Impact of COVID-19 on Assertive Community Treatment (ACT) from March 2020 to February 2021 in Bronx, NY

Abstract

Introduction: Patients with serious mental illnesses (SMI) have higher rates of metabolic illnesses, cardiovascular and respiratory disease, as well as social deficiencies such as poor housing, and limited support systems. This makes them vulnerable to relapses, symptom exacerbations, and a wide range of negative health and psychosocial outcomes especially during the COVID-19 pandemic. However, having appropriate strategies to address their needs and adequate accessibility to mental and medical health care services, can decrease the rate of psychiatrically/psychological and medical decomposition and save their life. The outreach to the patient with SMI during the pandemic was very challenging. Assertive Community Treatment (ACT) is an evidenced-based practice that offers treatment, rehabilitation, and support services to individuals that have been diagnosed with SMI. The Covid-19 pandemic caused an increase in the difficulty of accessing to ACT services as well. The current study evaluates the impact of COVID-19 on ACT services from March 2020 to February 2021 in NYC. Our aim is to make recommendations that would develop some interventions and action plans to improve ACT services during crisis. Method: This is a retrospective study on patients who are followed by Bronx ACT team affiliated with the Institute for Community Living (ICL) in NYC from March 2019 to February 2021. The study compared the number of hospitalizations and the number of visits in March 2019February 2020 (pre-Covid-19 period) to March 2020February 2021(Covid-19 period). Data analyzed with SPSS. Result: 68 patients were included in the study. A total of 311 hospitalizations registered. 189 from March 2019 to February 2020 and 129 from March 2021 to February 2021 which shown statistically meaningful decrease (P-value 0.026). A total 7968 Visits registered. 4201, from March 2019 to February 2020, 100% in person visit and 3767 from March 2021 to February 2021, 51% tele-visit and 49% in person visits, Which is statistically not meaningful (PV > 0.05). Discussion/Conclusion: Our study demonstrated that if essential services are defined and maintained while promoting staff resilience and wellness, along with giving psycho-education to patients and their family members, the rate of hospitalization in SMI patients during the Covid-19 pandemic can be reduced and these patients can remain healthy in the community. It’s also important to reiterate that Tele-health played a critical role to provide ACT services while lowering the patients and the healthcare-providers’ risk of Covid-19 infection. Check for updates wide range of psychological outcomes has been observed during the virus outbreak, at individual, community, national, and international levels. Specifically, at the individual level, people are also likely to experience fear of getting sick or dying, feeling helpless, and being stereotyped by others [3]. The prevalence of stress, anxiety, and depression, because of the pandemic in the general population, are 29.6, 31.9 and 33.7% respectively. In the current crisis, it is vital to identify individuals prone to psychological disorders from different groups and at different layers of populations, so that with appropriate psychological strategies, techniques and interventions, the general population’s mental health is preserved and improved [4]. Recent studies have revealed Citation: Motamedi N, Gunturu S, Tabor E, et al. (2022) Impact of COVID-19 on Assertive Community Treatment (ACT) from March 2020 to February 2021 in Bronx, NY. Arch Community Med 4(1):40-44 Motamedi et al. Arch community Med 2022, 4(1):40-44 Open Access | Page 41 | an association between medical history and increased anxiety and depression caused by the COVID-19 spread [5,6]. Previous researches had shown that medical history and chronic illnesses are associated with increased psychiatric distress levels [7]. People who have a history of medical problems and are suffering from poor health may feel more vulnerable to a new disease [8]. Suicidal ideation was elevated during the COVID-19 pandemic; approximately twice as many respondents reported serious consideration of suicide in the previous 30 days than did adults in the United States in 2018, referring to the previous 12 months (10.7% versus 4.3%) [9]. For such groups including the elderly, the minorities, the severely mentally ill, those suffering from substance use disorders and the homeless, COVID-19 has also created significant barriers to access to health services, partially due to the disruption of services, an overwhelmed healthcare system and the pressure on medical professionals. Assertive Community Treatment is an evidenced-based practice that offers treatment, rehabilitation, and support services, using a person-centered, recovery-based approach, to individuals that have been diagnosed with serious mental illness (SMI). ACT is well-established and best-researched community, psychiatric model of care. There are three broad categories outlined high standards of care: 1) Human resources: structure and composition, including using team approach, having frequent team meetings, and small caseloads 2) Organizational boundaries, including taking responsibilities for crisis intervention, admission, discharge planning, and defining admission criteria, and 3) Nature of Services, including community-based engagement, assertive outreach, high frequency and intensity of services, etc. In short, successful community psychiatry’s best-practices of care rely on essential services that involved regular, in-person support of patients in the community milieu. Outreach is one of the core components of the ACT service delivery models, and the other fidelity features facilitated this by mandating high provider-to-client ratios, interdisciplinary collaboration and flexible work schedules to allow patients’ timely access to care [10,11]. The main goal of ACT services is to assist individuals to achieve their personally meaningful goals and life roles. ACT is to help people become independent and integrate into the community as they experience recovery. Secondary goals include reducing homelessness and unnecessary hospital stays. In this way, ACT offers treatment in the "real world" and the team of professionals provides help using a "whole team" approach ([12] OMH). COVID -19 could affect patients with SMI who get ACT services in different way. It affects them not only same as general population but also because of disruption of ACT services and difficulty with outreach, possibility decreasing quality of care increasing rate of medication non-adherence, as well as overwhelming and burning out of the ACT providers. Telemedicine has proved to be a safe and effective method of providing services to patients with psychiatric disorders including evaluation, psychotherapy, medication management, case management, supportive counseling, and psychoeducation. However, implementation of telemedicine in the United State in the mental health field in general and particular in ACT program has its own limitations such as lack of access to phones and broadband WiFi and is yet to provide a substantial level of care [13,14]. Our current study evaluates the impact of COVID-19 on ACT services from March 2020 to February 2021 in NYC. Our aim is to make recommendations that would develop some interventions and action plans to improve ACT services during the crisis. Methodology/Data Analysis and Evaluation Techniques This is a retrospective study on patients who are followed by Bronx ACT team affiliated with the Institute for Community Living (ICL) in NYC from March 2019 to February 2021. The Electronic Health Record (EHR) and data would be reviewed from March 2019 to February 2021 to collect number of visits, number of hospitalizations. Visits including tele-visits and in-person visits which were done by a multidisciplinary ACT team member. Data from March 2019 to February 2020 considered as preCovid-19 and from March 2020February 2021 Covid-19 and data compared in two duration of time.