MASS GENERAL DEPARTMENT OF PSYCHIATRY NEWSLETTER FOR .
M A S S G E N E R A L D E PA RT M E N T O F P SYC H I AT RY N E W S L E T T E R F O R F R I E N D S A N D S U P P O RT E R S S U M M E R 2 0 2 0The New (Virtual) RealityCovid-19 Has Spurred a Revolution in the Delivery of Care“We were able to provide uninterruptedcare in the middle of a pandemic.”— ANNE D. EMMERICH, MDTelepsychiatry was the immediate and necessary responseto the greatest public health emergency in a century. For thedepartment, however, the transition to virtual care is permanent,with a hybrid model of in-person and virtual care envisioned whenCovid-19 is over.Photo by Jessica Rinaldi, The Boston GlobeTwo weeks in March. That’s how longit took the Department of Psychiatryat Massachusetts General Hospital totransform the delivery of patient care.The Covid-19 crisis forced healthcare practitioners across the hospital toswitch from in-person to virtual visitspractically overnight. But the transition totelemedicine was particularly dramatic — andextraordinary successful — for Mass GeneralPsychiatry clinicians. Before the pandemicshuttered Boston in mid-March, 4 percent ofpatient visits were virtual, meaning patientsseen by their clinicians via computer screens.By May, 98 percent of patient visits werevirtual.“There is a benefit from in-person, but– wow,” says Associate Chief of Psychiatry forJanet R. Wozniak, MDClinical Services Jeff Huffman, MD. “For somuch of psychiatry, we can deliver really goodcare even from afar,” he notes. “There’s a lot you can do to providesupport, assistance, guidance, diagnosis, all just over video or eventhe phone.”Telepsychiatry is here to stay“There is no going back,” says geriatric psychiatrist AnthonyWeiner, MD, director of clinical care in the Geriatric PsychiatryClinical and Research Program at Mass General. “The futurehas arrived.”Even before Covid-19, Dr. Weiner says, the traditional officevisit was becoming an “increasingly outdated concept.”Dr. Weiner is one of the department clinicians whochampioned telepsychiatry pre-pandemic, a recipient ofphilanthropic support from the George Frederick Jewett EastFoundation. Increasingly, his older adult patients were findingit difficult to keep appointments for a host of reasons: trafficcongestion, cost of parking, inclement weather. They were alsograppling with decreased mobility and the need to depend onfamily and friends to get to his office. He recalls one patient in his80s with anxiety disorder who was “totally stressed out coming toContinued on p. 4
TA Messagefrom the Chiefhe world has changed since my lastmessage in Mindscapes. The Departmentof Psychiatry at Massachusetts GeneralHospital responded quickly and nimbly to theCovid-19 crisis, providing uninterrupted patientcare with compassion, solicitude and flexibility.Our faculty did not miss a beat. I cannot beprouder of them.Telemedicine, as you will see from this issue’scover story, has transformed the field of psychiatry. Ithas made it possible for us to care for more patientsthan ever before. While there will always be a needfor in-person care, it seems likely that the virtualcare revolution is here to stay. But we need to bediligent in our efforts to make that a certainty. Whileinsurers are temporarily covering telehealth visits,there is no guarantee that these reimbursements willcontinue post-pandemic. I am hopeful, but this issueof reimbursement parity underscores our substantialneed for philanthropic support.The department, like our country, is grapplingwith the problem of systemic racism and how bestto address it, institutionally, and in our own hearts.We are looking inward, to see what actions wecan and should take to increase diversity withinour own ranks and help to eliminate disparities inhealth care. It will take time, but we are committedto moving forward. In July, department leadershipdonated to The Boris Lawrence Henson Foundationin honor of our entire team and in support of theeffort to eradicate the stigma around mental healthissues in the African-American community.I am immensely grateful for the supportwe have received for our work during thesechallenging and uncertain times. In particular,I would like to thank Kent and Liz Dauten fortheir recent 10 million gift to the Dauten FamilyCenter for Bipolar Treatment Innovation. Theircommitment and belief in our mission helpstrengthen the Dauten Center and our department.The Dautens’ gift also speaks to confidencein our future. My vision for the department is thesame as the day I assumed the position of chief lastOctober: to transform the mental health landscapeand expand care for all who need it. With your help,we will work to ensure better days ahead.MAURIZIO FAVA, MDPsychiatrist-in-ChiefMGH Guide to Mental Health ResourcesWhen Covid-19 began its terrible sweepthrough Massachusetts in mid-March, theDepartment of Psychiatry at Mass Generalimmediately recognized the crucial need toprovide resources to help people cope. By theend of the month, the department had createdthe MGH Guide to Mental Health Resourcesfor Covid-19, an online, centralized source oftimely and accurate information to reach asmany people as possible.“Clearly, many of the things that we rely onfor mental health, including social connectionand access to care, were under threat,” saysAssociate Chief of Psychiatry for ResearchJordan Smoller, MD, ScD. “And there wasthis flurry of information that was difficult toevaluate. So, we recognized we might be ableto make a difference fairly quickly by having acentral, curated source of valuable information.”Dr. Smoller, along with colleague KarmelChoi, PhD, a clinical and research fellow in thePsychiatric and Neurodevelopmental Genetics2mass general department of psychiatryUnit, is responsible for developing and curatingthe guide.By late July, more than 65,000 peoplehad visited the guide, housed on the hospital’swebsite. The department also launched a Spanishlanguage website version. Updated regularly, theguide provides resources in a variety of formats—podcasts, videos, links to lectures and free appsas well as news stories and the latest research.“Jordan and Karmel have done atremendous job compiling and updating theguide, an extensive resource available toanyone in need, 24/7,” says Psychiatrist-inChief Maurizio Fava, MD.“It was really a team effort from theentire department,” Dr. Smoller says. “Thegenerosity, the collaboration, the suggestionsfor resources that could be made availablewere extraordinary.”The guide is available online alth-resourcesSummer 2020, Vol. 13, No. 1Chief of PsychiatryMaurizio Fava, MDSenior Director ofDevelopmentAlex DippoldSenior EditorMary HurleyProduction ManagerAidan ParkinsonWritingMary HurleyAidan ParkinsonEditingJennifer WellsDesignCatalano DesignPhotographyMGH Photo LabCapehart PhotographyJessica Rinaldi,The Boston Globemassgeneral.org/psychiatryWAYS TO GIVEFor information about how to support the clinicalcare, research, teaching and community healthactivities of the Mass General Department ofPsychiatry, please contact Senior Director ofDevelopment Alex Dippold at 1-617-726-7504 oradippold@mgh.harvard.edu.
A Legacy of Service from MGH Leadership Council for Psychiatry FoundersCarroll M. Carpenter and Michele Kesslercreated the MGH Leadership Councilfor Psychiatry in 2006 to support theDepartment of Psychiatry’s efforts toadvance mental health treatment andreduce the stigma of mental illness. InFebruary, after 15 years of committed,determined leadership, Carroll and Michelestepped down from their roles as co-chairs.Their legacy reflects the Council’s stellaraccomplishments: More than 47 million raised for thedepartment Five endowed Mass General chairs Three Harvard Medical School endowedprofessorships Nearly 800,000 given annually to thechief’s discretionary fund for cuttingedge projects that might never havelaunched otherwise“On behalf of the department, I extendmy deepest thanks to Carroll and Michelefor their 15 years of steadfast devotion toimproving mental health,” says Psychiatristin-Chief Maurizio Fava, MD. “We areextremely grateful for all they have done forCarroll M. Carpenter, Patty Ribakoff, Maurizio Fava, MD, Michele Kessler, and Donna Emma at the Feb. 27 Leadership Councilevent in Palm Beach hosted by Michele and Howard Kessler.our department and for our patients.They have touched countless people andhave made their lives better. There is nogreater legacy.”“We are proud to be of service,” Carrolltold Council members at their annualdinner and seminar in Palm Beach inFebruary. “It has been a joy to attempt insome small way to give back and supportthese incredible physicians.”Carroll and Michele founded theCouncil with the help of a committedgroup of like-minded friends. Today, theCouncil has more than 90 members whoare “ambassadors” for the department— sharing the latest advances in patientcare and research while supportingfaculty through annual membershipcontributions, special gifts and fundraisers.“It has been an enormous honor andprivilege to have played a small part inbringing us all together,” said Michele. After15 years, she noted, “we are also lookingahead. There is untapped talent, vigor, andenthusiasm on the Council. And we thinkthis is a good time to tap it.”New Leadership Council Co-ChairsDonna Emma and Patty Ribakoff, philanthropists, health careadvocates and successful business executives, are the newco-chairs of the MGH Leadership Council for Psychiatry.“Michele and I are thrilled that these two deeply talented womenwill bring their leadership skills and passion for MGH and MGHPsychiatry to the Leadership Council,” says Carroll M. Carpenter, whoco-founded and co-chaired the council with Michele Kessler. “Theirresumes are deep and impressive — proven great success in theirbusiness skills and past top leadership at Mass General.”Donna and Patty say they are honored and excited to continue thework of Carroll and Michele in supporting the department of Psychiatryand destigmatizing the public perception of mental health issues.“The innovative and compassionate care MGH Psychiatrydelivers to patients and their families is a national model for the field,and I am so honored and proud to be associated with it,” Patty says.The co-chairs seek to expand Council membership whiletaking full advantage of online resources and digital technology toprovide members with up-to-date information and more year-roundprograms such as faculty webinars.“We want to empower Council members as ambassadors for thedepartment,” Donna says. “We encourage member involvement andwelcome their feedback, connections and resources.”Patty and Donna say they look forward to working with theCouncil’s co-chairs: Heidi Cox, Nancy Crate, Miranda Donnelly,Mary McMillan Morse and Virginia Guest Valentine.Both are longtime hospital supporters. Patty is an honorarytrustee who previously served as trustee and co-chair ofphilanthropy and helped lead the Campaign for the Third Centuryof Medicine. Donna has been a Council member since 2016 and wasappointed vice-chair in 2019. She and her husband, Larry Davis, arealso members of the Dauten Family Center for Bipolar TreatmentInnovation Patient and Family Advisory Council.For more information on the Council, please contact Donna andPatty at mghpsychcouncil@partners.org.mindscapes newslet ter3
The New (Virtual) Realitycontinued from p. 1my office.” It took the patient and his wife 2.5 hours to travel thenine miles from home to hospital.Telemedicine “has changed my life,” states Ken V., a patientof Andrew Nierenberg, MD. Ken can click on a Zoom link — thevideoconferencing service currently used by the department — fiveminutes before his appointment. “The format is exactly the same” ashis in-person visit, except now it saves him 3.5 hours. “It was a fourhour ordeal for a half-hour appointment,” Ken says. “By the time Igot to see [Dr. Nierenberg], I didn’t have clarity of thought.”The patient no-show rate has “plummeted,” departmentclinicians report. And when there is a last-minute cancellation, it iseasy to reschedule.The field of psychiatry “lends itself exceedingly well tovirtual care,” according to Dr. Huffman. “Our providers have beenextraordinarily flexible, nimble, willing and thoughtful aboutproviding this virtual care.”The department laid the groundwork for this successfultransition five years ago, when it launched a pilot program. TheMassachusetts General Physicians Organization provided financialsupport, initially because insurance companies would not pay forremote visits, and later, when insurers agreed to reimburse but atlower rates than for office visits. While telemedicine quickly caughton with clinicians, payment issues and challenges related to thenexisting technology dampened their enthusiasm, notes AssociateChief of Psychiatry for Quality and Safety Janet Wozniak, MD, whospearheaded the pilot.Obstacles removedThe pandemic, with lightning speed, changed the rules andremoved the obstacles:Insurance Reimbursement. Insurance companies nowreimburse virtual care — computer and phone — at in-personrates. For the first time, a phone call is counted as a patient visit toexpand access to care for as many people as possible and to ensureprivacy. “The equity issue pushed it forward,” says Dr. Wozniak.Patient Location. Restrictions on virtual care for patientswho live in other states where clinicians do not have a medicallicense have been lifted for the most part. “It was consideredpracticing without a license,” Dr. Wozniak says. The issue had beenparticularly challenging for an academic medical center like MassGeneral, which serves patients in different parts of the country.“It is changing the way we practice,” says Gagan Joshi, MD,director of the Autism Spectrum Disorder Program and medicaldirector of the Alan and Lorraine Bressler Clinical and ResearchProgram for Autism Spectrum Disorders. Medicine in general, heobserves, is notorious for not keeping up with technology. “Wewere paper and pen five years ago.” Like his colleagues, he creditsthe department’s visionary pilot program for preparing them fortheir virtual future.4mass general department of psychiatryExpanding access, shattering stigmasTelepsychiatry is a model that can increase access to care andreduce the stigma of mental illness, clinicians say, even with theinequities posed by the lack of high-speed internet or computersin underserved communities.“One of our biggest problems in psychiatry is access,” saysDr. Wozniak. “How hard is it to get your doctor on the phone to askquestions? Virtual visits allow us to have briefer, but more frequentcontacts during many parts of a person’s illness, which is really theideal way to care for someone.”Says Dr. Joshi, “If a patient calls with a crisis, I just schedule avirtual visit right away. And I see and talk to them right away. Thereis an ease of availability.”Connie Sullivan, whose 22-year-old daughter, Christine, isa patient of Dr. Joshi’s, describes the visits as “efficient,” adding,“we do get to the heart of the matter very quickly, but they arenever abrupt or lacking in patience and warmth.” Dr. Joshi usesFaceTime to visit with Christine on her cell phone. Connie is takenwith his ability to read her daughter’s expressions so easily. “Shemisses him very much,” Connie adds. “We miss the hugs, thepersonal, hands-on touch. But she knows he’s there.”Dr. Wozniak believes telemedicine is tearing down barriersto care. “This concept of walking into an office with the sign‘Psychiatry’ on the door can make people self-conscious andprevent them from getting care, especially for our colleagues whowork at the hospital in other departments,” she says. “As much aswe in psychiatry feel there should not be any stigma associatedwith seeking treatment, we have to admit, in our society there isstill a lot of stigma,” she says.
In many ways, telemedicine is the 21st century version of thehome visit. Seeing patients in their home environment, not tomention their pets, family members and dishes in the sink can beenlightening. Virtual visits are especially helpful with some issues,such as obsessive-compulsive disorder: Here are the doorknobs Iwon’t touch. Here is the light switch I can’t stop flicking.Another plus: improving the speed and efficacy of treatment.Virtual visits have led psychotherapists to consider, would it beuseful to do cognitive behavioral therapy every day for five days,instead of once a week for five weeks?Challenges remainOn the flip side, privacy can be an issue, especially for patientswho don’t have a separate space. One concern: who else in thehouse can hear the confidential conversations of doctor–patient?When might a relative walk in on a session? “I don’t call thelandline, in case somebody yells out, ‘hey, it’s your psychiatristcalling!’ No one wants to hear that,” Dr. Joshi says.Other downsides include the inability to fully assess apatient’s physical status, from weight gain or loss, to a handtremor or other medication side effects. The lack of eye contact,a key part of a mental status exam, can be a challenge. A teenagepatient of Dr. Wozniak’s always had difficulty engaging in therapy.But now, when this youngster is done talking, she just gets up andwalks away from the computer or clicks the off button. “In theoffice, there are less distractions, there is a feeling of intimacy thatcan’t be replicated on video, and the patient is more of a captiveaudience,” Dr. Wozniak says.The positives of virtual care far outweigh the negatives,patients and their doctors say. “Patients have been overwhelminglygrateful for these visits,” says Anne Emmerich, MD, a staffpsychiatrist who assists department faculty with telehealthtechnology. “We were able to provide uninterrupted care in themiddle of a pandemic.”“I’m seeing advantages that frankly didn’t exist before.”A First-Person Clinician PerspectivePsychologist Douglas Katz, PhD, is director of psychology at the Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General HospitalIn the back of your mind as a clinician, youalways wish you could see what is going on ina person’s life. If you could see their naturalenvironment, you feel you could help themmove forward more effectively. Now we can dothat with telehealth.I have been pleasantly surprised by howhelpful it has been.For a lot of people with serious mentalhealth problems that impact their functioningon a day-to-day basis, they feel less alone now.Because in some sense, the whole world isliving in ways that more closely resemble howthey have been living for some time. I havepeople say, ‘I actually feel better equipped tomanage this period than a lot of my friendsand family who don’t suffer from mentalillness because I know what it’s like to feel likeyou really can’t go anywhere or do much ofanything. I know what it’s like to have intenseanxiety and dread. I have skills that people whoare new to these feelings don’t have.’ That hasimproved the esteem of some of my patients.It can be a herculean task for someone inthe middle of a serious depressive episode toget to the office. Simply getting out of bed anddressed and getting teeth brushed can feel likeDouglas Katz, PhDclimbing a mountain. For them, it is a relief thattheir treatment is so easy to access. Significantlate cancellations or no-shows among peoplewith major depression have simply evaporated.As somebody who practices a lot ofcognitive behavioral therapy, I am alwaystrying to get patients to do behavioralexperiments to test out their beliefs. If adepressed person believes, ‘I’m too depressedto get my laundry done,’ I make a plan in theoffice for how they are going to test that belief.But now, I am essentially in their home withthem. I will say, ‘alright, I am going to wait here,and I want you to go into your room and getall of your laundry and put it in the basket andbring it back here, sit right down and we’ll gofrom there.’People with a lot of anxiety will engage inavoidance. They push aw
MINDSCAPES NEWSLETTER 3 Carroll M. Carpenter and Michele Kessler created the MGH Leadership Council for Psychiatry in 2006 to support the Department of Psychiatry’s efforts to advance mental health treatment and reduce the stigma of mental illness. In February, after 15 years of committed, determined leadership, Carroll and Michele
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