Supporting patients in quarantine

The Nebraska National Quarantine Unit, the only federally funded quarantine facility in the United States, is specially designed to safely confine and monitor individuals exposed to, but not sick with, a hazardous infectious disease while protecting health care workers and the surrounding community. While quarantine is critical to prevent the spread of serious illness, it can also lead to new and worsening mental health symptoms.

Psychologist David Cates, PhD, director of behavioral health at Nebraska Medicine and vice chair of clinical services in the department of psychiatry at the University of Nebraska Medical Center, serves as the unit behavioral health consultant, where he works to improve these outcomes. From helping patients and guests feel more control of their environment to connecting them with social support, Cates and his multidisciplinary team apply behavioral strategies to reduce stress and prevent anxiety and depression.

We asked Cates about how quarantine can affect people’s mental health and how he collaborates with other health care providers to support quarantined individuals in the unit.

The literature indicates that people in quarantine are at risk for depression and anxiety, with those who have pre-existing psychiatric conditions at higher risk. There can be tremendous stress from the conditions that prompted quarantine in the first place, as most individuals exposed to a potentially deadly disease will naturally contemplate the consequences of contracting it.

Then there’s the stress of quarantine itself. While it can be very difficult to quarantine at home, quarantining in a facility can be even more challenging, because you have less control over your daily life. In addition, often the length of quarantine is unclear, or it changes as we learn more about the disease or as public health officials update their guidance.

There may also be limitations on in-person socialization, and some individuals may not be able to work. If you can’t work, you may have financial strain due to loss of income. There may also be difficulties meeting family or social obligations. In addition, there’s overall diminished sensory input because you’re essentially in a room alone throughout your quarantine period.

This is a side gig and volunteer role I fell into. Before we opened the quarantine facility, Nebraska Medicine had a biocontainment unit for patients who are diagnosed with highly hazardous infectious diseases, such as Ebola. Soon after starting at Nebraska Medicine in 2012, the social worker supporting the biocontainment unit announced she was leaving and the unit needed someone to take over.

I began reviewing the literature and quickly learned about the impact of isolation and quarantine, and the importance of psychological interventions in preventing mental health symptoms from developing or worsening. Now, I serve as the behavioral health consultant for both the biocontainment unit and the quarantine unit, the latter for people who have been exposed to, but are not diagnosed with, these infectious diseases.

The team includes nurses, respiratory therapists, physicians, and other health care providers who usually work in other hospital units but train for working in the biocontainment and quarantine units. My role is both to help the team protect their own mental health given the stress of working with highly infectious diseases and to improve mental health outcomes for people in quarantine and isolation.

Health care workers are at risk for significant psychological distress from working with patients who have been diagnosed with or exposed to highly hazardous infectious diseases. I meet regularly with them as part of their routine training regarding personal protective equipment (PPE) use, the diseases they may treat and other medical aspects of caring for this population. I get a portion of each of those training sessions to work on wellness and resilience. When the units are deployed, I talk with staff, providing support as needed. When they’re stressed, they know they can reach out, because we have a long-standing relationship.

I also provide direct support for patients in the biocontainment unit and guests in the quarantine unit. My work is based on psychological first aid, which is designed to help victims of disasters in part by providing stabilization, mobilizing existing coping resources, and promoting connection with social supports.

It’s highly dependent on the needs of the individual or groups in quarantine, but there are some general principles that apply across the board. One of the most valuable things we can do is keep people updated on information that is important to them. For example, most people want to know what’s happening locally and globally in terms of the index disease, how long quarantine may last, the criteria for leaving quarantine, availability of any medical testing for infection, and treatment options if they get sick.

It’s also critical to give people as much control as possible over their daily living environment. When you’re confined in a room for days on end, small things can become very important. Having access to needed supplies and being able to make decisions regarding food, lighting, room decoration, personal care products, and the daily schedule can all make a difference. If someone wants a particular book or wants to pursue a certain hobby, for example, we will try to facilitate it. This type of control over daily life can be essential for one’s well-being.

Social support is also crucial. I encourage people to connect with their available social supports and assist with problem solving in this regard when needed. If they are quarantining as a group, which isn’t always the case, there may be opportunities to leverage the group itself for support.

The core of our support is a daily town hall meeting conducted on Zoom. First, the physicians provide a medical update and answer questions. Next, nursing leadership discusses day-to-day logistics such as food options and garbage pick-up. Then, depending on group dynamics, I may share information on coping with quarantine, lead a group discussion, or teach stress management.

If there’s a group activity guests are interested in, we can often help set it up. For example, we have had trivia contests and have brought in speakers via Zoom to share information on topics of interest.

I also meet with some guests individually, either via Zoom or in person with full PPE. This is usually in response to a request from the guests themselves, though at times it may be at the suggestion of our medical or nursing team when they are concerned about someone’s well-being.

After the Nebraska Biocontainment Unit or National Quarantine Unit deploys, the team debriefs to review what went well and where we can improve. This provides an ideal opportunity to enhance the support we provide, including psychological support. This process has already begun with the end of our most recent deployment to support 18 Americans exposed to the Andes Hantavirus, and we’re eager to implement the changes with our next deployment.