Virtual mental health support in Covid 19
@outdoorprescrip‘s #MadCovidDiaries 8.7.2020 – this is a reblog from their fantastic blog
I am one of the lucky ones. I’ve received support during Covid-19 virtually. I appreciate I am lucky to have received any support at all as I know many have had nothing. A virtual interaction this week has pushed me out of my depression to put some words together.
This week I attended my weekly Skype appointment. The health care professional alternates between working from home and in the office. This week they were in the office, I could hear background noise of other staff talking and people were walking past them in the video. The noise was an immediate distraction and I felt exposed. As I became more uncomfortable I had to say something and they offered to go into a quieter room.
Thinking about this interaction afterwards I wondered how communicating virtually is considered as an interaction. In my mind it should be treated in the same way as a face to face appointment. Would it be acceptable in a face to face to face appointment to have members of staff walking in and out of the room? If a professional knew this could happen in a face to face appointment would they move rooms in advance of the appointment taking place so it didn’t cause a difficulty for the patient? Knowing the professional well I don’t believe that they would ever do anything which could cause distress, but I think it’s important to highlight how easy it is to treat video contact more casually than other interactions. Having to ask for your needs to be met can cause feelings of guilt, which can then dominate the appointment itself or afterwards.
Since the reopening of pubs there’s been questioning on social media about when mental health patients can resume face to face contact. Responses in the public domain have felt unclear. Ranging from ‘The welfare of staff is paramount’ to ‘Face to Face is offered if there is a medical need’. These responses make me feel uneasy. They also trigger feelings of guilt, that by asking for face to face support I am putting the lives of staff at risk. Who decides if there is a medical need? How do we know if there is a medical need where we can’t easily compare which is more effective? Studies are being shared based on historical data comparing digital support versus face to face support, but the studies were not conducted during global pandemics. People’s situations are very different right now. If someone has therapy via Skype and it’s not effective they may lose their chance to have face to face therapy in the future. I worry that digital technology is being seen as an acceptable alternative, rather than a temporary ‘make do’ solution that it was initially intended to be.
What does it feel like to have therapy or support over video or telephone? To me it feels impersonal, you don’t feel the warmth of the interaction. My privacy feels invaded, I don’t see health professionals in my home in ‘normal, non corona times’. My home is my safe space, it feels difficult having such personal conversations in my home. I live with my family and each week I dread trying to sort out how I can have a confidential appointment with them in the house. Even if they are in another room I feel like I can’t be as open as I’d be if they weren’t there. If I ask them to go out I feel consumed by guilt.
The processing of information can be difficult over video message, I find I can’t think as fast as I would do if we were face to face. I also miss the walk I would take to and from the appointment, often finding myself rushing to log on to Skype without having had a chance to think about what we are talking through. At the end of the appointment it feels strange to be left in my home with difficult feelings, without the walk home to decompress. I find video messaging much more tiring than face to face interactions and a difficult video interaction can sometimes write off the rest of the day. I only have limited capacity for video contact, so if my mental health support is over video and my work is also over video it leaves little head space for using any of the social aspects of video contact to cope with isolation. I know I am lucky that I am able to cope with using phone or video, for some mental health patients both of these things may be impossible and I really worry about people who’ve been without support with no end in sight.
For all other Corona Virus changes and relaxations of restrictions we seem to have timelines of when things will begin again. These give an element of certainty in really uncertain times. Mental health patients are not being given certainty about when face to face support will recommence. I think many of us understand that there will be issues to iron out before it begins, but the often radio silence about Trust plans can make things even more challenging. People need to be given hope. The fact that it’s down to individual trusts to decide (and even individual teams) it’s making it a post code or diagnosis lottery.
I’ll end this blog with a few observations of things that have helped with virtual support for me personally:
- Using headphones helps me to process the information better and gives more of a feeling of confidentiality. It helps if the health care professional if also using headphones as I don’t feel the appointment is confidential if they are using computer speakers and I don’t know who they are sharing the environment with.
- Having a written summary after the appointment helps, this is sent by email and is usually a copy/paste of my notes.
- Both the health care professional and myself having a place to talk virtually without others in the room.
- I minimise the video of myself when on video as it’s a distraction seeing myself.
- Emailing relevant information to the health care professional in advance of the appointment eg food or mood diaries.
- If the therapy would usually contain an element of written information eg the therapist drawing something or patient completing written work it is helpful for the health care provider to have an understanding of the functionality of the platform they are using to make the virtual therapy as similar to in person therapy. There is lots of online learning for this.
- As a health care professional a video interaction is a professional one, showing you are treating it that way is important, dressing as you would do for work, choosing an appropriate background if you have that option. Being mindful of your body language, positioning the screen so you aren’t peering down at someone for example.
- Speaking up if there are connection problems, if you can’t understand what is being said because the internet has slowed down.
- Planning something for after the appointment, such as a walk, to have some quiet time to process the interaction.
This blog feels like it needs an ending, so I’ll end it with a personal observation. I am having very few interactions with others at the moment, small amounts of human connection mean a lot. Sometimes a few minutes of just normal conversation in an appointment can mean the world. Perhaps it is seen as unprofessional, but it a time where we are feeling isolated, anxious, distressed a small comment can help. In a support group last week a health professional shared a photo of a bullfinch they’d seen in their garden that week. A glimpse of warmth in communication which can feel cold and clinical.
One thought on “Virtual Mental Health Support in COVID19: I worry that digital technology is being seen as an acceptable alternative, rather than the temporary ‘make do’ solution that it was initially intended to be.”
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