about mental health: “Mental health and addiction have been exposed,” he said. “They’re out there, and I think that that’s another kind of byproduct of what we just went through.”

He said it unfortunately became a very common story for people to relapse because of the pandemic, whether it was due to the inability to get medications or to access their normal support systems. He pointed out that Alcoholics Anonymous and Narcotics Anonymous meetings stopped, even though there were attempts to hold the meetings online. “Most patients that I deal with will tell me it just wasn’t the same,” he said. “They really needed the true fellowship of being in the same room with other people and having that human connection. So while it certainly helped some people, it didn’t help enough.”

Hoverkamp also pointed out the difficulty that health care networks have in attracting clinicians to work on the East End. Anyone involved in the Stony Brook system can attest “it has been impossible for us to attract clinical help out here this far out east,” he said. And that includes doctors, nurses and all medical specialists.

The good news he offered is that an investment in new talent is about to pay off.

“We did start a residency program that’s specific to Stony Brook Eastern Long Island Hospital,” Hoverkamp said. “And we are currently on our fourth year. … and we’re going to start graduating residents after this year. And I already have it on good authority that there’s a few of them that might want to be staying.”

Another area where telemedicine comes in involves policing. Wilner said the Family Service League works with police departments to provide assessments by a licensed counselor, via smartphone or tablet, during psychiatric emergencies.

“They do the assessment there to determine whether or not they need to come to the emergency room because if we can avoid that … it’s obviously a better experience all around,” she said, noting the benefits of keeping people at home, in their community, with their support system surrounding them.

It was a project supported by the late Southampton Town Police Chief Steven Skrynecki, who died last month of cancer.

“He was very proud of it,” Shaw noted. “It was really important to him.”

Maytal said one of Weill Cornell’s priorities is to ensure that wherever primary care goes, mental health services follow.

“The primary care division here really has a commitment to treatment of depression, anxiety, substance use disorders and other mental health conditions as part of the spectrum of what primary care entails, and they obviously can’t do that on their own,” Maytal said. “But one of the things that is happening rather quickly now … is developing what are called ‘integrated programs,’ where mental health is delivered in and through the primary care doctor’s office. … And it also involves using screening tools to catch things earlier rather than waiting for things to get worse and being reactive.”

Wilner said Stony Brook provides mental and behavioral health services to South Fork primary care offices, and often does so via telemedicine.

“Our psychiatrists sometimes start and stabilize the patients on medication via telemedicine … through their primary care docs, and then the primary care docs pick up those prescriptions so that our psychiatrists are available to manage new patients in need, so we don’t have that backlog.”

Schools have come to the table to help children and teenagers with mental health issues through the North Fork Mental Health Initiative and South Fork Mental Health Initiative, and Wilner is on both boards.

She said that while school districts are more attentive, there’s also more of a problem. “And so it’s very hard to meet the needs and identify everybody who has needs and get them into treatment,” she said.

Hoverkamp said that even prior to the pandemic, however adult psychiatry struggled, child and adolescent psychiatry struggled even more. He said that, for whatever reason, resources aren’t funneled toward children and adolescents — as evidenced by programs closing down.

Not being able to attend the first day of kindergarten or attend high school or college graduation and going through remote learning and isolation will all have long-term effects and lead to learning deficits, Hoverkamp said.

Maytal added that overcoming the challenges of remote learning and managing child care is difficult in poor parts of the East End, where people have fewer resources.

The medical professionals also agreed that the scope of the effects of the pandemic on children remains to be seen. And in some cases, children may have been isolated with their abusers or had other triggers of anxiety, depression, self-mutilation and suicidal ideation.

Signs of mental health struggles for parents to look out for in children include irritability, school refusal, difficulty sleeping, social anxiety and more dependence on parents.

Stony Brook Medicine revealed the results of the first-ever Long Island LGBTQ+ Health Needs Assessment Survey last month, and they showed that anxiety and poor mental health are common among members of the community due to the mistreatment and stigma they face in society.

“It is definitely a population that requires a lot more attention, and certainly from mental health providers and substance use disorder providers,” Jackowski said.

She noted that there have been discussions about providing outpatient services at the The Edie Windsor Healthcare Center in Hampton Bays, a clinic for the LGBTQ+ community and anyone living with HIV.

“Imagine going to a gynecologist as a male? It can’t be a very comfortable experience, right? So I think the idea of having places like Edie Windsor is so important,” Wilner said.

She said Stony Brook’s child and adolescent inpatient unit is seeing more transgender adolescents who are in need of hospitalization due to severe depression, often with suicidality.

Maytal said Weill Cornell psychiatry has a clinic specifically for people of the LGBTQ+ community. “People know that there’s a place for them to go, and doctors know there’s a place for them to refer,” he said. “The challenge is how to get people to ask for help.”

He emphasized the importance of health care providers screening patients so they don’t have to ask for help. He said screening for mental health normalizes the conversation — making it as common as checking blood pressure.