Report from Town Hall: "Wishes, Fears and Risks"

"Wishes, fears, and risks when returning—or not—to the office?”

Part One: PowerPoint Presentation by Todd Essig

The Town Hall started with a presentation outlining the practical and emotional challenges we face when trying to balance the risks and rewards of returning to the office. Here is the powerpoint presentation.

Part Two: Framing the Breakout Groups by David Scharff

"In this exercise, we’d like you to focus more narrowly than usual by sharing your own views on the wisdom of returning to the office, on the fears and obstacles that may pertain, on any special circumstances that would alter your own views, and on the practicalities involved in the differences of online therapy and in-room therapy during COVID. Each group’s discussion will inevitably be a mix of what you understand of expert information and advice on the risks of COVID in-person meetings, your own situation, the problems of your own patients, and the need to balance their safety with that of yourself and your family. It should make for interesting discussion. We hope that when we reconvene for our large group meeting, as many of you as possible will share a digest of your own views and what you learned from your small group.”

Part Three: The Breakout Groups (summary by Brenda Bauer)

Members of the Covid-19 Advisory Team who attended the Town Hall wrote summaries of the themes and issues discussed. Brenda Bauer then volunteered to collate them all into a single summary of what took place in the breakout groups. Here is the summary she prepared:

Breakout groups provided town hall attendees a semi-structured discussion format to digest the town hall presentations together, and to both receive and offer support. Each group had 5-7 attendees each from various regions of the country, from a variety of mental health disciplines who are working in a large assortment of contexts (private practice, mental health clinics, hospitals, public and private schools, preschool, corporations). Several subjects emerged across breakout group discussions. These involved: 1) Safety of treaters and patients, 2) Economic considerations, 3) Clinical concerns, and 4) Existential-identity issues related to the pandemic.

Safety of treaters and patients: Naturally, many attendees expressed great concern about their own safety, that of their families, friends, colleagues and their patients with regard to Covid-19. The majority of attendees indicated that they had no plans to return to treating patients in-person until a vaccine is widely available. There were a number of reports, however, of attendees who are/were treating patients in-person either outdoors, or in their offices or some other clinical environment. These attendees gave voice to various specifics related to physical space (office and other spaces) modifications and adaptations, and ventilation-air circulation, along with the PPE they have opted to use for in-person visits. Some attendees holding in-person visits expressed the belief that it was not reasonable to refuse seeing patients in-person for such an extended period of time, particularly when the number of infections are low in certain areas. Others cited that various professionals, such as outpatient physicians, dentists, and physical therapists, for example, were largely back to the office seeing their patients. However, the overall trend in what attendees were reporting skewed in the direction of great caution and concern about in-person treatments, and general acceptance of what seems to be a “community standard” in mental health of not offering in-person visits to patients in the present pandemic environment.

Economic considerations: Many individuals expressed worry about the continued financial viability of practice in the current pandemic environment. A large number of attendees noted that they had either already given up their office, or would be upon the renewal of their lease. Others expressed significant concern that third party payers would eventually refuse to reimburse for virtual treatment, and that some patients no longer have reasonable insurance coverage due to job loss, etc. Some noted that their own household was at present less economically stable due to the continuing pandemic environment.

Clinical concerns: Many attendees noted uncertainty about how the virtual environment was changing the way they were conducting treatments, and the patient’s capacity to take in the modified treatment conditions. Attendees noted their general fatigue of the virtual environment, and that certain patients were expressing weariness of the virtual treatment, too. Others commented that they had themselves sought and initiated a virtual treatment (as patients) and were surprised to learn how quickly one can adjust to the virtual environment, and that they now see it as more viable and effective than they once had. Some attendees noted how challenging it was to retain new patients who had initiated treatment in the virtual environment. Others mentioned how difficult it was to terminate treatment in treatments that had been exclusively virtual. In addition, some commented that terminating long-term treatments virtually after, in some cases, many years of in-person treatment, created other problems and concerns for both the treater and patient. Child treaters noted that virtual treatment with children was particularly challenging in the present environment.

Existential-identity issues related to the pandemic: Many attendees expressed a general sense of weariness about the pandemic conditions and some wondered aloud, “will this ever end?” Attendees also expressed feelings of loneliness, isolation and dislocation in their work that had intensified over the pandemic. There was a palpable longing for “normalcy” and the “good old days” of practicing in-person, without fear of catching Covid. Interestingly, some attendees commented on how the pandemic has brought family members and friends closer together in certain instances, and expressed appreciation for this forum as a place to discuss many issues that had emerged over the arc of the Covid crisis.