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Faces on the Front Lines

The Yale Department of Psychiatry is shining a light on members of the Department who are on the front line of Yale's response to the COVID-19 pandemic.

Aniyizhai Annamalai, MBBS, MD, Associate Professor of Psychiatry

Annamalai treats vulnerable patients with serious mental illness for longitudinal psychiatric, as well as primary care, at the Connecticut Mental Health Center (CMHC). She also runs the Adult Refugee Clinic at Yale New Haven Hospital (YNHH).

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

As a physician dually trained in internal medicine and psychiatry, I chair the Infection Control Committee at CMHC. With the COVID-19 crisis, my role is to consult on all questions related to reducing risk of transmission among staff and patients at CMHC. There are multiple facets of this, from effective screening at entry sites to determining staff and patient exposures to optimizing Personal Protective Equipment (PPE) use. In my role, I adapt guidelines published by other health care facilities and the Centers for Disease Control (CDC) to inform our local response to COVID-19. I have personally tried to be available to any staff member that has concerns about COVID-19 and its effects on them or their patients.

Q: Describe the greatest challenge presented to you or your work over the last several weeks, and how you have addressed that challenge.

Even though my direct role is in mitigating COVID-19 transmission at CMHC, these recommendations inevitably overlap with issues of workforce depletion, staff anxiety, equipment shortages, structural deficits, and social determinants that affect disease transmission. It is a time of confusion, uncertainty and a rapidly changing landscape and I have to remind myself that any issue, minor though it may seem, needs to be addressed to achieve the larger goal of reducing COVID-19 transmission among our patients and in the community. I also have to remember that my patients have ongoing needs and I have to continue to address them, whether or not COVID related, since for them those needs are as important now as at any other time.

Q: What advice or words of encouragement would you give to other faculty, trainees, and staff in the Department/Yale community during this time?

When faced with challenging COVID related issues, remember the larger context and that everyone is in this together and working at various levels to manage the COVID crisis. And amidst the chaos, remind ourselves of the things that we should be thankful for. I would strongly urge everyone to reflect on all the changes COVID-19 has caused in our personal and professional lives and draw lessons on what we could and should change when the crisis has passed. This is a time to rethink everything we have always assumed as "normal."

Todd Barnes, Clinical Outcomes Leader, Yale New Haven Psychiatric Hospital

Barnes works to identify, measure, and improve critical processes and outcomes in the inpatient setting. He seeks to listen to nurses and front line staff to better understand the challenges they face and potentially improve a process or workflow in support of the larger system.

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

On the hospital operations side, there's been a significant wave of change in response to COVID-19 that needed to be planned and implemented quickly and reliably. I was initially involved with helping to develop the psych hospital's COVID task force charter - meaning helping to organize the scope and action plan for what needed to happen. As the work evolved, I've been asked to produce a daily Psych & Behavioral Health COVID daily update to provide an official source of clinical and operational updates for staff. Trying to do my best to synthesize critical information and make it available to all staff.

Q: Describe the greatest challenge presented to you or your work over the last several weeks, and how you have addressed that challenge.

On a personal level, I feel a little guilty that I'm not in a role of providing direct care - that I can't be as practically helpful as I'd maybe like to be. I'd like to recognize all our environmental staff, protective services, frontline techs, nurses, and clinicians because they're shouldering a much greater challenge than I am. For my part, one important challenge is not just thinking in the day-to-day but thinking about changes that will improve our care down the road. It's hard to think far ahead, when there's so much to respond to on a day-to-day basis. I think we're doing our best to push changes that will improve our standard communication within the hospital, but there's still room for improvement here.

Q: What advice or words of encouragement would you give to other faculty, trainees, and staff in the Department/Yale community during this time?

A poem that I find comforting and also meets social distancing guidelines: "The Peace of Wild Things" by Wendell Berry:

When despair for the world grows in me
and I wake in the night at the least sound
in fear of what my life and my children's lives may be,
I go and lie down where the wood drake
rests in his beauty on the water, and the great heron feeds.
I come into the peace of wild things
who do not tax their lives with forethought
of grief. I come into the presence of still water.
And I feel above me the day-blind stars
waiting with their light. For a time
I rest in the grace of the world, and am free.

John Cahill, MD, PhD, Assistant Professor of Psychiatry

Cahill is based at the Connecticut Mental Health Center (CMHC), with an interest in building Learning Healthcare Systems for continuous innovation, knowledge translation and performance improvement in the community-based care of severe and persisting mental illness.

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

I've worked on health informatics implementation to support a shift to remote working at CMHC, as well as multi-stakeholder liaison and collaboration to develop a centralized resource and guidelines for CMHC physicians during this crisis. I've also helped senior leadership in coordinating staffing and workflow adjustments at CMHC, and assisted with the development of pilot initiatives to identify and serve particularly vulnerable groups within the CMHC community.

Q: Describe the greatest challenge presented to you or your work over the last several weeks, and how you have addressed that challenge.

It feels like we have launched more clinical workflow and informatics innovations in the last couple of weeks than we have in the last couple of years! It is easy during these times of rapid and dynamic change for some stakeholders' voices to be drowned out. I think it pays to pause, be still and remain silent periodically to listen for those voices. I am extremely grateful to my patients, colleagues, and supervisors for helping keep the channels of communication open - creating opportunities to deepen relationships, question assumptions and shift frames.

Q: What advice or words of encouragement would you give to other faculty, trainees, and staff in the Department/Yale community during this time?

For me, the degree to which the current crisis is exposing some of the inherit vulnerabilities in our systems, is largely eclipsed by demonstrations of camaraderie, courage, resourcefulness and resilience in our communities of care - from our patients, support staff, trainees and clinical colleagues - through to our leadership. I hope and expect that the connections we forge, lessons we learn and innovations we implement in tackling this crisis will continue to bear fruit when we are through to the other side.

Louis DeAngelo, IT Support Specialist

DeAngelo works to deploy, support, and maintain computer workstations, as well as recommend various IT solutions to the clinical and research sections within the Department.

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

I worked with Department leadership to review the technical needs for end users while working remotely. Once we established what was required, we prepared workstations to work with end users' home environments that ensured continuity. I also worked with various groups to deliver provider solutions via telemedicine, utilizing Zoom for both tablets and computers.

Q: Describe the greatest challenge presented to you or your work over the last several weeks, and how you have addressed that challenge.

The greatest challenge is working on clients' computers while following the COVID-19 guidelines, to ensure both myself and clients are safe. I addressed this challenged by wearing the proper PPE equipment, wiping down computers and packages before working on them, and keeping 6 feet or more between clients and myself at all times.

Q: What advice or words of encouragement would you give to other faculty, trainees, and staff in the Department/Yale community during this time?

During this time, it's important to stay connected through technology with family members, friends, and associates since technology offers the safest communication environment for all. Through this time, it made me realize how quickly life can change and to appreciate the small things in life because they can be taken away so easily.

Ebony Dix, MD, Assistant Professor of Psychiatry

Dix works as the Unit Chief of the Inpatient Geriatric Psychiatry Unit at YPH (Celentano-5 at SRC). She serves not only in a leadership and administrative capacity, but also as a clinician and educator.

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

In response to the COVID-19 crisis, I have been working with my colleagues in the Department to develop and implement workflow changes on the unit, which ensure the safety of both the patients and unit staff. This includes the utilization of telehealth technology, the dissemination of daily updated guidelines related to infection prevention strategies and operationalizing protocols for assessing and isolating symptomatic patients.

Q: Describe the greatest challenge presented to you or your work over the last several weeks, and how you have addressed that challenge.

The greatest challenge I have encountered in recent weeks has been adapting to a "new normal," which entails being physically distant yet emotionally present, in the care of patients and in providing support to my friends and colleagues across the country who are on the front-lines.

Q: What advice or words of encouragement would you give to other faculty, trainees, and staff in the Department/Yale community during this time?

My advice to others would be to be mindful of the cognitive and emotional toll these trying times will have on everyone, therefore proactive self-care will allow us to optimize our compassionate care of others.

Jihoon Kim, MD, First-Year Resident

Kim has been caring for patients rotating between services in Psychiatry, Neurology, and Internal Medicine as a part of his training. He is currently taking care of patients on the inpatient Internal Medicine service.

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

As the COVID-19 crisis is rapidly becoming worse every day, I deferred my vacation so I could continue to work for the Department of Internal Medicine and help fight against COVID-19. I've also reached out to my alma mater, Seoul National University Hospital, so that they can share South Korea's experience with COVID-19, and what they have learned from their successful fight against the virus to help our hospital. This is a really challenging time for my colleagues and my patients, and I am doing whatever I can to be of help to them.

Q: Describe the greatest challenge presented to you or your work over the last several weeks, and how you have addressed that challenge.

The greatest challenge for me over the last several weeks has been the anxiety. I'm constantly worried about people who are more vulnerable to this virus. My friend who is a medical resident in NYC got hospitalized after contracting COVID-19 during his patient care. Some of my colleagues here are very vulnerable to this virus (immunosuppressed, cardiac complications, etc.), and some live with vulnerable family members. I am young, healthy, and I live alone, so volunteering to work more in the medical units so that I can spare my colleagues who are more vulnerable was one way that I could protect them. I also worry about people in the community who are more vulnerable - whether due to age, comorbidities, or social situation. My colleague's beloved uncle just passed away from the virus. Hearing news of people dying from this virus has been heartbreaking, and the only way I could cope with that distress was to do my best as a doctor to help treat patients, so that this disaster may end faster.

Q: What advice or words of encouragement would you give to other faculty, trainees, and staff in the Department/Yale community during this time?

This crisis will eventually be over, and we are doing our best to fight against the virus. Please hang in there and stay safe!

Jeffrey Mufson, MD, Fourth-Year Resident

Mufson is the Chief Resident on the Psychiatric Consultation Service.

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

I became aware of staffing shortages on the Internal Medicine service and wanted to help out. I volunteered to work on the Step Down Unit team on NP10 and have been assisting with the medical management of both COVID and non-COVID patients.

Q: Describe the greatest challenge presented to you or your work over the last several weeks, and how you have addressed that challenge.

Figuring out the best way to distance from my family while I take on a role with an increased risk of exposure to COVID has been very challenging (my son gives great hugs, which I miss!). An incredibly supportive wife has been immensely helpful.

Q: What advice or words of encouragement would you give to other faculty, trainees, and staff in the Department/Yale community during this time?

Working across departments has given me a look into how immense the challenges are across the system. Everyone is under a strain and it is inspiring to see so many people in different jobs confronting this situation.

Sirena Simpson-Taylor, Nurse Manager, VA Connecticut Healthcare System

Simpson-Taylor is the nurse manager of the 16-bed inpatient mental health unit at the VA Connecticut Healthcare System in West Haven. She oversees the day-to-day operations of the unit and works in collaboration with psychiatrists, residents, and medical students, and other multidisciplinary professionals while managing a team of 16 registered nurses and 12 nursing assistants.

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

The steps I have taken to assist in the department's response to the COVID-19 crisis include working in collaboration with the MH COVID-19 team, a wonderful team of psychiatrists, psychologists, and medical doctors by ensuring the daily assessments of the frontline staff were completed ensuring a close to a symptom-free environment of care as possible. I have been able to keep the frontline staff abreast of the daily changing situation of COVID-19 by providing them with the most up-to-date information as it relates to the care of the employees and our patients by working closely with the Employee Health and Infection Prevention units.

The unknowns of the COVID-19 virus have increased fears and anxiety in almost everyone, so to help alleviate some of these fears and anxieties in the staff, I have enlisted the help and support of our Employee Assistance Program Coordinator, Christine Bhiday, APRN. Also, I provide any new updates about the unit to the leadership of the Psychiatric Department, Drs. Ismene Petrakis and Alec Buchannan. The assistant nurse manager, Carl (Tony) Macarthur, and I have been able to assist the organization by allocating staffing resources to the COVID-19 screening stations and providing support to the staff on our inpatient medical unit. As a member of the Code Grey committee, I have collaborated with Keiko Muto, nurse manager of the Psychiatric Emergency Room (PER) in facilitating changes to the procedures on how the organization would respond to code greys, or behavioral disturbances. I am currently working closely with Safety and Employee Health to ensure the staff on 8E, the inpatient mental unit can be properly fit-tested for a respirator type mask. Lastly, the staff on 8E has been great in educating the patients on COVID-19 by providing education on proper hand hygiene and the benefits of social distancing.

Q: Describe the greatest challenge presented to you or your work over the last several weeks, and how you have addressed that challenge.

The greatest challenge presented to me over the last several weeks has been dealing with the rapid development of symptoms related to COVID-19 and the almost daily organizational response protocols which directly aligned with recommendations from the CDC. I have managed to address this challenge by maintaining a calm and organized approach, so that staff can have the most up-to-date information and protocols to follow ensuring safety for the patients, themselves and their families.

Q: What advice or words of encouragement would you give to other faculty, trainees, and staff in the Department/Yale community during this time?

My advice or words of encouragement to other faculty, trainees and staff in the Department would be to understand and appreciate that we came into this together and we will see it through together. Stay well.

Rajita Sinha, PhD, Director, Yale Interdisciplinary Stress Center

Sinha is the Foundations Fund Professor in the Department of Psychiatry at Yale University and also Professor of Neurobiology and Child Study. She is Chief of the Psychology section in Psychiatry and Co-Director of Education at the Yale Center for Clinical Investigation, home of the NIH supported Yale Clinical Translational Science Award. She is the Founding Director of the Yale Stress Center, a university-wide center that focuses on understanding the stress mechanisms affecting health behaviors, mood and emotion regulation and chronic disease risk.

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

The Yale Stress Center has been providing information to various news outlets, answering questions and providing guidance on coping with the stress, fear, anxiety and panic during this COVID-19 pandemic in the U.S.

I participated in Yale University's multi-expert Town Hall on coronavirus on March 18 via Zoom. On March 25, Ms. Anne Dutton, LCSW, the Yale Stress Center's Director of Mindfulness Education, began offering free weekly Zoom sessions on Coping with the Anxiety of COVID-19 Through Mindfulness that have attracted participants nationally and beyond.

I am also consulting with YNNH's Dr. Kristine Olson in their response for inpatient healthcare providers and is part of Dr. Krystal's task force led by Dr. Samuel Ball on Psychiatry and Child Study Center's response to support Yale Medicine and the wider community during this extremely challenging time.

Jacob Tebes, PhD, Professor of Psychiatry

In addition to Professor of Psychiatry, Tebes also serves as Chief of Psychology at the Connecticut Mental Health Center (CMHC), and Director of The Consultation Center and the Department's Division of Prevention and Community Research.

Q: What steps you have taken to assist in the Department/Yale's response to the COVID-19 crisis?

Everyone experiences stress, and everyone can be resilient. That belief is the foundation for the Stress and Resilience Town Halls, a new Departmental initiative that I lead to support individuals and families connected to Yale School of Medicine and the Yale New Haven Health System communities, as well as several affiliated institutions.

Town halls create a supportive virtual space where individuals can share their stresses and their strategies to promote resilience. Each town hall is co-led by a psychiatrist and a psychologist. A town hall begins with a brief presentation on a specific theme by one of the co-leaders, followed by a discussion in which participants offer each other mutual support, encouragement, and tips from their own experience. We know that a variety of people attend, including physicians, nurses, clerical and technical staff, maintenance workers, faculty, professional staff, administrators, and family members. Town halls cover a range of rotating themes that change as new stresses are identified in the groups. To date, almost 400 people have attended a town hall, some more than once.

Q: Describe the greatest challenge presented to you or your work over the last several weeks, and how you have addressed that challenge.

In mid-March, Dr. John Krystal, Chair of the Department of Psychiatry, planted the seed for this initiative by asking how our Department could support a Yale community that will be under stress in responding to the pandemic. I volunteered to lead a Departmental initiative to offer Stress and Resilience Town Halls, but was concerned about scaling up quickly. I was only able to do so because of the generosity and dedication of so many.

There are more than a dozen faculty psychiatrists and psychologists who generously volunteer their time. There is Chris Gardner, who organizes communications and publicity for the town halls, and Susan Florio, who provides administrative and technical support. Finally, there is my outstanding team of postdoctoral and psychology fellows - Keisha April, Michael Awad, Brittany Miller-Roenigk, and Corianna Sichel - who annotate each town hall to ensure that we continue to meet the needs of participants and address emerging issues throughout the pandemic.

Q: What advice or words of encouragement would you give to other faculty, trainees, and staff in the Department/Yale community during this time?

I feel sadness for the lives lost and the many adversities felt because of the pandemic. But each day I am also motivated by three practices: gratitude, forgiveness, and resolve. I am deeply grateful for the collaboration, courage, and sacrifice by many at Yale, in our country, and across the world in response to this pandemic. Each day, I also remind myself to try to be more forgiving because no one is at their best right now, including me, and we are all doing our best in trying times. Finally, I am motivated by a deep resolve to meet any challenge that awaits us to overcome this pandemic and its aftermath.