New ways of working: COVID-19 as a catalyst for change in acute mental health services

Tong, Kezanne; Crudden, Genevieve; Tang, Wen; McGuinness, David; O’Grady, Margaret; Doherty, Anne M.

doi:10.1136/leader-2020-000366

Cited by 2 publications

(2 citation statements)

References 30 publications

(12 reference statements)

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“…Nonetheless, despite ongoing and substantial demands on EDs and hospitals, it is rational and reasonable to reconsider the role of the ED in improving healthcare access for people experiencing homelessness. This is congruent with other emerging ED-demandreduction initiatives that focus on identifying frequently presenting ED patient cohorts or those with specialist needs, such as mental health diversionary pathways [31] or geriatric assessment teams [32]. Indeed, a common issue seen in frequent ED presenters is multi-faceted problems that could often be more effectively addressed through long-term, community-based resources and supports rather than by EDs or hospitals.…”

Section: Emergency Departments At the Frontline Of Homeless Healthcaresupporting

confidence: 68%

Optimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments

Currie

Stafford

Hutton

2023

IJERPH

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The ED is often the first and sometimes the only place where people experiencing homelessness seek medical assistance. While access to primary healthcare is a preferable and more cost-effective alternative to ED, for many reasons, people experiencing homelessness are much less likely to have a regular General Practitioner compared to those living in stable accommodation. Drawing on a growing body of emergency care and homelessness literature and practice, we have synthesised four potential interventions to optimise access to care when people experiencing homelessness present to an ED. Although EDs are in no way responsible for resolving the complex health and social issues of their local homeless population, they are a common contact point and therefore present an opportunity to improve access to healthcare.

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Section: Emergency Departments At the Frontline Of Homeless Healthcaresupporting

confidence: 68%

Optimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments

Currie

Stafford

Hutton

2023

IJERPH

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“…It is possible that these reduced supports available for service users have impacted rates of self-harm presentation in this population. In this service, measures were implemented to mitigate the impact of unmet mental health need on the emergency services to reduce the risk of infection among our patient cohort (Tong et al 2021). Another potential reason for the increased number of individuals actively engaged with MHS who presented with self-harm since the onset of the COVID-19 pandemic relates to increased referral rates to community MHS (College of Psychiatrists of Ireland 2020), with these increased case-loads potentially including many individuals who had previously engaged with MHS requesting additional supports due to the perceived and potential deleterious impact of the COVID-19 pandemic on their mental health.…”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on presentations of self-harm over an 18-month period to a tertiary hospital

O’Malley

McIntyre

McGilloway

et al. 2023

Ir. j. psychol. Med.

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Objectives: To examine and compare rates and methods of self-harm presenting to a tertiary referral hospital during an 18-month period since the onset of the COVID-19 pandemic with a similar period immediately prior to the pandemic onset. Methods: Data from an anonymized database compared rates of self-harm presentations and methods employed between 1st March 2020 and 31st August 2021 to a similar time-frame prior to the onset of the COVID-19 pandemic. Results: A 9.1% increase in presentations with self-harm was noted since the onset of the COVID-19 pandemic. Periods of more stringent restrictions were associated with higher levels of self-harm (daily rate of 2.10 v 0.77). A higher lethality of attempt was demonstrated post-COVID-19 onset (χ2 = 15.38, p < 0.001). Fewer individuals presenting with self-harm were diagnosed with an adjustment disorder since the onset of the COVID-19 pandemic (n = 84, 11.1%, v. n = 112, 16.2%, χ2 = 7.898, p = 0.005), with no other differences pertaining to psychiatric diagnosis noted. More patients actively engaged with mental health services (MHS) presented with self-harm (n = 239 (31.7%) v. n = 137, (19.8%), χ2 = 40.798, p ≤ 0.001) since the onset of the COVID-19 pandemic. Conclusions: Despite an initial reduction, an increase in rates of self-harm has occurred since the onset of the COVID-19 pandemic with higher rates evident during periods of higher government mandated restrictions. An increase in active patients of MHS presenting with self-harm potentially relates to reduced availability of supports and particularly group activities. The recommencement of group therapeutic interventions for individuals attending MHS in particular is warranted.

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New ways of working: COVID-19 as a catalyst for change in acute mental health services

Cited by 2 publications

References 30 publications

Optimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments

Optimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments

The impact of the COVID-19 pandemic on presentations of self-harm over an 18-month period to a tertiary hospital

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