Should we send all mental health staff home for good?
By Dr Rahul Khanna
What was laughable in 2019 is now a serious question. Our experience, published recently in Australasian Psychiatry, suggests it is worth considering and opens several opportunities.
As the COVID-19 case numbers in Victoria, Australia neared 500 in March 2020, our publicly funded state-wide psychological trauma service started experimenting with working-from-home (WFH) arrangements. What began as an option for staff with ‘special circumstances’ became optional then mandatory for all psychology and some psychiatry staff within a fortnight.
A range of tools were crucial to this effort. Clinical consultations occurred using the web-based teleconsultation platform Coviu. Meetings and informal communications utilised Microsoft Teams, after a previously planned organisation-wide Microsoft 365 rollout was brought forward due to the pandemic. A teleconsultation policy was drafted, covering clinical risk management, escalation pathways, documentation, and general technology tips. Advice included: maintaining tidy workspaces, avoiding fine patterned clothing (due to the Moiré effect), showing the torso to enhance trust, disabling distracting notifications and using a speakerphone for audio if connection problems emerged. Remote access to our electronic medical record, long possible through Citrix, was also indispensable.
Far from the disaster some feared, the change brought both planned and unexpected benefits. We saw our non-attendance and cancellation rate drop 7% compared to the same period in 2019 despite an overall increase in appointments booked and a stable staffing profile. Clinicians were able to creatively continue trauma-focused psychotherapies using tools like Google Maps Street View feature as a tool for exposure therapy. Informal communication via Teams increased the surfacing of ideas for quality improvement from frontline staff. Part time staff also became more engaged. Although this came at the cost of some erosion of work-life separation, most chose to exercise the increased opportunity to connect with colleagues that work on different days and have a greater voice in decision-making.
From a personal perspective, our new WFH processes reduced the time off work I needed following surgery. It is not hard to extrapolate from this experience and think of the increased opportunity of workforce participation for those with disabilities or returning from workplace injuries that are sadly becoming rife in healthcare. In fact, one client suffering from posttraumatic stress disorder whose last sustained employment was as a casual removalist has spent most of 2020 in a large agency with a six-figure salary thanks to the ability to work from home. Their usual difficulties managing crowded work environments melted away allowing their work outcomes to speak for themselves, resulting in praise and a contract extension.
We did however need to be mindful of patients’ changed circumstances. For example, some found it difficult to find privacy for consultations while whole households were working and studying from home. Clinicians also had to remember that clients were immediately returning to an often-stressful home environment. As such, ending sessions in a comparatively relaxed state was even more important than usual. Occasional technical challenges also marred the experience. Similarly, clinicians themselves needed a safe and private location to work. They also had to be particularly diligent regarding communication with administrative staff and colleagues when issues arose.
We would encourage those who want to know more to read the original article for more reflections and advice, including links to supplementary resources for distributed teamwork.
Article Details
Making working from home work: reflections on adapting to change
Rahul Khanna, Tess Murnane, Shakira Kumar, Timothy Rolfe, Stephanie Dimitrieski, Michael McKeown, Maryam Ejareh dar, Laura Gavson, Charu Gandhi
First Published September 10, 2020 Research Article
DOI: 10.1177/1039856220953701
Australasian Psychiatry
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