Mobilizing a psychiatric crisis response to COVID-19 for NYC hospital workers: Lessons learned from the mental health front lines

New York City was the early epicenter of the pandemic in spring 2020, with Montefiore Medical Center and the surrounding Bronx communities being especially impacted. The stress on Montefiore associates was further compounded by the systemic inequalities faced by the communities they serve including high rates of poverty, poor infrastructure, disproportionate exposure to environmental pollutants, reliance on public transportation and densely populated apartment units. Like other major NYC medical centers, Montefiore faced the harrowing challenges of having limited personal protective equipment, COVID-testing capability, ventilators, bed capacity, and providers to treat the projected onslaught of critically ill patients. The Department of Psychiatry and Behavioral Sciences recognized the imminent need to provide expediated mental health services to Montefiore associates thrust into a rapidly evolving and uncertain situation, experiencing direct and vicarious traumatization and potential moral injury, and at risk of exhaustion and burnout. The Department of Psychiatry, in collaboration with the Department of Medicine, hospital leadership, and others, rapidly implemented strategies to increase access to mental health services for Montefiore associates. The Swift Montefiore Associate Response Team (SMART) clinical program was launched on March 30, 2020 and aimed to eliminate barriers of wait-times, complex referrals systems, out of pocket costs, incompatible insurance, and limited after hours availability of faculty. Capacity was created for telehealth and in person visits during and after routine office hours. This service offered up to 12 sessions of individual psychotherapy and/or pharmacotherapy to target COVID-19-related distress. Participating faculty were asked to dedicate four hours per week to this program. Eligible patients were Montefiore associates, self referred or referred by other treaters or by Occupational Health Services, who were seeking treatment at least in part due to COVID-related distress. At the conclusion of the SMART program, we conducted a study to explore the patient and providers' evaluations of program experiences, perceived helpfulness, and common treatment concern. A chart review was conducted on all patients (n = 52) who received outpatient services through the SMART clinical program. A subset of these patients (n = 15) and providers (n = 21) also responded to the survey. Patients included physicians, nurses, and employees in support and administrative roles (68.42% female; Mage = 42.39, SD = 13.53) and providers included eight psychologists and 13 psychiatrists with 4-40 years of professional experience (M = 15.52, SD = 13.41). Anxiety, insomnia, and depressed mood were the most common treatment concerns reported (Supplemental Data, Table 1). Additional qualitative analyses were performed from which the themes of anxiety, depression and loss, trauma/acute stress response, and work concerns emerged. Our study reinforced the necessity of key program development features noted by other authors including anticipating the mental health need, using leadership capable of mobilizing systems and resources quickly, convening a multidisciplinary team, delegating tasks, and setting timelines, developing training and educational materials, and developing a marketing strategy. (PsycInfo Database Record (c) 2022 APA, all rights reserved)