Comparison of mental health service activity before and shortly after UK social distancing responses to the COVID-19 pandemic: February-March 2020

Stewart, Robert; Martin, Evangelia; Bakolis, Ioannis; Broadbent, Matthew; Byrne, Nicola; Landau, Sabine

doi:10.1101/2020.09.26.20202150

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…While the results of our study cannot be generalized to other regions and countries, another study in Germany showed a ca. 27% decline in emergency mental-health service use in one psychiatric hospital, which is comparable with our results, and evidence from studies from the UK and Germany points to the same direction of an overall reduction of inpatient mental healthcare utilization (7)(8)(9)(10)(11). Our study adds new information about a diagnostic shift toward more acutely ill patients.…”

Section: Discussionsupporting

confidence: 90%

“…When comparing the same periods in 2019, they found a much lower reduction of only 3-8% (9). Finally, inpatient numbers decreased by 13.6% in the time period March 16-March 30, 2020, compared to the time period February 1-March 15, 2020 (10). Primary-care psychological therapies were even more affected: the number of patients accessing psychological therapies for anxiety and depression in southern England dropped by an average of 55% in the 9 weeks after lockdown (11).…”

Section: Introductionmentioning

confidence: 95%

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Utilization of Inpatient Mental Health Care in the Rhineland During the COVID-19 Pandemic

Zielasek

Vrinssen

2021

Front. Public Health

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Background: During the Coronavirus-19 (COVID-19) pandemic, considerable changes occurred in the utilization of mental health care.Objectives: We conducted an analysis of the changes of inpatient and day patient mental health care utilization in an association of psychiatric hospitals during the COVID-19 pandemic.Materials and Methods: We used the statistics database of the association of nine psychiatric hospitals of the Rhineland Regional Council (Landschaftsverband Rheinland, LVR). We compared the case numbers of spring 2019 and spring 2020 and analyzed alterations in the diagnostic spectrum. Finally, we analyzed the age, gender, and diagnoses of patients tested positive for COVID-19.Results: A total of 25,612 inpatient psychiatric hospital admissions were assessed. Case rates decreased by 25% during the COVID-19 pandemic. Changes varied between diagnostic groups, and there were even increases in case numbers for certain diagnoses. Women and patients of higher ages were overrepresented among psychiatric inpatients with COVID-19.Conclusions: The COVID-19 pandemic resulted in considerable reductions in the total number of mental health-care admissions and in changes in the diagnostic spectrum. The results may be explainable by deferrals of elective hospital admissions during the acute phase of the pandemic and by destabilizing effects of the pandemic and social distancing on people with mental disorders.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 95%

Utilization of Inpatient Mental Health Care in the Rhineland During the COVID-19 Pandemic

Zielasek

Vrinssen

2021

Front. Public Health

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“…This is in keeping with an earlier analysis of the same dataset examining the period from 1 February to 31 March 2020. 29 This reduction in patients registered following April 2020 may reflect the discharge of patients in the initial stages of the pandemic who may have previously had limited input from mental health services. This is supported by the fact that there was no demonstrable change in clinical activity measured through mentions of antipsychotic and mood stabiliser medications during the same period.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on remote mental healthcare and prescribing in psychiatry: an electronic health record study

et al. 2021

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ObjectivesThe recent COVID-19 pandemic has disrupted mental healthcare delivery, with many services shifting from in-person to remote patient contact. We investigated the impact of the pandemic on the use of remote consultation and on the prescribing of psychiatric medications.Design and settingThe Clinical Record Interactive Search tool was used to examine deidentified electronic health records of people receiving mental healthcare from the South London and Maudsley (SLaM) NHS Foundation Trust. Data from the period before and after the onset of the pandemic were analysed using linear regression, and visualised using locally estimated scatterplot smoothing.ParticipantsAll patients receiving care from SLaM between 7 January 2019 and 20 September 2020 (around 37 500 patients per week).Outcome measures(i) The number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals per week.(ii) Prescribing of antipsychotic and mood stabiliser medications per week.ResultsFollowing the onset of the pandemic, the frequency of in-person contacts was significantly reduced compared with that in the previous year (β coefficient: −5829.6 contacts, 95% CI −6919.5 to −4739.6, p<0.001), while the frequency of remote contacts significantly increased (β coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite this change in the type of patient contact, antipsychotic and mood stabiliser prescribing remained at similar levels.ConclusionsThe COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in psychiatric prescribing. Nevertheless, further work is needed to ensure that older patients are able to access mental healthcare remotely.

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“…5 Single-site reports from UK services have highlighted falls in activity following the 23 March d national lockdown, followed by increased demand for some services, decreased activity for others, shifts from f2f to virtual consultations and a rise in mortality. [14][15][16][17][18][19] Drawing on a network of providers, we sought to determine the level and heterogeneity of such mental healthcare changes across multiple national sites using a quasi-experimental, regression discontinuity design in time.…”

Section: And Problems Inmentioning

confidence: 99%

Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design

et al. 2021

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ObjectivesTo investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020.DesignA regression discontinuity in time (RDiT) analysis of daily service-level activity.Setting and participantsMental healthcare data were extracted from 10 UK providers.Outcome measuresDaily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 ‘lockdown’ policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites.ResultsPooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect.ConclusionsMH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.

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Comparison of mental health service activity before and shortly after UK social distancing responses to the COVID-19 pandemic: February-March 2020

Cited by 5 publications

References 18 publications

Utilization of Inpatient Mental Health Care in the Rhineland During the COVID-19 Pandemic

Utilization of Inpatient Mental Health Care in the Rhineland During the COVID-19 Pandemic

Impact of the COVID-19 pandemic on remote mental healthcare and prescribing in psychiatry: an electronic health record study

Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design

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