A multicenter study of short-term changes in mental health emergency services use during lockdown in Kitchener-Waterloo, Ontario during the COVID-19 pandemic

Abstract

Background The COVID-19 pandemic and subsequent lockdown measures have led to increasing mental health concerns in the general population. We aimed to assess the short-term impact of the pandemic lockdown on mental health emergency services use in the Kitchener-Waterloo region of Ontario, Canada. Methods We conducted an observational study during the 6-month period between March 5 and September 5, 2020 using National Ambulatory Care Reporting System metadata from mental health visits to three regional Emergency Departments (ED); mental health and substance related police calls; and calls to a regional mental health crisis telephone line, comparing volumes during the pandemic lockdown with the same period in 2019. Quasi-Poisson regressions were used to determine significant differences between numbers of each visit or call type during the lockdown period versus the previous year. Significant changes in ED visits, mental health diagnoses, police responses, and calls to the crisis line from March 5 to September 5, 2020 were examined using changepoint analyses. Results Involuntary admissions, substance related visits, mood related visits, situational crisis visits, and self-harm related mental health visits to the EDs were significantly reduced during the lockdown period compared to the year before. Psychosis-related and alcohol-related visits were not significantly reduced. Among police calls, suicide attempts were significantly decreased during the period of lockdown, but intoxication, assault, and domestic disputes were not significantly different. Mental health crisis telephone calls were significantly decreased during the lockdown period. There was a significant increase in weekly mental health diagnoses starting in the week of July 12 – July 18. There was a significant increase in crisis calls starting in the week of May 31 – June 6, the same week that many guidelines, such as gathering restrictions, were eased. There was a significant increase in weekly police responses starting in the week of June 14 – June 20. Conclusions Contrary to our hypothesis, the decrease in most types of mental health ED visits, mental health and substance-related police calls, and mental health crisis calls largely mirrored the overall decline in emergency services usage during the lockdown period. This finding is unexpected in the context of increased attention to acutely deteriorating mental health during the COVID-19 pandemic.

Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany – Results From the COVID Ψ Psychiatry Survey

“…This pattern may reflect a habituation of the system and its users to the pandemic situation. As in this study, other health systems experienced worse outcomes as a consequence of the reduced mental health services ( 18 , 30 , 36 , 38 ). Alarmingly, many particularly vulnerable and precarious groups were especially affected ( 18 , 39 ).…”

“…Similar to this study, studies in several other regions, including the UK, Italy, Spain, Denmark, Switzerland, Australia, Canada, and the US, observed an overall decrease of inpatient admissions but an increase in involuntary admissions and more acute cases ( 4 , 26 – 35 ). Most regions reported reduced utilization for affective and anxiety disorders, but often no change for psychotic and sometimes addiction disorders ( 36 , 37 ). Similarly, despite often much higher COVID-19 incidences, service restrictions were much less pronounced in the second high incidence phase in winter 2020–2021 than in the first such phase in spring 2020.…”

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“…Similar to this study, studies in several other regions, including the UK, Italy, Spain, Denmark, Switzerland, Australia, Canada, and the US, observed an overall decrease of inpatient admissions but an increase in involuntary admissions and more acute cases (4,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Most regions reported reduced utilization for affective and anxiety disorders, but often no change for psychotic and sometimes addiction disorders (36,37). Similarly, despite often much higher COVID-19 incidences, service restrictions were much less pronounced in the second high incidence phase in winter 2020-2021 than in the first such phase in spring 2020.…”

Scrolling Through the COVID-19 Pandemic: Exploring the Perceived Effects of Increased Social Media Use on the Mental Health of Undergraduate University Students

“…In addition, the same study found that children with autism spectrum disorders experienced worsening mental health mostly due to changes in routine demonstrating the impact of social restrictions on vulnerable populations of society (O’Sullivan et al, 2021). Even where researchers documented a decrease in mental health emergency department visits and crisis calls throughout the first wave of the pandemic, they acknowledge that data may present differently if collected over a longer period as an accumulation of stress, loneliness, isolation, and other factors may have taken longer to develop (Dainton et al, 2021). With respect to Canadian data, Statistics Canada’s Survey on COVID-19 and Mental Health (SCMH) showed that the proportion of Canadian adults screening positive for major depressive disorder (MDD) increased from 15% in fall 2020 to 19% in spring 2022 (Statistics Canada, 2021).…”