Abstract
Finding themselves outside the traditional supply chain for personal protective equipment (PPE) for health care staff, leaders of behavioral health provider organizations have had to devise creative strategies — from the local to the global — in order to secure equipment to protect employees and patients during the COVID‐19 crisis.
Bottom Line…
Behavioral health organizations have had to look at home and abroad in their effort to secure equipment to protect staff and patients from transmission of the novel coronavirus.
Finding themselves outside the traditional supply chain for personal protective equipment (PPE) for health care staff, leaders of behavioral health provider organizations have had to devise creative strategies — from the local to the global — in order to secure equipment to protect employees and patients during the COVID‐19 crisis.
National Council for Behavioral Health President and CEO Chuck Ingoglia told MHW last week that some relief for the organization's community behavioral health members recently arrived in the form of a completed order of 2.3 million surgical masks from China. The same entity that handles distribution of Mental Health First Aid manuals for the National Council is in the process of distributing the masks to the member organizations that placed a formal order for them with their national association, Ingoglia said.
Community mental health centers are by no means alone in the scramble for PPE. In fact, Ingoglia said, the National Council has been contacted by groups ranging from some state mental health departments to county jails as their leaders conduct their own searches for PPE. “Everyone is desperate to find PPE,” he said.
Anxiety‐ridden process
The National Council's decision several weeks ago to place a large order for surgical masks stemmed largely from the high quantity of minimum orders that many suppliers of the equipment demand. With it being impractical for an individual facility to place an order at such high minimum quantities, a National Council member suggested a collaborative approach that would meet many centers' needs.
Just over 1,000 organizations placed orders for surgical masks, and the National Council in turn placed the order of 2.3 million masks with a supplier in China. National Council member facilities can operate sufficiently with surgical masks, not needing the N95 masks that are more tailored to staff in hospital settings.
Then came the waiting game, and the worry over possible problems such as whether the U.S. government might impound the supply coming from abroad. “This has been weighing on us for weeks,” Ingoglia said. But the order cleared Customs, and the masks now will be on their way to National Council members.
While there have been some requests among members for items such as protective gowns and gloves, the scope of the community behavioral health organization's needs for PPE is generally limited to masks, Ingoglia said.
It is important to remember that while most community behavioral health organizations have successfully transitioned in‐person outpatient services to telehealth, many are still operating essential street outreach, crisis services and residential care that require close person‐to‐person contact. “Not everything is virtual,” Ingoglia said.
Also, “Most of our staff have never used this kind of equipment before,” he said. The National Council is working on creating a video that will show facility staff members how to properly use and preserve a face mask. The latter consideration becomes important in a period marked by short supply of PPE.
Concerns at hospitals
Although the psychiatric health system members of the National Association for Behavioral Healthcare (NABH) operate a higher‐intensity level of care than what community mental health facilities generally provide, concerns about protecting staff and patients from virus transmission are still a new priority for many.
“Our members have not traditionally used PPE,” NABH President and CEO Shawn Coughlin told MHW. “But they are still interacting with individuals on a daily basis. They didn't have reserves set aside.”
Larger hospital facilities that have held relationships with suppliers for some time have adjusted to the sudden need for PPE better than smaller organizations, some of which have had to resort to placing calls with international brokers in the middle of the night, Coughlin said.
Another concern for psychiatric hospital staff comes with the push for universal masking for all staff and patients. In an environment that houses at‐risk behavioral health patients, “You can't just be giving out cloth masks,” which could generate ligature‐related concerns, Coughlin said. Hospitals also may be working with patients who don't fully grasp the gravity of the virus threat, he said.
The National Council's guidance document for managing COVID‐19 risk in residential behavioral health facilities (accessible at https://www.thenationalcouncil.org/covid-19-guidance-for-behavioral-health-residential-facilities/) states that all patients, staff and visitors in residential settings should be required to wear surgical masks while awake (or cloth face coverings if surgical masks are not available). But the document adds that there will be cases in which a patient cannot comply due to symptom‐related or other concerns, in which case steps should be taken to ensure that people nearby wear face coverings to reduce the risk of transmission.
The guidance also suggests that facilities enhance the availability of alcohol‐based hand sanitizers and reinforce the use of effective hand hygiene practices.
The document states that hospital regulators are not expected to cite facilities for noncompliance with safety protocols during the pandemic, but it urges facility leaders to demonstrate that they are taking the steps they can to secure the supplies of PPE they need.
Is issue on the radar?
The National Council reported last month that in its online survey of 880 behavioral health organizations to assess the impact of the COVID‐19 crisis, 82.9% said they do not have enough supply of PPE for two months of operations (see MHW, April 27).
In the absence of sufficient supply, individual organizations have tried to identify their own suppliers. In some cases, they have been able to work out arrangements with local hospitals or through a state's public health response infrastructure, Ingoglia said. And from a practical standpoint, “They've moved everything they can to virtual, as they try to minimize contact,” he said.
A letter that was sent to Vice President Mike Pence and other federal leaders to express the need for more attention to behavioral health providers' challenges during the pandemic has not received a formal response, Ingoglia said. But federal health leaders in charge of preparedness efforts have met with the behavioral health community and have expressed interest in elevating these issues in the national discussion, he said.
Coughlin believes the experience of this crisis will convince NABH members to pay more attention to storing basic supplies for future emergencies. But he adds that at the moment, there is a greater focus on staff being ready to meet an anticipated explosion of behavioral health needs in the community.
“We know there is going to be a second wave of behavioral health issues,” Coughlin said. “There is going to be a huge surge in demand.”
How are you faring during this crisis? We'd like to hear from you
During this pandemic, many organizations have been forced to make quick shifts to work‐from‐home arrangements or other accommodations. What creative ways has your organization adopted to support your workforce during this COVID‐19 crisis? Be as specific in your comments as possible. You may email your comments to vcanady@wiley.com.