Analysis of the utilization, processes, and outcomes of inpatient mental healthcare during the first three waves of the COVID-19 pandemic in the federal state of North Rhine-Westphalia, Germany

Abstract

BackgroundDuring the first phase of the Coronavirus-19 disorder (COVID-19) pandemic in the spring of 2020, utilization of inpatient mental healthcare was significantly reduced. We now report on a long-term observational study of inpatient mental healthcare in a large psychiatric hospital association in North Rhine-Westphalia, Germany, covering the second and third pandemic waves of autumn and winter 2020 followed up until June 2021.ObjectivesAnalysis of the changes of inpatient and day patient mental healthcare utilization in an association of psychiatric hospitals during the COVID-19 pandemic from January 2020 until June 2021.Materials and methodsWe used the statistics database of the association of the nine psychiatric hospitals of the Rhineland Regional Council (Landschaftsverband Rheinland, LVR). We compared the case numbers of the pandemic period with previous years and analyzed changes in the diagnostic spectrum, rates of coercion and therapeutic outcomes. We also analyzed age, gender, diagnoses and coercive measures of patients tested positive for COVID-19 during inpatient psychiatric healthcare.ResultsCase rates were reduced during and after the COVID-19 pandemic episodes of 2020 and the following months of spring and summer 2021. Changes varied between diagnostic groups, and there were even increases of case numbers for acute psychotic disorders. Coercive measures increased during the pandemic, but therapeutic outcomes were maintained at the pre-pandemic level. Women and patients of higher ages were overrepresented among psychiatric inpatients with COVID-19.ConclusionThe COVID-19 pandemic led to over during reductions of inpatient psychiatric hospital admissions and changes of the diagnostic spectrum accompanied by increased rates of coercive measures. These effects may reflect an overall increased severity of mental disorders during the COVID-19 pandemic, deferrals of inpatient admissions or a lack of outpatient mental healthcare services utilization. To differentiate and quantitate these potential factors, further studies in the general population and in the different mental healthcare sectors are needed. In order to reduce the number of COVID-19 cases in psychiatric hospitals, vaccination of people of higher ages and with dementias seem to be the most needed strategy.

Involuntary Hospitalizations in an Italian Acute Psychiatric Ward: A 6-Year Retrospective Analysis

“…45,46 The annual trend of admissions divided between VHs and IHs shows a progressive sharp decrease in VHs admissions, concurrent with the pandemic, while the number of IHs admissions remained relatively stable over time, surpassing the number of VHs admissions in absolute terms by the year 2022. This result clearly highlights that, despite the emergency situation, there was a portion of individuals whose admission was necessary and urgent due to acute and severe conditions, and this is in line with national and international studies, 42,[47][48][49][50] which reported a similar trend during pandemic with an increase in involuntary hospitalizations and coercive measures in Psychiatry. In accordance with most authors, we can hypothesize that, during pandemic, reduced availability of outpatient service activities and, at the same time, stressful conditions of isolation as well as reduced treatment of non-COVID-19 related disorders could have…”

“… 50 These results were confirmed by another study, which reported that while voluntary cases decreased considerably during the pandemic, involuntary cases increased slightly, indicating a deterioration in treatment quality during the pandemic. 48 Another study further confirmed these results during the COVID-19 pandemic, 49 suggesting an overall increased severity of mental disorders during the pandemic, due to deferrals of admissions or reduction of mental healthcare services interventions. This unexpected result underlines the need for regular and careful monitoring of the most serious psychiatric conditions, especially in the outpatient setting, particularly for preventing non-adherence to treatment, the main cause of involuntary hospitalization.…”

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

“…In Germany, Flammer et al (2022) reported an increase in the percentage of involuntary admissions and the utilization of seclusions and restraints in 2020. Zielasek et al (2022) studied the utilization of inpatient mental health care in Germany during the first waves of the COVID-19 pandemic. They reported increased use of seclusions and restraints and increased admission of patients with psychotic symptoms during that period.…”

“…Many facilities and public services (e.g., shelters, group homes, schools, social services) had to shut down or limit access, making patient discharges more complex and increasing patients' length of hospital stay (LOS). Recent studies reported increased involuntary admissions and use of coercive measures, such as restraints and seclusion, during the pandemic (Flammer et al, 2022;Zielasek et al, 2022).…”

Impact of COVID-19-Related Social Distancing on the Incidence of Inpatient Aggression at a Public Psychiatric Hospital

“…Consistent with previous reports, this study highlights the impact of COVID-related social distancing on the incidence of inpatient aggression. Studies have shown both increased and decreased rates of inpatient aggression during the COVID-19 pandemic [27][28][29][30][31]. One reason for this heterogeneity of results may be that many studies did not adjust for hospital bed occupancy in their analysis.…”