Mental health service activity during COVID-19 lockdown among individuals with Personality Disorders: South London and Maudsley data on services and mortality from January to May 2020

Abstract

The lockdown and social distancing policy imposed due to the COVID-19 pandemic is likely to have a widespread impact on mental healthcare for both services themselves and the people accessing those services. Previous reports from the South London and Maudsley NHS Trust (SLaM; a large mental health service provider for 1.2m residents in South London) highlighted a shift to virtual contacts among those accessing community mental health and home treatment teams and an increase in deaths over the pandemic first wave. However, there is a need to understand this further for specific groups, including those diagnosed with a personality disorder who might have particular vulnerabilities. Taking advantage of the Clinical Record Interactive Search (CRIS) data resource with 24-hourly updates of electronic mental health records data, this paper describes daily caseloads and contact numbers (face-to-face and virtual) for individuals with personality disorders across community, specialist, crisis and inpatient services. The report focussed on the period 1st January to 31st May 2020. We also report on daily accepted and discharged trust referrals, total trust caseloads and daily inpatient admissions and discharges for individuals with personality disorders. In addition, daily deaths are described for all current and previous SLaM service users with personality disorder over this period. In summary, comparing periods before and after 16th March 2020 there was a shift from face-to-face contacts to virtual contacts across all teams. Liaison and Older Adult teams showed the largest drop in caseloads, whereas Early Intervention in Psychosis service caseloads remained the same. Reduced accepted referrals and inpatient admissions were observed and there was a 28% increase in average daily deaths in the period after 16th March, compared to the period 1st January to 15th March.

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

“…In the meantime, a number of approaches received from policy bodies for dissemination of findings reported here could not be accommodated because of results being under consideration for publication. The experience of attempting to follow the traditional academic publishing route in the context of rapidly changing circumstances requiring up-to-date data is a reason underlying recent dissemination of pandemic-relevant output from CRIS primarily via pre-print (16-19). The manuscript presented here has been amended from that originally submitted to remove statements of inference that might warrant peer-review.…”

Self-harm presentations to Emergency Departments and Place of Safety during the ‘first wave’ of the UK COVID-19 pandemic: South London and Maudsley data on service use from February to June 2020

“…Within the UK, preliminary reports highlighted a shift from face-to-face to virtual contacts across community mental health services (2) and a reduction in inpatient care (3) during the first wave of the pandemic. However, less is known about the ways in which presentations to Emergency Departments (EDs) and Places of Safety (POS) were changing during this time, particularly in relation to episodes of self-harm.…”

“…While the main concerns have been related to increased stress and anxiety in the general population, a statement from the World Health Organisation highlighted particular concern, anticipating increased self-harm and suicidal behaviour during the pandemic (1). Within the UK, preliminary reports highlighted a shift from face-to-face to virtual contacts across community mental health services (2) and a reduction in inpatient care (3) during the first wave of the pandemic. However, less is known about the ways in which presentations to Emergency Departments (EDs) and Places of Safety (POS) were changing during this time, particularly in relation to episodes of self-harm.…”