The early impact of COVID-19 on mental health and community physical health services and their patients’ mortality in Cambridgeshire and Peterborough, UK

Abstract

Background COVID-19 has affected social interaction and healthcare worldwide. Methods We examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths. We conducted interrupted time series analyses with respect to the time of UK “lockdown”, which was shortly before the peak of COVID-19 infections in this area. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI). Results Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity. Conclusions COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. “Supply” changes may have reduced access to mental health services for some. “Demand” changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.

The Medium-Term Impact of COVID-19 Lockdown on Referrals to Secondary Care Mental Health Services: A Controlled Interrupted Time Series Study

“…Therefore, although it is possible that the longerterm effects identified in this study may not result solely from the social consequences of COVID-19 lockdown but also from adaptation and "rebound" of the health system from the initial sharp decline resulting from lockdown, the prior probability that the changes observed were caused by the pandemic is extremely high and this may have been direct or via a range of indirect mechanisms. For example, these effects may reflect both changes in supply (reduced provision of health services, and the prioritization of urgent over routine referrals with discouragement of routine referral) as well as changes in patientled demand (17). Regression to the mean ("what went down most, came up most") cannot explain our data fully.…”

“…To our knowledge, this is the first study to evaluate systematically the longer-term effects of COVID-19 lockdown on a population's mental health in a clinical setting via a detailed examination of the trajectory of referral numbers. With a rigorous study design to detect causal effects in time series data, we found that after an initial decrease (17), lockdown led in the medium term to an acceleration in the rate of referrals. The significant longerterm effects revealed in our study are generally consistent with the mental health concerns associated with COVID-19 raised by others.…”

“…Notably, referral types that showed the greatest initial drop (Figure 2) tended to show the largest subsequent rate increase (Figure 3). Referral numbers reflect the actions of professionals, and the instantaneous drop reflected, in part, attempts by health services to minimize the probability of patients entering high-risk areas for infection unnecessarily (17), and to release resources for the management of patients with COVID-19. However, it is less clear that this explains the subsequent increase in referral rates.…”

Exploring the Impact of COVID-19 on Mental Health Outcomes in Children and Adolescents: A Systematic Review

“…For example, somatic symptoms in youth may be related to their new social reality due to COVID-19, which possibly introduced new challenges to young people in addition to the developmental challenges of their age. Furthermore, this new situation with the imposed social and physical restrictions may have also introduced additional barriers to accessing informal and formal help-seeking for mental health problems in youths, similarly to adults [ 53 , 54 ]. In addition, young people may now have restricted exposure to elements that operate as protective agents against mental health difficulties.…”

The roles of a psychiatrist in the COVID-19 pandemic

“… 25 , 26 However, reports from mental health services in the United Kingdom have indicated initial falls in activity following the first national lockdown, but a subsequent increased demand for some services: with shifts from face-to-face appointments to on-line consultations, and a possible rise in mortality. 27 , 28 , 29 , 30 Virtual consultations can be challenging, but can offer advantages (e.g. greater convenience for patients who are undertaking caring roles, reduced appointment non-attendance rates) over previous means for assessment in some situations.…”