Caseload Overload Portends Serious Problems

An often-overlooked secondary effect of COVID-19 is subsequent neurological and psychiatric problems. At the beginning of April, new research published in The Lancet showed that 1 in 3 survivors of COVID-19 has neurological or psychiatric problems six months after recovery from the illness.

For 12% of all survivors, this was their first-ever psychiatric or neurological illness. The psychiatric outcomes studied were anxiety, depression/mood, and psychotic disorder. While the numbers were worse for those with severe illness, the results weren’t much different for patients who were not hospitalized.

If 12% of the over 32 million cases to date have a first-ever psychiatric diagnosis afterward, that is over 3.5 million first-time mental health patients!

These statistics don’t include the increased mental health concerns triggered by the secondary economic and isolation stressors, even amongst those not infected. Last month, the CDC reported dramatic increases in anxiety and depression across the county over the past year, especially among young adults.

And these studies did not include children. Yet millions of children have also been infected with COVID-19. Although we don’t know the rate of mental health problems in children in comparison to adults, even if it’s only half the rate, that would mean that over 1 million kids need services—of whom 200,000 are receiving their first diagnosis.

These dismal predictions are screaming loud and clear- mental health care needs are mushrooming at an alarming rate!

This means higher caseloads for therapists everywhere. Even before COVID, therapists were already struggling to stay on top of their heavy caseloads. Also before COVID, therapists were worried that some of their clients were falling through the cracks.

What hope do these therapists have as they continue to deliver quality care to their clients and maintain quality of life for themselves amidst this tidal wave of new problems?

Effective solutions are needed, and they are needed fast!

5 Quick and Effective Solutions

1. Boundaries

Inform clients of your boundaries for cancellations, and be firm about implementing them. While the therapy session should be a flexible time for clients to address topics necessary for their healing, structure regarding the session needs to be maintained to keep both you and your clients accountable.

Be sure to start and end sessions promptly so that you have time to complete documentation afterward, grab something to eat or drink, attend to your personal needs, consult with a colleague, and/or take a moment to regroup before seeing your next client.

2. Time Management

Schedule clients as recurring appointments, and be sure to confirm the next appointment before your client leaves at the end of the session.

While you would like to help every one of your clients and it can be heartbreaking to refer them to someone else, you need to stop seeing clients who aren’t adhering to the attendance policy, and provide them referrals to help with barriers to keeping the appointment as scheduled (e.g., closer to home, different hours, etc.).

If you feel yourself sliding into burnout, remember:

Don’t hesitate to use PTO if available, and take a day or two to get your feet back on the ground, so that you can return more refreshed and energized. You need to get back to yourself so that you deliver peak performance.

3. Prioritize

As your schedule becomes fuller and tighter, one of your mantras needs to become: Organize and Prioritize. Use a system that places items onto a grid with importance and urgency on two axes. This will allow you to immediately see those things that are a priority and need to be tackled as soon as possible.

To the degree possible, you need to maintain control of your time. Don’t jump to respond to every request from others, such as paperwork or tasks that can wait. And remember that when unexpected changes occur in the day, which they will, you will need to reprioritize and adjust your plans accordingly.

4. Consult

Take advantage of your clinical supervisors’ guidance, not only to receive insight on a case but about how many and which type of cases are appropriate for you. Keep in mind that your caseload needs to be aligned with your level of experience.

When taking on new cases, consider the amount of prep time that the additional case will require as well. And don’t forget about the mental energy resources necessary for high-risk clients and your follow-up time between sessions.

5. Self-Care

Therapists are known to preach about self-care to their clients – but often find it challenging to heed their own advice. There are endless ways to be productive. You will always have something that you can work on.

But what you need to realize is that, if you take a break, your work will still be there waiting when you return. There’s no “right amount” of time for a break. It could be 15 minutes, 3 hours, an entire day, a weekend, or even a longer vacation.

And aside from breaks, you need to take care of yourself regarding sleep, nutrition, and exercise. Find some time to do the things that you love and a few moments for mindfulness which can be practiced in as little as 1-5 minutes a day.

Don’t Panic

It’s quite easy to become filled with anxiety and feel a sense of panic when confronting a high caseload. This often triggers a stress reaction which includes the release of adrenalin.

It is a myth that this will cause a “fight” or flight” response. For many people, panic causes a “freeze” response which makes thinking or action impossible, a form of paralysis. This “freeze” leads to reducing or even eliminating productivity, or worse to making mistakes; both of which will probably increase the sense of panic, creating a vicious cycle.

Endeavor to incorporate these solutions to gain control over a potentially overwhelming situation, and you will see that both you and your clients will reap the benefits!