How and when to deliver care in-person vs. virtually (notes) CAMH

Yesterday I attended an one hour education period with CAMH virtually. Tomorrow I have another hour with York University. I don’t want to fall behind too much and so what I have decided to do is to write my notes to you and keep a copy of that for myself, record my education hours on my resume and for my college and appropriate association and then I can carry on with the other stuff. So, as you know I have gone from in person at my home office to virtually or telephone. However, there are still times that I do see a person in my office. I went from an office that was comforting and warm to an office that is almost sterile. My books I donated to my old professor, a Jesuit. He is now in a retirement home and so I asked him to donate them to the library when he is finished. He has told me that to read all those books a person can get a fine education. I did not donate the books he wrote. I have only one shelf of books in my office right now and another in my other home office. I re-placed my comfy love seat with wooden/metal chairs which is easy to sanitize. I have cleaning supplies replacing cute ornaments on my filing cabinet. I have had one long term client in my home office and I could tell he does not like the changes. However, COVID has changed everything. Back to CAMH. The presenters were Sandra Easson-Bruno from North Simcoe Muskoka Specialized Geriatric Services and Dr Allison Crawford - CAMH, General Psychiatry and Health systems Division, Associate Chiefs. I am always honoured to be invited. There was discussion regarding how overdoses skyrocketed in April, May and June. I see people who suffer addiction as well as their partners and/or families. Sometimes one doesn’t think he or she has a problem but arrives because of an ultimatum. There are different stages which I have written about before so I won’t elaborate. However, there are times when one really wants to get help and there the work can begin. The one suffering the addictions is the one who needs to recognize that he or she needs the help. When it comes to virtual therapy the presenter stated there was an indication that some are less vocal and they might disengage from treatment. Loneliness can increase. There was concerns about the family environment virtually. There are eyes there. I have noticed that myself especially with children. They know their parents are listening and therefore children won’t open up. Others I see use the therapy virtual room as a way of letting others know what they are saying. It is easy to tell when they start whispering with something they don’t want to share. Yes there are eyes as the presenters reported and I have noticed. With my weekly discussions of self/client care this is one topic which has been shared as we all experience virtual therapy in our care for others (I have missed last week and will also miss this week due to seeing clients and more education). In person, when I see clients, they are free to speak. There is no one listening except me. No one is standing by the door. They are safe and free. Another issue raised regarding the elderly is the circumstances of virtual when there is confusion with an elderly person, or a fall. I do see elderly people in my office and not on line. Usually a family member will bring them in and I encourage the escort to return in 50 minutes. I tell them where the local bakery is. CAMH is having 7000 virtual visits a month. I have gone from seeing people 99 % in person and about 1% by telephone to 99% virtually and 1% in person or communicating via telephone. I do try to encourage virtual. However people I see can afford to see me, either because of their EAP, Insurance or ability to pay my fee. I have decided not to increase my fees this year due to COVID. The presenters talked about Virtual mental health and the client’s experience. What happens when they cannot afford a virtual device? How can they access a device? How about their ability to engage? They also talked about those having no access what so ever to technology, not being able to see or hear. They talked about social isolation being huge. However, they also talked about great virtual programs. One of the things they mentioned is how many organizations where people depended on are now closed. I have heard complaints about that especially from the families of seniors. They talked about guidelines for virtual groups. Overall, a lot was covered in an hour. So now I will post the hour in my education platforms. My own thinking has changed since using virtual. If you read one of my previous blogs where I posted a paper regarding the ethics of virtual therapy, you will notice how I examined the pros and cons of virtual vs in person. Because of COVID I have had to move quickly to continue the care of my clients. I also had to consider my own health risk. I am six feet away from my clients in person. There is a sanitizer bottle near me and one near my clients. However, I do prefer to see clients virtually. I had to find a platform to keep my clients as safe as possible and so there are more expenses incurred for that service. After COVID I will continue to see clients virtually, because it offers a platform to those who can’t visit me because of distance, travel etc….I have noticed that some clients no matter how sick they are still wanted to see me but after COVID, they can from the comfort of their homes. The session I had with CAMH also stated they would send us the slides which I will be grateful for since they have forms I would like to have my clients compile if they wish since they can compare their virtual experience to in- person. I want to know the pros and cons my clients feel about virtual vs in person. I already have knowledge of that from clients who share it immediately without asking. There are also the guidelines for group work. I already know how to do group therapy but have never done it virtually though I offered it during the pandemic to one senior’s group. There wasn’t access or know how of virtual use. There went my offering. It is the thought that counts. No? So, I understand the concerns for those dealing with seniors. If there is a big company out there or even people who no longer have use for their devices, please donate them to CAMH or other organization who can provide it to people who don’t have access to technology. That can mean so much for someone suffering in isolation. There was also a request for that from hospitals during the COVID madness when it started. Please reach out to an elderly person by phone to just say hi. I have seen so much sadness because of the pandemic, but I have also seen so much caring from our people in Toronto as well. So many have stepped up to help others. And that helping of others is also therapeutic. It has emotional health benefits. I have two more educational events this week. There is another one hour talk from York University regarding Acute Discrimination and the Asian - white mental health gap during COVID -19. I want to share that with you probably on Friday if I can. Saturday I will be attending a virtual meeting with Canadian Association of Family Therapy (I also have to start recording hours for them as well) and a session early evening/late afternoon regarding brief therapy for couples in crises. It is all good. One of the mentions in the talk from CAMH is the effect this is all having on service providers. As for myself, I took an entire month off this summer. I am also taking the time and money to beautify my outside space. I started this fall and will continue in the spring. I want to spend as much time outside as possible during our short summer. The summer disappeared so fast. Take care. Don’t forget to focus on self care. Talk soon.