Impact of COVID-19 pandemic on involuntary and urgent inpatient admissions for psychiatric disorders in a German-wide hospital network

Fasshauer, Jonathan Mathias; Bollmann, Andreas; Hohenstein, Sven; Mouratis, Konstantinos; Hindricks, Gerhard; Meier‐Hellmann, Andreas; Kuhlen, Ralf; Broocks, Andreas; Schomerus, Georg; Stengler, Katarina

doi:10.1016/j.jpsychires.2021.07.052

Cited by 37 publications

(42 citation statements)

References 22 publications

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“…As the restrictions were intensive and prolonged in the jurisdiction in which study was conducted, it may be less surprising that the main findings of this study relate to the dramatically increased admission rates and involuntary admission orders. This study also replicates the findings from Switzerland and Germany, which also found that involuntary admission increased during the COVID-19 pandemic, although this related to all psychiatric presentations and not just psychotic disorders (Ambrosetti et al, 2021; Fasshauer et al, 2021).…”

Section: Discussionsupporting

confidence: 89%

The incidence and admission rate for first-episode psychosis in young people before and during the COVID-19 pandemic in Melbourne, Australia

O’Donoghue

Collett

Boyd

et al. 2021

Aust N Z J Psychiatry

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Objective: The COVID-19 pandemic has had a profound effect on global mental health, with one-third of infected individuals developing a psychiatric or neurological disorder 6 months after infection. The risk of infection and the associated restrictions introduced to reduce the spread of the virus have also impacted help-seeking behaviours. Therefore, this study aimed to determine whether there was a difference during the COVID-19 pandemic in the treated incidence of psychotic disorders and rates of admission to hospital for psychosis (including involuntary admission). Methods: Incident cases of first-episode psychosis in young people, aged 15 to 24, at an early intervention service in Melbourne from an 8-month period before the pandemic were compared with rates during the pandemic. Hospital admission rates for these periods were also compared. Results: Before the pandemic, the annual incidence of first-episode psychosis was 104.5 cases per 100,000 at-risk population, and during the pandemic it was 121.9 (incidence rate ratio = 1.14, 95% confidence interval = [0.92, 1.42], p = 0.24). Immediately after the implementation of restrictions, there was a non-significant reduction in the treated incidence (incidence rate ratio = 0.80, 95% confidence interval = [0.58, 1.09]), which was followed by a significant increase in the treated incidence in later months (incidence rate ratio = 1.94, 95% confidence interval = [1.52, 2.49]; incidence rate ratio = 1.64, 95% confidence interval = [1.25, 2.16]). Before the pandemic, 37.3% of young people with first-episode psychosis were admitted to hospital, compared to 61.7% during the pandemic (odds ratio = 2.71, 95% confidence interval = [1.73, 4.24]). Concerning the legal status of the admissions, before the pandemic, 27.3% were admitted involuntarily to hospital, compared to 42.5% during the pandemic (odds ratio = 1.97, 95% confidence interval = [1.23, 3.14]). Conclusion: There was a mild increase, which did not reach statistical significance, in the overall incidence of first-episode psychosis; however, the pattern of presentations changed significantly, with nearly twice as many cases presenting in the later months of the restrictions. There was a significant increase in both voluntary and involuntary admissions, and the possible explanations for these findings are discussed.

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Section: Discussionsupporting

confidence: 89%

The incidence and admission rate for first-episode psychosis in young people before and during the COVID-19 pandemic in Melbourne, Australia

O’Donoghue

Collett

Boyd

et al. 2021

Aust N Z J Psychiatry

View full text Add to dashboard Cite

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“…The data suggest that the most severely ill patients continued to receive care, if necessary, on an involuntary basis, while less severely ill patients tended to avoid hospital care themselves or were not admitted due to the very restrictive case policy of hospitals. A similar development was observed in most medical specialties (9,10). Notwithstanding the fact that these longitudinal observational data do not allow for causal inferences in their nature, with respect to the use of coercion, we are not aware of any other explanation for this State-wide phenomenon.…”

Section: Discussionsupporting

confidence: 79%

Increase in coercive measures in psychiatric hospitals in Germany during the COVID-19 Pandemic

Steinert

Hirsch

Eisele

et al. 2022

Preprint

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Objective : To examine whether the pandemic in 2020 caused changes in psychiatric hospital cases, the percentage of patients exposed to coercive interventions, and aggressive incidents. Methods ; We used the case registry for coercive measures of the State of Baden-Wuerttemberg, comprising case-related data on mechanical restraint, seclusion, physical restraint, and forced medication in each of the State’s 31 licensed hospitals treating adults, to compare data from 2019 and 2020. Results: The number of cases in adult psychiatry decreased by 7.6% from 105,782 to 97,761. The percentage of involuntary cases increased from 12.3 to 14.1%, and the absolute number of coercive measures increased by 4.7% from 26,269 to 27,514. The percentage of cases exposed to any kind of coercive measure increased by 24.6% from 6.5 to 8.1%, and the median cumulative duration per affected case increased by 13.1% from 12.2 to 13.8 hrs, where seclusion increased more than mechanical restraint. The percentage of patients with aggressive incidents, collected in 10 hospitals, remained unchanged. Conclusions: While voluntary cases decreased considerably during the pandemic, involuntary cases increased slightly. However, the increased percentage of patients exposed to coercion is not only due to a decreased percentage of voluntary patients, as the duration of coercive measures per case also increased. The changes that indicate a deterioration in treatment quality were probably caused by the multitude of measures to manage the pandemic. The focus of attention has shifted from prevention of coercion to prevention of infection.

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“…A total of 84% of the institutions reported that they had established special wards or spaces for providing care for patients with SMI and comorbid SARS-CoV-2 infection, but that these areas were not used much because the first high incidence phase in Germany was not as severe as expected ( 10 ). The studies of routine data from a German psychiatric hospital network reported an overall decrease in emergency hospital admissions during this phase but an increase in the proportion of involuntary and urgent admissions ( 11 , 12 ). The evidence also hints at significant reductions in utilization in the German outpatient mental healthcare system during the first wave of the pandemic: For example, in March 2020, the number of individual psychotherapy cases decreased by 23%, and in April 2020, the number of psychiatric treatment cases, as measured by case-based lump sum payments, decreased by 30% and the number of group therapy cases decreased by as much as 60% ( 13 ).…”

Section: Introductionmentioning

confidence: 98%

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

et al. 2022

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Psychiatric inpatient treatment, an important pillar of mental health care, is often of longer duration in Germany than in other countries. The COVID-19 pandemic called for infection prevention and control measures and thereby led to shifts in demand and inpatient capacities. The Germany-wide COVID Ψ Psychiatry Survey surveyed department heads of German psychiatric inpatient institutions. It assessed changes in utilization during the first two high incidence phases of the pandemic (spring 2020 and winter 2020/21) and also consequences for care, telemedicine experiences, hygiene measures, treatment of patients with mental illness and co-occuring SARS-CoV-2, and coercive measures in such patients. A total of n = 71 psychiatric departments (of 346 contacted) participated in the survey. The results showed a median decrease of inpatient treatment to 80% of 2019 levels and of day hospital treatment to 50% (first phase) and 70% (second phase). Reductions were mainly due to decreases in elective admissions, and emergency admissions remained unchanged or increased in 87% of departments. Utilization was reduced for affective, anxiety, personality, and addiction disorders but appeared roughly unaffected for psychotic disorders. A lack of integration of patients into their living environment, disease exacerbations, loss of contact, and suicide attempts were reported as problems resulting from reduced capacities and insufficient outpatient treatment alternatives. Almost all departments (96%) treated patients with severe mental illness and co-occurring SARS-CoV-2 infection. The majority established special wards and separate areas for (potentially) infectious patients. Telephone and video consultations were found to provide benefits in affective and anxiety disorders. Involuntary admissions of persons without mental illness because of infection protection law violations were reported by 6% of the hospitals. The survey showed high adaptability of psychiatric departments, which managed large capacity shifts and introduced new services for infectious patients, which include telemedicine services. However, the pandemic exacerbated some of the shortcomings of the German mental health system: Avoidable complications resulted from the lack of cooperation and integrated care sequences between in- and outpatient sectors and limited options for psychiatric hospitals to provide outpatient services. Preventive approaches to handle comparable pandemic situations in the future should focus on addressing these shortcomings.

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Impact of COVID-19 pandemic on involuntary and urgent inpatient admissions for psychiatric disorders in a German-wide hospital network

Cited by 37 publications

References 22 publications

The incidence and admission rate for first-episode psychosis in young people before and during the COVID-19 pandemic in Melbourne, Australia

The incidence and admission rate for first-episode psychosis in young people before and during the COVID-19 pandemic in Melbourne, Australia

Increase in coercive measures in psychiatric hospitals in Germany 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

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