Acute mental health presentations before and during the COVID-19 pandemic

Abstract

Background A number of community based surveys have identified an increase in psychological symptoms and distress but there has been no examination of symptoms at the more severe end of the mental health spectrum. Aims We aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the COVID-19 pandemic. Method We analysed electronic data between January and April 2020 for 2534 patients referred to acute psychiatric services, and tested for differences in patient demographics, symptom severity and use of the Mental Health Act 1983 (MHA), before and after lockdown. We used interrupted time-series analyses to compare trends in emergency department and psychiatric presentations until December 2020. Results There were 22% fewer psychiatric presentations the first week and 48% fewer emergency department presentations in the first month after lockdown initiated. A higher proportion of patients were detained under the MHA (22.2 v. 16.1%) and Mental Capacity Act 2005 (2.2 v. 1.1%) (χ2(2) = 16.3, P < 0.0001), and they experienced a longer duration of symptoms before seeking help from mental health services (χ2(3) = 18.6, P < 0.0001). A higher proportion of patients presented with psychotic symptoms (23.3 v. 17.0%) or delirium (7.0 v. 3.6%), and fewer had self-harm behaviour (43.8 v. 52.0%, χ2(7) = 28.7, P < 0.0001). A higher proportion were admitted to psychiatric in-patient units (22.2 v. 18.3%) (χ2(6) = 42.8, P < 0.0001) after lockdown. Conclusions UK lockdown resulted in fewer psychiatric presentations, but those who presented were more likely to have severe symptoms, be detained under the MHA and be admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID-19 waves.

The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review

“…Our findings are consistent with reports of increased acuity of presentations in some mental health services. 67,68 The increases in presentation frequency reported by studies that were conducted in healthcare settings treating more potentially lethal episodes of self-harm, such as ambulance calls and trauma admissions, indicates that the pandemic has affected the threshold for help-seeking. Evidence also shows that non-statutory mental health services, such as charities, experienced increased demand in the months following the onset of the pandemic.…”

Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review

“…This, in combination with an important decrease of presentations from Berlin outside our catchment area (63.9 vs. 56.9%, Table 1 ), suggests a concentration to more local help-seeking behaviour and has not been shown yet in other studies focusing on pEDs. It may be due to stay-at-home advice of the government and a reduced mobility of patients [ 26 , 49 ] (cf. last paragraph of Introduction).…”

Characterizing Unusual Spatial Clusters of Male Mental Health Emergencies Occurring During the First National COVID-19 “Lockdown” in the East Midlands Region, UK: A Geospatial Analysis of Ambulance 999 Data

“…During the first national “lockdown,” the number of new referrals to psychological services decreased markedly which corresponds with a decrease in GP appointments ( Davies, 2020 ). Similarly, over the course of the pandemic, the role of pharmacies ( Royal Pharmaceutical Society, 2021 ) has evolved to include supporting people with mental health needs, while presentations of acute mental health conditions to A&E were increasingly supported by mental health liaison units ( Mukadam et al, 2021 ). Overall, statistical analysis to explain the location of clusters included measures of distance (km) from health services such as GPs, pharmacies, and A&E, as well as distance from passive green space, such as commons and arboretums, active green space, such as cricket pitches, and blue space, such as ponds and beaches.…”