Seriously Mental Ill Patients Increase Independence During Pandemic

One common thread in the global COVID-19 pandemic is that it certainly keeps us on our toes. The unpredictability of the virus itself, its spread, and its physical effects on clients have boggled the medical community and the public for nearly a year. Now, well-into this unusual period of history, we’re also seeing its effects in other areas of life.

Stepping Up to the Difficulties

“One thing that has surprised us is that our seriously mental ill (SMI) clients have really stepped things up to become more independent since COVID began,” said Randy Allen, counselor at Behavior Management Systems, which serves the mental health needs of more than 11,000 people in a 20,000-square-mile area in South Dakota.

“We have about 1,000 SMI clients in the Greater Black Hills area, most of whom are living independently,” Allen explained. “Many have figured out the bus system and things like how to order groceries so they can do curbside pick-up. Since many are in the high-risk category, they have started paying more attention to their physical health.”

Telehealth Helps Them Stick to Plan of Care

Right before the pandemic began, Behavior Management Systems had started telehealth training and implementation. “We were actually in the process of setting up our telehealth technology and training at the end of last winter,” said Kim McNemar, clinical site supervisor for Southern Hills, Behavior Management Systems.

“Mary DeVany of the Great Plains Telehealth Resource & Assistance Center (gpTRAC) came to help us,” McNemar said. “Dozens of our therapists were getting set up on zoom, learning about telehealth visits, and studying the ethical ramifications. It lined up perfectly; by the beginning of COVID, we were feeling confident that we could use telehealth in our practice.”

For many SMI clients, transportation to doctor’s appointments and counseling sessions is challenging. “Transportation costs something, whether that be shoe leather, dollar bills, or time,” Allen said. “Our SMI clients really appreciated telehealth visits because it removed a big barrier for them.

“When SMI clients are working, they might have to take half a day off to catch three buses to get to a 15-minute medication check appointment,” Allen continued. “Now, they can do the same appointment during their coffee break.”

In addition, these clients can also do their counseling appointments virtually. “We’ve had way fewer no-shows and cancellations since we started offering telehealth visits,” Allen said. “That means our clients are sticking to their plan of care, and we are more efficient in delivering that care.”

Leveling the Playing Field

Prior to COVID-19, the SMI clients were traveling to Behavior Management Systems for their appointments. When the shift to telehealth visits occurred, there was an unexpected shift in the balance of client-therapist relationships.

“You know, as therapists, we think we have a great influence on our clients, but we sometimes don’t recognize the influence they have on us,” Allen reflected. “The fact that COVID forced us to stop in-person appointments meant that we had to back off in a sense within the relationship. Telehealth introduced new ways for us to interact with our clients. It showed us how we were actually getting in the way of some of our clients’ development.”

Over the last few months, one of the therapists at Behavior Management Systems contracted COVID. This individual continued to see clients from her home through telehealth appointments to keep both the clients and the staff safe. “It was interesting because during this time, her clients would check on her,” Allen said. “They could sort of ‘take care of her’ during their own telehealth appointments with their concern and caring.”

Connecting Through the Isolation

Many of the SMI clients have difficulty with social interactions as part of their mental illness. To assist with this, Behavior Management Systems also helps them try to create a community outside of their families and their therapeutic relationship.

“We used to have a facility where SMI clients could congregate, have snacks together or watch TV,” Allen said. “It was always packed, and obviously, we had to close that down during the pandemic.”

However, many of the SMI clients started taking it upon themselves to connect with one another through virtual visit. “They wanted those same interactions, and they started initiating Zoom calls amongst themselves to get together and connect. It’s really been amazing how these SMI clients have stepped up to the challenges afforded by the pandemic.”