Nurses go extra mile to ensure mental health clients protected from COVID

Winnipeg Regional Health Authority
Published Monday, May 9, 2022

Throughout the pandemic, they've not only been making "house calls," they've been actively working to find, educate, encourage and, occasionally, provide a little incentive to get their clients/participants immunized against COVID-19.

The nurses working with two of the Winnipeg Regional Health Authority's mental health programs - the Program of Assertive Community Treatment (PACT) and the Early Psychosis Prevention and Intervention Service (EPPIS) - knew that a proactive approach was required for their clientele, whose needs differ significantly from those of the general public. 

"EPPIS works with individuals experiencing their first episode of psychotic symptoms.  PACT works with individuals who have significant mental health issues such as schizophrenia, schizo-affective disorder and bipolar disorder and struggle to manage in the community," explains Arlene MacLennan, Manager Specialized Mental Health Services. "They require a variety of services and supports to remain in community and work on their recovery."

Underlying those services and supports is the understanding that these individuals don't often keep to a schedule, and therefore need nurses to go the extra mile.

"One of the many things the teams are very good at, be it the nurses or any of the other team members, is that they’re not expecting people to come to our offices for an appointment or show up on time," McLennan says. "In fact, if you visited our PACT or EPPIS offices, you’d see very few staff because they are out and about, working to find and work with their individuals, some of whom are homeless. Assertive outreach is a huge component of the work the teams do."

When COVID hit, nurses worked to ensure that individuals could make the necessary connections to receive their vaccines. That included scheduling vaccinations, took individuals to those appointments, and educating them about COVID-related topics.

Christina Breitkreitz, Team Lead for PACT's Winnipeg West office (one of several located throughout the city) says the client/participant education effort started early in the pandemic.

"At the start of the pandemic, even before the arrival of vaccines, the information coming out about COVID was very new, rapid and ever-changing. Getting it out to clients/participants was one of the biggest roles our nurses played," Breitkreitz says.  

"That information included the basics, including What is COVID? How can we protect ourselves? How can we protect others? That's where it started out. It was a major change in our clients'/participants' day-to-day lives and it was certainly a change in our work environment. How we worked with people in the community along with how we interacted and worked with each other changed quite dramatically."

Helping individuals through the immunization process was also key.

"As time went on and COVID vaccines were developed, there was a need to work with individuals who were interested in being vaccinated — to help them navigate a system they found difficult to grasp. When you experience severe and persistent mental health concerns, it can result in barriers beyond those experienced by the general public. For instance, just the length of time spent waiting to receive a vaccine can be very difficult for people with a mental health diagnosis. It's very anxiety-provoking, and they sometimes need our support. Another thing a lot of people take for granted is access to technology. Many of our individuals don't have access to a smart phone, to a computer, or to the internet. That made tasks such as getting a COVID test result or booking a vaccine appointment difficult. Our nurses spent a lot of time helping individuals with those types of issues."

Ingrid Manoosingh, Team Leader for PACT's office at 496 Hargrave, says the extra work nurses put in paid dividends in terms of their clients'/participants' COVID safety.

"In some cases, we've had to come up with very creative ways to entice people to go get their first and second vaccinations," she explains. "That might be as simple as providing some COVID education, but in others it might have meant telling an individual, ‘Let’s go do this, and I'll treat you to a burger or slice of pizza.' We had to work with each person to find effective ways to help them along."

With approximately 20 nurses working with up to 500 clients, the process took determination, patience and organization. Given that vaccine availability was initially based on age, Manoosingh's team relied on lists to prioritize individuals.

"In our office, our capacity is 110 participants, so our nurses had to be organized, making lists based on ages from the oldest to the youngest and then starting the process of taking people to get their vaccinations."

Of the team's current roster of 107 clients, 105 have had two COVID vaccinations, and 69 have had their booster shot.

"Those results demanded a lot of coordination amongst the whole team," Manoosingh says. "We were pounding the pavement, sending a few people out to the downtown area, grabbing some of our people that were more marginalized, and waiting in line with them."

Thanks to a great deal of hard work and coordination from the PACT and EPPIS teams, the overall effort to help mental health clients navigate through the various waves of the pandemic has been a success, MacLennan says.

"One of the things that the nurses have always done really well on both the PACT and EPPIS teams is helping ensure our individuals have access to information, and to a family physician. It's often more than traditional nursing; it's the ability and willingness to advocate for individuals, and I think that’s what the nurses bring to our teams. They know how to get individuals the information, care and follow-up they need. And I think our results speak to the value of the effort and legwork they continue to put in."