Patients presenting to an acute general hospital with acute mental health needs: a retrospective observational cohort study

Abstract

ObjectivesTo examine the numbers and patterns of patients presenting to an urban acute general hospital with acute mental health presentations and to further investigate any variation related to the COVID-19 pandemic.DesignRetrospective observational cohort study.SettingAn urban acute general hospital in London, UK, comprising of five sites and two emergency departments. The hospital provides tertiary level general acute care but is not an acute mental health services provider. There is an inpatient liaison psychiatry service.Participants358 131 patients attended the emergency departments of our acute general hospital during the study period. Of these, 14 871 patients attended with an acute mental health presentation. A further 14 947 patients attending with a physical illness were also noted to have a concurrent recorded mental health diagnosis.ResultsLarge numbers of patients present to our acute general hospital with mental health illness even though the organisation does not provide mental health services other than inpatient liaison psychiatry. There was some variation in the numbers and patterns of presentations related to the COVID-19 pandemic. Patient numbers reduced to a mean of 9.13 (SD 3.38) patients presenting per day during the first ‘lockdown’ compared with 10.75 (SD 1.96) patients per day in an earlier matched time period (t=3.80, p<0.01). Acute mental health presentations following the third lockdown increased to a mean of 13.84 a day.ConclusionsLarge numbers of patients present to our acute general hospital with mental health illness. This suggests a need for appropriate resource, staffing and training to address the needs of these patients in a non-mental health provider organisation and subsequent appropriate transfer for timely treatment. The COVID-19 pandemic and the resulting lockdowns have resulted in variation in the numbers and patterns of patients presenting with acute mental health illness but these presentations are not new. Considerable work is still needed to provide integrated care which addresses the physical and mental healthcare needs of patients presenting to acute and general hospitals.

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

“…Paranoid schizophrenia was a predictor of Covid-19 period in the logistic regression analysis, too (Table 4 ). An increase in rates of presentations with SPD during the Covid-19 period was shown in various studies of similar design [ 12 , 18 , 19 , 23 , 49 – 51 ]. One may speculate that patients with chronic psychotic disorders and high need of psychosocial facilities have suffered more than other diagnostic groups from the lockdown restrictions which included closing or limited accessibility of many psychosocial [ 41 ] and psychotherapeutic [ 52 ] facilities.…”

“…However, there are also studies, which do not show an overall increase in presentation rates in patients with SPD [ 15 , 21 , 28 , 30 ], stressing local differences. An absolute increase in presentations with paranoid schizophrenia has only been reported in few studies [ 12 , 51 ]. Interestingly, these studies have longer observation periods (6 months or longer) than most other Covid-pED studies yet.…”

“…All studies, so far, found that absolute numbers of presentations with depressive disorders decreased during the first lockdown [ 12 – 15 , 18 – 22 , 26 , 28 , 30 , 31 , 48 , 50 , 51 ]. In the current study the decrease was 29.4% and hence was comparable to earlier studies (68.3% [ 18 ], 43.5% [ 21 ], 28.3% [ 12 ]).…”

Características clínicas en pacientes atendidos en una unidad de psiquiatría de emergencia en un hospital general de Perú

“…2023;84(4):399-409. 404 embargo, es importante destacar en este estudio, que la tasa de derivación a la unidad de psiquiatría de emergencia fue relativamente baja en comparación con otros estudios (7,25) . Una posible explicación es que los pacientes con trastornos mentales no están siendo identificados y remitidos adecuadamente por médicos de emergencia, lo que puede llevar a una falta de atención temprana.…”

What are the barriers and enablers to trauma-informed emergency departments? A scoping review protocol

“…Individuals with mental health problems often experience trauma,15 20 making their visits to the ED challenging, as the setting can potentially trigger traumatic memories. Approximately 5% of ED visits are primarily due to mental health issues,26 27 with an additional 5% having both mental health diagnoses and physical ailments 26. Data show that mental health attendances to the ED have increased 133% over 8 years27 In 2020, multiple Royal Colleges jointly issued a position paper advocating for increased involvement of mental health professionals in ED along with concurrent assessment 28.…”