Articles: Staying together apart: Artistic approaches to Covid-19 &
How to ethically increase access to care during COVID-19: {Below}

Staying together apart: Artistic approaches to Covid-19

By Evelyn Antony
July 27, 2020

Editor’s Note: In this issue, we are welcoming a student voice from Scotland to give us some ideas about how psychologists there are approaching care during the global pandemic.

"Staying together apart" can prove difficult for those who have relatives in different countries, those who are in long-distance relationships and those with friends from their college years. However, during these unprecedented times, it has become increasingly challenging to stay connected with people locally and nationally, particularly for individuals who are more vulnerable.

How can vulnerable people express their mental-health issues creatively?

Artlink Edinburgh and the Lothians, a Scottish charity that supports young adults through creative solutions, has continued to inspire people by asking them to send photos of their favorite landscapes, clothes and prints, which can be used in future projects – for tote bags, mugs, posters and other graphic designs. The charity also has been active on its YouTube channel, Artlink TV, encouraging people to create glitter jars to reduce anxiety, do nail art and complete wool laser mazes indoors. Initiatives like these encourage people to maintain ongoing communications with their support or community groups and, consequently, feel more positive and think "outside the box," which is essential in sustaining good mental health.

Psychologists and researchers have come together to implement practical

differences during the pandemic. Taking to Twitter, the staff of The

Psychologist, the British Psychology Society

magazine, has brainstormed ideas for maintaining and strengthening

social identities including knitting, gaming, meditation and walking. More

importantly, the creation of shared identities has been advocated by one of

the virus's most affected countries – Italy. Communal singing from balconies

has become an avenue for those worst affected, helping them feel a sense

of empowerment and stand firm in solidarity.

With cultural and creative industries at a loss (e.g., festivals, museums, art galleries), where have people turned for entertainment? Creative writing in journals is one of the ways in which people are exerting their negative thoughts about the pandemic, as well as keeping a record of their mood changes. Some people have headed to the back catalogs of old magazines to create paper mâché models, as suggested by The Psychologist team. It seems that enhancing skills that haven't been utilized for a while is becoming more common, particularly among couples going for therapy.

Psychotherapists and counselors say that people who attend couples therapy have picked up their paintbrushes to express their emotions freely, consequently strengthening their relationship and creative abilities.

Overall, "staying together apart" with support groups, family and friends are better enabled through technology. Furthermore, picking up on previously disregarded hobbies or expressing yourself through painting can aid feelings of loneliness, confusion, and distress, all of which may feature prominently in your life during the current pandemic.

Evelyn Antony is a third-year psychology (Master of Arts with Honours) undergraduate student studying at the University of Edinburgh, Scotland, UK, under the School of Psychology, Philosophy and Language Sciences (PPLS). She is an active community volunteer and works as a project support assistant for the School of PPLS, improve academic services and professional relations. Her email address is em.antony04@googlemail.com

How to ethically increase access to care during COVID-19

By Jordan Cattie, Ph.D.
July 27, 2020

COVID-19 is an unprecedented public health crisis with both mental-health and financial impacts. Psychologists’ skill sets are critically important in meeting the challenges of the present moment.

Yet many clients are losing financial security (job loss, reduced hours due to furloughs, changes in insurance benefits) while potentially relying on mental-health treatment more than ever. Being able to contribute and offer relief is an important value for psychologists. But to best serve our clients, it is important to thoughtfully and ethically navigate the ethics of billing and payment.

Many psychologists ask: How can we use our skills for the common good and give clients a financial break as needed? How can we adapt our practices and policies to ethically consider current economic realities?

Relevant standards appear in the Informed Consent to Therapy (10.01a), Fees & Financial Arrangements (Standards 6.04), and Conflicts of Interest (3.06) portions of the ethics code. Usually, informed consent includes the cost of the therapy, types of reimbursement accepted, payment schedule, when fees may be renegotiated and policies regarding missed appointments and late payment.

Standard 6.04 adds that any anticipated limitations to services because of financial limitations should be discussed as early as possible. Currently, millions of Americans are experiencing financial difficulty; instead of being the exception, validating and normalizing conversations about the financial impacts of COVID-19 and treatment/payment should become the rule.

If finances are not discussed, clients may experience shame or guilt related to their ability to pay. They may reduce the frequency of mental health services to a subtherapeutic level or skip needed appointments if unable to pay a balance that is due.

This brings us to conflicts of interest. According to Standard 3.06, psychologists must be aware of when financial matters might impair their objectivity, competence or effectiveness. Unintentionally (and invisibly when not discussed), financial strain can impair therapy. Psychologists also must be mindful of their own limits and clearly articulate how and when they are able to provide financial relief and flexibility to clients, as their own financial concerns can also interfere with therapy.

Many psychologists offer some flexibility for clients who experience

difficulty paying for services, either temporarily or ongoing (e.g., sliding

fee, maintaining a set pro bono caseload). However, making exceptions

to overall practice policies can quickly become ethically complicated

and raise equity concerns.

For example, factors such as implicit bias or financial literacy can systematically

affect which clients ask for or receive financial assistance.

Instead, psychologists can be proactive and transparent. Develop a financial policy that applies equally to your entire practice and make it available to all clients. This way, you can be prepared to discuss finances and invite clients to choose from among available options (e.g., reduced fee, payment plan, flexible scheduling, pro bono, assisting with referral to another setting or others selected by the provider). You should document the plan that is agreed upon and when it will be revisited. Check in with clients to normalize and validate the experience of new or exacerbated financial difficulties. Be clear and specific about how you can help; vague statements like “we can work something out” often exacerbate anxiety.

Finally, utilize an ethical decision-making model in consultation with colleagues to promptly collaborate around challenges you may encounter. Reference guidelines on providing financial breaks to patients can be found at https://www.apa.org/monitor/2009/01/fees.

After witnessing multiple interconnected crises, many psychologists may wish to help in new ways to increase access to mental healthcare. Consider engaging in advocacy with like-minded colleagues to pursue patient rights, expand access to mental healthcare or telemedicine or promote social justice.

Consider donating supervision or consultation time to trainees or

professionals in your area; sharing your skillset in this way can disseminate specialized services and training to new and lower-fee settings. Finally, consider volunteering for and supporting community groups that provide peer support. These groups create valuable and free-of-cost opportunities for peers to connect with and support one another.

Jordan Cattie, Ph.D., is an assistant professor in Emory University’s Department of Psychiatry & Behavioral Sciences. Her professional activities are focused on increasing access to mental healthcare for OCD through clinical services, training, and advocacy. Her email address is: jordan.cattie@emory.edu.