The Impact of COVID-19 on Psychiatric Acuity in a Community Psychiatric Hospital

Abstract

The COVID-19 pandemic has had extensive impacts on mental health care delivery. Anecdotal observations of inpatient care teams at Pennsylvania Psychiatric Institute suggested increased patient acuity during the pandemic. The authors found no consensus definition for measuring psychiatric acuity in the literature. We performed an interrupted time series analysis to identify whether COVID-19 was associated with changes in several hospital parameters that might reflect our patients' access to psychiatric services and acuity. We found increases in inpatient parameters for length of stay, rates of involuntary admissions, and the incidence of restraints, seclusion, and 1:1 observation orders. Observing these increasing trends can inform mitigation efforts to improve the quality of mental health care treatment and care delivery. We suggest the use of these metrics for objective measurements of psychiatric acuity.

Impact of the SARS-CoV-2 Pandemic on Hospitalizations in an Acute Psychiatric Ward

“… 9 This choice forced by the pandemic circumstances, which limited hospitalizations to the most serious clinical cases, fostered longer hospitalizations, often in involuntary regimen and characterized by aggressive behaviour from hospitalized subjects, as reported in another recent study. 18 In fact, we reported a relatively stable number of involuntary hospitalizations during the whole study period, suggesting that the most serious clinical cases needed to be hospitalized even during a health emergency such as the pandemic, probably because they reported worsened conditions due to stressful situations of infection fear and/or restrictive lockdown measures. Involuntary (or compulsory) psychiatric treatment is necessary in case of need for urgent therapy refused by the subject in a serious psychiatric clinical situation.…”

“…Another study confirmed the greater severity of clinical conditions of hospitalized patients during the pandemic, as suggested by the length of stay, the rate of involuntary admissions and the incidence of restraints and seclusion. 18 …”