Impact of COVID-19 on Primary Care Mental Health Services: A Descriptive, Cross-Sectional Timeseries of Electronic Healthcare Records

Abstract

Introduction. There are growing concerns about the impact of the COVID-19 pandemic on mental health. With government-imposed restrictions as well as a general burden on healthcare systems, the pandemic has the potential to disrupt the access to, and delivery of, mental healthcare. Ultimately, this could potentially lead to unmet needs of individuals requiring mental health support. Methods. Electronic healthcare records from primary care psychological therapy services (Improving Access to Psychological Therapy) in England were used to examine changes in access to mental health services and service delivery during early stages of the COVID-19 pandemic. A cross-sectional, descriptive timeseries was conducted using data from 1st January 2019 to 24th May 2020 across five NHS trusts to examine patterns in referrals to services (n = 171,823) and appointments taking place (n = 865,902). Results. The number of patients accessing mental health services dropped by an average of 55% in the 9 weeks after lockdown was announced, reaching a maximum reduction of 74% in the initial 3 weeks after lockdown in the UK. As referrals began to increase again, there was a relatively faster increase in referrals from Black, Asian, and ethnic minority groups as well an increase in referrals from more densely populated areas. Despite a reduction in access, service providers adapted to infection control guidance by rapidly shifting to remote delivery of care. Interpretation. Services were able to rapidly adapt to provide continuity of care in mental healthcare. However, patients accessing services reduced dramatically, potentially placing a future burden on service providers to treat a likely backlog of patients in addition to a possible excess of patients as the long-term consequences of the pandemic become more apparent. Despite the observational nature of the data, which should be noted, the present study can inform the planning of service provision and policy.

Utilization of Inpatient Mental Health Care in the Rhineland During the COVID-19 Pandemic

“…While the results of our study cannot be generalized to other regions and countries, another study in Germany showed a ca. 27% decline in emergency mental-health service use in one psychiatric hospital, which is comparable with our results, and evidence from studies from the UK and Germany points to the same direction of an overall reduction of inpatient mental healthcare utilization (7)(8)(9)(10)(11). Our study adds new information about a diagnostic shift toward more acutely ill patients.…”

“…Finally, inpatient numbers decreased by 13.6% in the time period March 16-March 30, 2020, compared to the time period February 1-March 15, 2020 (10). Primary-care psychological therapies were even more affected: the number of patients accessing psychological therapies for anxiety and depression in southern England dropped by an average of 55% in the 9 weeks after lockdown (11).…”