HJAR Jul/Aug 2020

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2020 11 again, and we’re just having to manage it. I think one of the ways you keep inpatient care low is by having enough outpatient care. I’m worried that there is probably not access to sufficient outpatient care. I don’t know howmany other providers in the state are full, and howmuch they are able to pro- vide care during the time of the crisis. There is also the issue of whether people have ade- quate insurance or a third party payer, such as Medicaid, or expansion through the pri- vate option. Editor Can you speak to how relation- ships are changing during the pandemic, and perhaps offer a few tips that would be helpful in dealing with relationships in the COVID-19 environment? Dr. Smith Relationships during this time are under stress. Whether it’s parent and child or husband and wife, all kinds of rela- tionship are under stress because this is a really stressful time, and it translates into the home, and into our closest relation- ships, especially when you can’t go out to get a break. You can’t use your usual coping mechanisms, and that puts more heat on things. We have a couples center here, and their volumes are up. We’ve had increased calls for their work, so we are providing that service via telemedicine. I think it’s impor- tant that people talk within the family con- text or friendship groups about what’s going not able to provide treatment for them. A large substance abuse provider went out of business in the last month, for example, so that left a lot of people who were depend- ing on them for treatment for their drug use disorder without a provider for their treat- ment. We’ve tried to pick that up where we can, but we also understand that our role here at UAMS is to support the whole state’s healthcare system. We want to eventually refer these patients who call in to us to com- munity providers, because that is where they need to get their care, especially if they prefer it. Our job is to help the state sustain itself, both during this trying time, and also in other situations apart fromCOVID-19. We are always asking, where is there not care available, and how can we make care avail- able to them? Editor Do we need more outpatient ther- apy, and are inpatient referrals up or down? Dr. Smith We’ve tried to keep our inpatient volumes here at the psychiatric research institute low, in case we needed to flex—in case the surge came at UAMS. We inten- tionally kept all of our inpatient numbers down in case we had a big influx of COVID- 19 patients. Sometimes you have emergen- cies; this weekend we were full to the gills with patients who were pretty acute on the psychiatric side, and now the hospital is full on, and be honest about that. This is not a time for people to be stoic and brave. They need to say, I’m feeling nervous, or I’m feel- ing anxious, or I see all those people con- gregating, and they’re not wearing masks, and they’re not social distancing, and I’m worried about the second peak that’s com- ing in COVID cases. I think that’s real stuff. Or, I’m worried about not being able to see my loved one who’s in a nursing home and they won’t allow visitors in, or who’s in an assisted living facility, and I know they’re lonely, and how do I FaceTime with them, or how do I make an appointment to visit with them from a safe distance at the window? Most hospitals are not allowing visitors, or are just beginning to open up to visitors, so that’s been stressful for people who have loved ones in the hospital that are very ill, or even women who are giving birth and the father might or might not be able to come in. I think all of that is hard for folks, and we need to acknowledge that it’s hard, and fig- ure out ways to either have safe human con- tact with people, such as via Zoom or Skype or FaceTime, but also realize that there is help available. ThroughAR-Connect, which is what our service is called, they can get that help. I think most of the community mental health centers in the state are now open. A lot of the private providers may or may not be open, I’m just unsure, but they may be opening up. We haven’t yet done our inventory of the providers, which we will be “We also understand that our role here at UAMS is to support the whole state’s healthcare system. We want to eventually refer these patients who call in to us to community providers, because that is where they need to get their care, especially if they prefer it.”