Over a year into the COVID-19 pandemic, 40 percent of Americans 18 and older are experiencing increased symptoms of anxiety and depression. Substance use has skyrocketed as more and more people turn to alcohol and drugs to cope with their increased isolation, uncertainties and stress.

Even as more Rhode Islanders get vaccinated, the demand for behavioral health services continues to rise, as does the workloads of frontline workers like those who staff Assertive Community Treatment (ACT) teams.

“Developed over 40 years ago, the Assertive Community Treatment model has withstood the test of time,” said Dan Kubas-Meyer, President and CEO of Thrive. “The premise is simple: start with a multidisciplinary team of medical doctors, nurses, therapists and case managers and give a person whatever service they need, whenever they need it. Done well, crises and hospitalizations are minimized, if not eliminated, giving recovery a better chance to take hold.”

A division of Thrive’s Community Support Program, Thrive’s ACT team serves clients who have a qualifying diagnosis of serious and persistent mental illness. This includes conditions schizophrenia, major depressive disorder, bipolar disorder and obsessive compulsive disorder. In addition, many ACT clients have been dually diagnosed with a substance use disorder, a developmental delay, or a brain injury.

The goal of ACT teams is to help individuals living with serious and persistent mental illness gain the skills they require to maintain stable lives in the community and move towards greater independence. ACT clients have access to symptom assessment, medication administration, medication monitoring, case management services and peer support.

Based at Thrive’s 2756 Post Road location in Warwick, the ACT team administers care to over 100 clients in the community and in their homes. During the COVID-19 pandemic, those who serve on the ACT team have faced a variety of challenges in response to clients’ increased behavioral health symptoms.

“People look to healthcare providers for answers,” shared Jenna O’Brien, RN. “My greatest challenge has been not having all of the answers to my patients’ questions about COVID-19 or the vaccines. As a nurse, I was taught to always give the most honest and evidence-based response possible. Unfortunately, a lot of answers to their questions are not available, and that causes my clients anxiety.”

Reassurances

Due to their behavioral health symptoms or co-occurring medical conditions, many clients are unable to travel or spend time with their relatives. “It bothers my clients tremendously that they can’t see their parents or attend funeral services of loved ones,” shared Anthony Macro, RN. “These stressors have such a negative effect on their behavior and their physical stability.”

Macro believes providing his clients with reassurances has been paramount in maintaining their level of mental health. “We have several clients who are medically compromised as well as having behavioral issues,” he continued. “They have enough to be apprehensive about. Letting them know we are there for them during this time – that’s been their best medicine.”

“A pandemic is something the ACT team has not faced before,” said Case Manager Julie Hannaway. “We had to learn to adapt to serve our population while also navigating our own fears and stress. There is a lot of unknown with this pandemic, how it would affect ourselves and the clients we serve. The biggest thing I had to adapt to is to take things one day at a time.”

Due to the nature of their clients’ symptoms, behavioral healthcare staff are sometimes put in difficult situations, which have occurred more frequently during COVID.

“Right at the beginning of the pandemic, one of my clients became very dysregulated and symptomatic and spit in my face,” said Assistant ACT team Leader Blanca Xavier. “What saved me was God’s grace, and wearing two masks that kept me safe from any exposure.”

Despite increased supports and ongoing daily contact to monitor symptoms Blanca Xavier’s client was eventually hospitalized. Jenna O’Brien recognizes this as a growing trend.

“I have seen an increase in the number of hospitalizations for psychiatric complaints. I have also noticed longer hospital stays,” said O’Brien.

While hospitalizations have increased, O’Brien has noticed a greater sense of independence and adaptability in her clients. “Before COVID, clients would rely on staff to transport them to the grocery store or doctor appointments. Now, they are reaching out more to their friends and neighbors, who have increasingly stepped up to help out when and where they can.”

Julie Hannaway concurs. “Our population has suffered from increased isolation and more barriers to their physical and mental health, substance use, finances and housing,” she said. “COVID-19 has pushed clients to work on more, and different, coping skills they wouldn’t normally initiate such as walking or exercising.”

“This pandemic has definitely caused a disruption in our methods of service, but at no point has it prevented our clients from receiving the care they need from us,” said Cori Cramer, a substance use clinician. “We’ve been forced to get creative and adjust our routines, but our nurses, case managers and clinicians show up every day and sometimes we put our clients’ needs before our own.”

Cori Cramer credits ACT team Leader Jamie Peche for keeping staff safe and helping them remain positive during the pandemic. “Jamie encourages us to make sure to take care of ourselves first, and only do what we feel comfortable doing,” she said. “He understands we are scared, too, and never pressures us to put ourselves at risk. He also checks in with us frequently regarding our own mental health and makes sure we feel safe.”

This type of teamwork is what is helping Thrive’s ACT team staff get through the pandemic. “It takes a certain kind of person to do what we do,” said Cori Cramer. “This work is not just a job, and my team members are not just coworkers. We are a type of family battling this demon of an illness together, attending to the needs of our clients, who have a piece of our hearts.”

Sarah Channing is Director of Development & Digital Media at Thrive Behavioral Health