Mental health care solutions in a pandemic

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Moving an entire organisation’s mental health services online is no mean feat – but the Epworth Clinic in Melbourne managed to achieve it last year as the COVID-19 pandemic hit.

Maya Zerman,  Director of Strategy and Operations at Epworth Clinic, said digitising services was “a big shift”.

“We had already been doing a bit of telehealth, particularly for our out-patient consulting, but we have a 63-bed in-patient facility and we also have on-site out-patient group therapies.

“Early on, no-one really knew the extent of what was coming and during that first lockdown here in Victoria, our priority was patient safety and to keep operating going in a COVID-safe way,” she said.

“We decided straight away that there would be no face-to-face group therapies, so we took a break from face-to-face outpatient groups for that initial two weeks and used that time to get everything up and running online.”

Ms Zerman said the first challenge was “getting the IT embedded” and then ensuring they had appropriate safety guidelines for patients.

“Pretty quickly we had to ensure we had enough iPads on the ground for our clinicians, and what kind of platform we would be using.

“With mental health treatment, often body language is really key to seeing how people are, so we looked into different platforms and Zoom became our solution,” she said.

“We also had to create a blueprint for not just clinical staff, but for how our patients would use Zoom. Literally, we had a ‘this is how you use Zoom’ guideline, particularly for patients.”

The staff at Epworth Clinic were used to running in-patient, group therapy programs face-to-face all day, and a decision was made to keep those programs going.

“We used telehealth there, delivering the programs to everyone individually in their rooms on the ward,” Ms Zerman said.

“Obviously, we had to ensure safety in the rooms was paramount and if anyone left the Zoom or become distressed, we had a follow-up protocol.

“Our clinicians would also still see patients in their rooms, one-on-one, dressed in full PPE.

“And for our out-patients, they agreed that if they left the Zoom or didn’t answer, then we would initiate a welfare check with their chosen household contact and then with emergency services if we weren’t able to contact them – thankfully we never had to do that.

“It was a big transition and there were a lot of hours put in. Our clinicians, our whole team really made it work, and that was due to the support we received from Epworth, from the top down.”

Ms Zerman said people were “wary” of coming into hospitals particularly during Victoria’s second lockdown, when COVID cases were spiking, but her team kept on providing services to those who needed it.

After such a rollercoaster 2020, face-to-face services were once again suspended for two weeks in January this year, following another COVID outbreak. 

“But we were able to stand up our telehealth service again overnight to ensure there was no disruption to patient care,” Ms Zerman said.

“I really feel proud of the work we did and the decisions we made.

“We were more conservative than some healthcare providers, but that meant we kept our patients and staff safe and did not have a single COVID case onsite the whole time and I am so grateful for that.

“During the two weeks we reverted to telehealth in January,  we were caught with not all private insurers covering the service delivery medium, but we made the decision to put patient care at the centre of everything we do. 

“Obviously we need to be a viable business, but really the importance of patient care and staying in sight of our values and our clinical governance has been at the heart of what we do at Epworth.”

Epworth Clinic is now looking at continuing a diverse model of care for mental health, with some face-to-face services and some telehealth services.

“We are just trying to respond appropriately to the needs of our community,” Ms Zerman said.

“What worries all of us in health is that we’re just scratching the surface when it comes to mental health issues (in the aftermath of COVID-19), particularly from the end of March.  That’s the end of JobKeeper, the end of support for people struggling with rent and there are significant social implications.”

During the past 12 months, Epworth has conducted more than 4,000 telehealth sessions – and that figure does not include doctors' private consultations.

“We were just so well supported by Epworth, and that’s the beauty of working for a not-for-profit,” Ms Zerman said.

“It was an awful situation but I’m so grateful we were able to give back to our community – that’s what people do in times of crisis, they come together, and we did that throughout this once-in-a-lifetime event.”

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