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APNA Tips & Info for Psychiatric-Mental Health Nurses

During any crisis, psychiatric-mental health nurses have a critical role to play: providing essential mental health care and psychosocial support to those impacted. Almost everyone will experience psychological distress at some point during a time like this and those with severe mental health or substance use disorders are especially in need of support. PMH nurses stand ready to ensure safety and continuity of care for their patients in the midst of challenges and uncertainties. As always, relying only on information from trusted sources is a necessity, as is seeking out support where it is needed.

Click here for a detailed one sheet from APNA with actionable tips for psychiatric-mental health nurses.

Policy Updates

In light of the public health emergency, new policies are being put into place to ease access to care. Full List of Policy Updates

TIP: States and local government agencies are making adjustments to regulations and sending updates to nurses registered in their state and posting them on State Board of Nursing websites. For regulatory changes to practice or prescribing in your state, check with your state board of nursing.

  • The declaration of a state of emergency allows HHS to waive certain federal licensing requirements for nurses and doctors in order to expand access to services. CMS has offered this guidance for health care providers. Note the Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a Hospital on relocation of psychiatric patients to acute care beds and Provider Locations and Provider Enrollment sections which address telehealth services and medicare billing privileges.
  • HHS waived penaltiesfor HIPAA violations against providers serving patients through technologies like Facetime or Skype during the COVID-19 public health emergency.
  • SAMHSA has relaxed regulations that require providers to obtain written patient consent for disclosure of substance use disorder records, if the provider determines that a medical emergency exists.
  • Medicare has expanded its telehealth policies and many states are expanding their Medicaid. Please check with your state for more information.
  • SAMHSA has expanded guidance pertaining to Opioid treatment during the COVID-19 health emergency. States can now request blanket exceptions for stable patients to receive 28 days of take-home medication for the treatment of opioid use disorder.
  • DEA-registered practitioners may prescribe buprenorphine via telehealth or phone consultation to individuals who have not received an in-person medical evaluation so long as the evaluation is determined adequate by the provider. An in-person evaluation is still required for new OTP patients treated with Methadone.

Telehealth Considerations

To help ensure continuity of care, knowledge of telehealth technologies accessible to patients in their homes, as well as the ability to quickly implement those technologies is critical.

TIP:If you do not have a telehealth technology in place, remember that you can use phone video chat apps such as Skype, WhatsApp or Facetime during the public health emergency. HHS has waived penalties for using non-HIPAA compliant technologies during this time.

  • A CMS Telemedicine Toolkit helps expand the use of technology to help people needing routine care and keep vulnerable beneficiaries and beneficiaries with mild symptoms in their homes while maintaining access to needed care.
  • This National Council resource offers current policies and considerations for adopting telehealth or expanding its current use.
  • An article from the Journal of the American Psychiatric Nurses Association explores the risks and benefits of telemental health, existing standards of care, practice guidelines, and more.
  • For guidelines specific to using video to provide mental health services, see this document from the American Telemedicine Association.
  • A guide from the Mountain Plains Addiction Technology Treatment Center offers tips for using text messages to improve substance use treatment outcomes
  • Agency for Healthcare Research and Quality provides a sample telehealth consent form as well as guidance for clinicians on how to obtain informed consent for telehealth.
  • A tip sheet from SMIAdviser on billing for telehealth sessions.

Coping During a Stressful Time

Arming yourself with information and resources is pointless if you are too stressed and burnt out to provide care. Strategies to manage stress and anxiety are more crucial than ever.

TIP: Be on the lookout for the symptoms of traumatic stress (see example symptoms of secondary traumatic stress to left) in yourself and check out these strategies for nurses on managing stress.

Your Support Community

Through APNA Member Bridge, psychiatric-mental health nurses are sharing ways to balance necessary safety measures and the wellbeing of their patients across settings.

TIP:If you are looking for information around how other psychiatric-mental health nurses are handling a specific issue associated with COVID-19, post your question to the All-Purpose Discussion Forum.

Mental Health & Substance Use Care

TIP: Brush up on your Psychological First Aid skills – an evidence-based early intervention strategy that can reduce and mitigate psychological sequelae in response to crisis or traumatic situations.
  1. Watch this 17-minute video on Psychological First Aid created by Dr. Jess Calohan, DNP, PMHNP-BC.
  2. Supplement with this slidedeck from Dr. Julian Ford at the National Child Traumatic Stress Network.

Browse the SAMHSA COVID-19 Resources for guidance specific to the issues mental health and substance use treatment providers are navigating. Below are a few highlighted excerpts.

Domestic Violence & Child Abuse

Conditions around COVID-19 may stimulate violence in families where it didn’t exist before and worsen situations in homes where mistreatment and violence has been a problem. Nurses should screen patients for intimate partner violence and child abuse and inform them that there is help available:

  • See this tip sheet for supporting survivors’ access to SUD and mental health services during the COVID-19 emergency
  • Make patients aware of the National Domestic Violence Hotline and share their information around staying safe during coronavirus.
  • Connect patients with local resources through the Department of Justice Office of Violence Against Women.

Care & Treatment Considerations

From Considerations for the Care and Treatment of Mental and Substance Use Disorders in the COVID-19 Epidemic:

  • Use outpatient treatment options to the greatest extent possible and reserve inpatient facilities for those for whom outpatient care is not an adequate clinical option
  • Use telehealth services to provide evaluation and treatment of patients, including evaluation for use of buprenorphine to treat opioid use disorder and individual and group therapies
  • Consider CDC guidance on precautions admitting new patients and management of residents who may have been exposed to or infected with COVID-19

On May 7, 2020 SAMHSA certified that mental health and substance use disorder treatment are essential medical services and may require personal protective equipment

Peer Support

Tobacco Use

  • A growing body of evidence suggests that tobacco use is a risk fact that contributes to COVID progression and higher risk of mortality. Learn more in this fact sheet from the National Behavioral Health Network.

Behavioral Health Organizations

From the Disaster Planning Handbook for Behavioral Health Organizations:

  • Reach out to other behavioral health treatment programs in the community to collaborate and assist displaced populations (p.16)
  • Your local or state public health department’s emergency manager can provide targeted planning assistance and serve as a link between the programs and broader disaster planning and incident response efforts. (p.17)
  • Clients need to know how they will be informed if the program closes or changes its hours of operation, what they should do if they cannot access services, or if they begin to experience a physical or mental health crisis (p. 34)

Nursing Care & COVID-19

In a pandemic, priorities shift. It is important to keep up-to-date with nursing best practices and competencies in a public health emergency.

TIP: Register for this ANA 3-Webinar Series: Be Confident Protecting Yourself and Providing the Best Care to Your Patients during this COVID-19 Pandemic.