The Impact of the COVID-19 Pandemic on Forensic Mental Health Services and Clinical Outcomes: A Longitudinal Study

Abstract

BackgroundThe COVID-19 pandemic has had a substantial impact on forensic mental health service provision and implementation. This study aimed to provide an analysis of the impact of COVID-19 related restrictions on routine outcomes within a large forensic mental health service in London, UK.MethodWe conducted a longitudinal cohort study using data collected routinely prior to the COVID-19 pandemic (April 2018–March 2020) and then stages thereafter (March 2020–March 2021; analyzed as March–May 2020, June–September 2020, October–December 2020, January–March 2021). We used causal impact models (Bayesian structural time-series) to examine the effect of COVID-19 related changes on routine outcomes related to service provision and implementation.ResultsThere was an overall increase in long-term segregation (LTS) hours during the pandemic; 140%, (95% Cl 107, 171%) during Lockdown 1; 113%, (159% Cl 127, 192%) during post-Lockdown 1; 45% (95% Cl 23, 68%) during Lockdown 2 and, finally, 90% (95% Cl 63, 113%) during Lockdown 3. The most negative outcomes were evident during Lockdown 3. Incidents of violence were significantly more frequent during Lockdown 3 than would have been predicted based on pre-pandemic data, including physical assaults to service users (206%, 95% CI 57%, 346%), non-physical assaults to service users (206%, 95% CI 53%, 339%), and self-harm (71%, 95% CI 0.4%, 135%). Use of enforced medication also increased during Lockdown 3 (317%, 95% CI 175%, 456%).ConclusionThe pandemic and its related restrictions negatively affected some service outcomes. This resulted in increased incidents of violence and increased use of restrictive interventions, beyond what would have been expected had the pandemic not occurred.

The impact of the COVID-19 pandemic on the psychosocial rehabilitation of forensic psychiatric patients in Austria

“…Although these numbers suggest that disease control was rather effective, our data show that the enacted measures concomitantly limited treatment efforts. Notably, a similar impact on therapeutic activities and temporary releases was reported in other states ( Heitzman & Gosek, 2021 ; Kennedy et al, 2021 ; Montanari et al, 2021 ; Puzzo et al, 2022 ). To prevent overcrowding of prisons and to facilitate alternatives to detention, updated regulations for the release of prisoners were approved in 21 out of 27 member states of the European Union in June 2020 ( European Parliament, 2020 ).…”

“…These findings contrast previous studies, reporting increased psychological distress due to COVID-19 in vulnerable groups ( Kozloff, Mulsant, Stergiopoulos, & Voineskos, 2020 ; Yao, Chen, & Xu, 2020 ; Zhu et al, 2020 ). Although a recent publication further suggested that violent incidents in forensic mental health institutions increased during the pandemic, the study did not find increased rates of damage to property and also showed a decrease in non-physical assaults to staff ( Puzzo et al, 2022 ). The fact that physical and non-physical assaults were not subdivided in our study may explain the differing results related to aggressive behavior.…”

“…According to human rights organizations, the pandemic aggravated the situation of detained persons due to excessive confinement and quarantine ( Amnesty International, 2021 ; Harm Reduction International, 2023 ). On the grounds that more restrictive conditions of detention reduce the risk for transmission of SARS-CoV-2, numerous European penal authorities suspended external service providers and psychological group counseling ( Kennedy et al, 2021 ; Montanari et al, 2021 ; Puzzo, Aldridge-Waddon, Stokes, Rainbird, & Kumari, 2022 ). In line with these reports, our study highlights the substantial impact of COVID-19 on forensic care in terms of rehabilitative activities and visitations in Austria.…”

Reduction of adverse events in a psychiatric inpatient eating disorder unit during the COVID‐19 pandemic

“…During this time reduction on average use of NGF tubes by 80.14% was also observed suggesting lesser use of coercive methods to feed adolescents with eating disorders. Given that there are no studies exploring the impact of COVID‐19 restrictions on adolescents within inpatient psychiatric setting, these findings are novel, unexpected and in contrast to what was found among adult inpatients (Flammer et al, 2022; Payne‐Gill et al, 2021; Puzzo et al, 2022). The findings also demonstrate the potential to improve and minimize adverse events in inpatient psychiatric units.…”

“…Research exploring the impact of pandemic restrictions on incidence of aggression and use of coercive measures, largely involves psychiatric adult inpatients and have shown mixed results—while some studies suggest a rise in incidence of violence and use of coercive methods (Flammer et al, 2022; Payne‐Gill et al, 2021; Puzzo et al, 2022), some have suggested a decline in aggression and violence within a similar time frame (Feeney et al, 2022; Martin et al, 2022).…”