Living through the COVID-19 pandemic can cause stress, anxiety, and depression, not to mention feelings of loneliness and isolation. But when we are under orders to stay at home, it is hard to get help for these issues. Fortunately, telepsychiatry—psychiatry appointments held by phone or  video session—are becoming more and more common and enable you to speak with a psychiatrist while maintaining social distancing. Claire Jackson-Rabinowitz, DO, Clinical Professor in Adult Psychiatry at Mount Sinai Beth Israel, shares some information you need to know about telepsychiatry.

What is a telepsych appointment?

Telepsychiatry is when we provide mental health care via phone or video sessions. Originating in the 1950’s, it has recently become more common as mental health care providers continue to provide care while maintaining social distancing.

We can perform most of  the mental health services we usually provide—aside from administering injectable medications—through virtual appointments. This includes initial consultations, one-on-one therapy, cognitive behavioral therapy, group treatment, family therapy, and medication management.

How does it work?

There are two types of telepsychiatry appointments: phone and video sessions. Most providers prefer video sessions because it gives us visual cues as well as verbal ones. However, if we do not have visual cues, we rely on other indicators such as tone of voice.

Before you log into a session, we recommend you find a quiet, private place to talk. If you are conducting your session over the phone, you will dial the number provided by your clinician or wait for a call. If you are participating in a video session, you dial into the telepsychiatry number and log into the video session on your phone, tablet, or computer. If your provider is still finishing up with another patient, he or she may guide you into a virtual waiting room. Otherwise, the provider will immediately invite you into the virtual session. These appointments generally last between 20 and 60 minutes. These days, with the added stress of the COVID-19 pandemic, mental health providers may also provide quick check-in calls for patients when needed.

In addition to one-on-one therapy, providers have found increased interest in group therapy such as mindfulness, which teaches anxiety-reducing techniques that include breathing and mediation. These skills are especially helpful during times of high stress.

Does telepsychiatry work for everyone?

Telepsychiatry works well for many people; some even prefer virtual visits over in-person appointments. Teenagers, for instance, are often excited to meet virtually. When we suggested this approach to our adolescent patients, they immediately downloaded the app and were ready to go. If you have a busy schedule, you may find it easier to squeeze in an appointment when you do not have to worry about travel time to and from appointments. And, in these days of limited childcare, at-home therapy may be easier for parents of young children.

I am reluctant to try virtual sessions. Are in-person appointments still available?

Yes.

We are open, and in-person appointments are available if you would prefer to see your therapist  face-to-face. However, to adhere to social distancing guidelines and keep all our patients safe, we would like to administer telepsych whenever appropriate and possible.

Also, please  keep in mind that in-person appointments during the COVID-19 crisis can be a bit disconcerting  as clinicians will  wear masks throughout the session.

How secure are these sessions? Will my privacy be protected?

We work hard to maintain your privacy and follow all HIPAA guidelines. We use a state-of-the-art security and encryption program for all sessions and we do not record calls nor is anyone in our office when we are speaking with a patient. For all appointments—intake and follow up— we check to make sure you are okay with working virtually. If you are not comfortable or able to complete a session via phone of video, we will work to schedule an in-person appointment.

Telepsychiatry has been very helpful during the COVID-19 pandemic. Many people may feel more stress, anxiety, and depression during these uncertain times. We are happy that we have been able to provide treatment throughout the crisis, and we look forward to continuing to do whatever we can to safely and responsibly provide care for those in need.

How can I make an appointment?

Please call us at the numbers listed below.

Mount Sinai Beth Israel:
212-420-2400 (All Patients)

The Mount Sinai Hospital:
212-241-5947 (Adults)
212-241-7175 (Children and Adolescents)

Mount Sinai Morningside and Mount Sinai West:
212-523-8080 (Adults)
212-523-3082 (Children and Adolescents)
212-523-3083 (CARES, a combined education and behavioral health program for teens)

Psychiatry Faculty Practice Associates:
To schedule an appointment with one of the physicians at The Mount Sinai Hospital’s Faculty Practice Associates (FPA), please call 212-659-8752 or email psychiatryfpa@mssm.edu.

The outbreak of COVID-19 is challenging all of us to cope in new ways. For people with depression and anxiety, life can seem overwhelming in normal times. Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai describes ways to deal with the feelings of anxiety and depression during this crisis.

Stress levels are high for everybody these days. For people who are already dealing with anxiety and depression, what advice would you give?

Many mental health providers are seeing their patients through telehealth. Should you not be able get to an appointment in person, your provider will likely be available to talk to you by phone or by online chat services like Zoom or Skype. It’s very important that while we isolate ourselves physically, we don’t isolate ourselves from the world or from people. If you can’t talk to your provider, make sure you are talking regularly to somebody, whether it’s a family member or a friend.  I encourage people to talk by phone, video call, Skype—or to reach out through social media.

The more we’re in touch with the idea that we’re all in the same boat, the less anxious we may become. Many people with depression and anxiety feel that no one understands them, and this increases the isolation.  Right now, a lot more of us are feeling isolated, so we are experiencing feelings that some people struggle with all the time.

Anxiety and depression are heightened by the feeling that no one can understand. But right now, we’re all going through the same thing and this provides an opportunity to really connect with each other as we realize that we’re part of a greater culture and humanity. I see an opportunity for healing, because more people will be able to empathize. Staying connected on social media and seeing what everyone else is going through may help people not feel so isolated.

I imagine being on social media can be a double-edged sword. How do you gauge when you’re exposing yourself to too much social media?

You certainly have to strike a balance. But I think the problem isn’t so much too much social media, but negative social media. It’s a matter of choosing your friends wisely, and choosing what you engage in. Sometimes we engage with people who trigger us with their negativity or politics that we don’t agree with.

But if you have friends who are posting important news information, humorous things, or positive items, this can be a great way to stay connected. It’s a good distraction from all the uncertainty and can be a pleasant way to spend some time. The positives of social media should be used to their fullest. Some people are sharing life-affirming stories about how people are helping each other. My rabbi posted a short, 20-second prayer that you could recite while washing your hands, while being mindful that your actions are helping to protect other people.  It can be a time to be inspired and connected to all the positives of humanity when we pull together.

Of course if you have friends who are posting things that you find upsetting, blocking or unfriending those people may help you feel in control at a time when you are controlling much less than normal. And that can be healthy. We have the power to mute negative messages.

What warning signs should you look for regarding anxiety and depression?

If you’ve gone a while without bathing, if you’re not eating, or not caring about getting dressed in the morning, letting the house get messy and out of control, then you should be getting outside help or trying to talk to someone. If you have thoughts that keep coming into your head that you can’t get rid of about becoming infected, or feeling everything around you is unsafe, that is also a sign that you might be getting very anxious. Even though there is truth to the idea that things on the outside might not be currently safe, social isolation, self-quarantine, and taking precautions should make you feel in control. If you can’t feel in control or feel your actions aren’t effective in increasing your safety, that is a warning sign.

We are in a real emergency. So it’s appropriate to have rational plans about worst case scenarios. What will I do if I get a fever or a cough? Do I have enough cough syrup in the house? Do I have a thermometer? These are reasonable thoughts to have, and formulating a plan for those things should provide reassurance.  But if they do not, it’s time to reach out to someone.

Mental health is being conducted on hotlines and many medical institutions have been preparing to deliver care like this for quite a while now. This is the day we’ve been preparing for—where people in need can have a reassuring voice on the end of the line that can walk them through their fears and anxieties.

As the outbreak of COVID-19 spreads throughout the greater New York area, people are adjusting to radical changes in their daily life. Businesses are closed, people are working from home—if they are able to work at all—and kids are trying to learn at home. It’s a stressful time for everybody. Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai, offers this advice about resiliency skills and coping with the COVID-19 crisis.

It’s hard not to get overwhelmed by the news. Should you limit the amount of news you watch?

There’s a part of me that wants to keep up with every update. I try to limit my exposure because much of the news is repetitive and some of it is sensationalized. I was out west in mid-March for a brief trip, and saw pictures on the news of empty shopping shelves here in New York. I was pretty worried until I got home that there might be shortages.  Of course when I did return, I realized that the situation wasn’t quite as bad as portrayed. People did panic-shop, but the shelves were also getting restocked. So my worry in that case was exaggerated.

On the other hand, it is a good idea to check in a couple times a day to get the latest reports. Let’s face it, a pandemic is a scary thing to be a part of, and there are important updates that we need in real time. The important news is information about what we can do or should be doing. We need to make sure we get our news from reputable sources, like the World Health Organization. Some news outlets have an agenda that they are trying to promote, and I don’t think that’s helpful or healthy to engage in because it may increase distress. But, even if you’re getting news from reputable sources, you don’t need it 24/7.

It’s hard to avoid if you’re home.

True, but it’s also a time when you can do other things at home other than having the TV on. It’s a time that you can read, write, do something creative, meditate, or try a recipe you’ve wanted to try. You can spend time playing with your children, writing letters, or get organized, even clean out your closet.

Think of something you can do at home that will make you feel productive, and that you’ve accomplished something at the end of the day. Put the focus on enhancing your home experience as opposed to what you can’t do in the outside world.

It’s also a really good time to check in on friends, neighbors and particularly, older folks. Now is the time to catch up with other people, perhaps there’s someone you haven’t had a chance to talk to. Or maybe there’s an older person who’s shut in and isolated and needs help. It’s a healthy and healing thing to think about other people, rather than focus exclusively on yourself.

Some people are reporting that they are learning a new “coronavirus skill or art.” Think about the things you have always wanted to do, but never had the time. Arts and crafts. Watercolors. Play a musical instrument.

Does sticking to a daily routine help keep you on track?

For some people it’s very good. For children, in particular, the structure of a routine is very grounding. But there is also something liberating about a guilty pleasure of going off routine. If you always wake up really early to commute to work, there is nothing wrong with giving yourself a treat of an extra hour of sleep to make up for some of the negative aspects of not being able to go out and do whatever you want. So I wouldn’t rigidly advocate it for everyone. If you feel lost without a structure, like you are wasting the day or failing to be industrious or productive, a schedule can be important. But for people who find themselves over-scheduled, there is something about putting the world on mute and listening to one’s needs that can promote a sense of well-being.

The key is to be mindful about it. We are being given an opportunity to connect with something inside of ourselves that hasn’t been nurtured. We have been given more time.  Sleep an extra hour, or skip a meal if you want. Do something you don’t ordinarily get to do. It’s a chance to embrace possibilities outside the box. We’re in a serious situation, but we can try to make the most of it and squeeze something positive out of it.

The people who are going to do the best are those who find special moments, special meaning, and special opportunities during this time. During the past couple days, I’ve gotten texts from people just asking “How are you doing? I’ve been thinking about you.” It’s wonderful to get those messages and connect when, otherwise, we might not have had time. And we’ll come out the other end of this changed in some way—maybe for the better.

Can you talk a bit about resiliency skills?

Optimism is certainly a big resiliency skill. Being able to look at the positive side of things is very important. I believe spiritual mindfulness is key; understanding what is in your control and what is not. And taking whatever control you can take, acting on it, and not feeling victimized. And knowing that this will all pass, and maybe good things will come from it in the future.  This is hard to do while people are getting sick and dying, and when people are losing their jobs and faced with economic hardship. Grieving losses in real time is an important key to resilience in the future. Realistically assessing and starting to think about what will need to happen in the weeks to come if one has lost one’s job is also important.

Not feeling helpless, but trying to act is also an important way to build resilience.  I am reminded of 9/11. At this time we want to behave in a way that when we look back, we will be proud of what we did during this pandemic—individually and as a society. If you bear that in mind, you won’t have disappointed yourself, and that is an important key to resilience.

Doing things for others—altruism—is also key. If you help others, even if there’s a certain amount of risk to yourself, you’ll feel good about yourself when all is said and done. Certainly health care workers on the front lines are expressing altruism each day.  People are scared right now. Even people I know who are always positive are worried about getting sick, or even worse, being a carrier and getting someone even more vulnerable at risk.  You should be careful if being helpful means posing a risk to yourself or to others.  Yet there are many ways to contribute without leaving the house.  We can show up each day in our lives—for ourselves and other people—and ask what can we do today to help. That’s resilience.