Psychiatric emergency department volume during Covid-19 pandemic

Abstract

One commonly reported phenomenon in the first months of the Covid-19 era in the United States has been the reduction in emergency department (ED) visits and hospitalizations of patients with heart attacks, strokes and other acute, non-Covid illnesses [1]. Less is known about whether and how the number of patients presenting to EDs for psychiatric problems has changed.Prior to the pandemic, there were reasons to believe that psychiatric ED visits might increase. Many people could experience distress such as anxiety, sadness, grief and anger during this uncertain time [2]. Because of physical distancing measures, normal sources of support might be less directly accessible. People with pre-existing mental illness may be particularly vulnerable to such change. Alterations to outpatient practices may mean that prior mental health treatment could be disrupted. Access to social services such as shelters or soup kitchens might decrease.Connecticut reported its first case of Covid-19 on March 8, 2020. Several local school districts shuttered the following week, and the governor issued an order for the suspension of non-essential business and for residents to stay at home effective March 23. As of the end of April, 27,700 cases and 2257 Covid-associated deaths had been reported in the state [3].Yale-New Haven Hospital (YNHH) is a 1541-bed tertiary care medical center with three local EDs (two in downtown New Haven and one in a nearby suburb), the sixth largest hospital by bed capacity in the country. The psychiatric emergency service (PES) is staffed 24 h per day and treats patients 16 years and older. Each year, the ED has about 200,000 patient visits per year including roughly 9000 PES visits.At YNHH, PES and overall ED volumes for January, February and early March 2020 were similar to prior years (see Table 1). However, starting in the last two weeks of March through the first week in May, PES volume declined about 26%, from an average of 24.2 patients per American Journal of Emergency Medicine xxx (xxxx) xxx YAJEM-159056; No of Pages 2

Emergency psychiatric service seeker referral pattern variations over the course of a pandemic

“…The coronavirus pandemic has led to significant changes in demand for emergency psychiatric services [ [1] , [2] , [3] , [4] ]. In January 2020, the first case was detected in Singapore [ 5 , 6 ].…”

“…The number of service seekers significantly increased to 55 cases per day following the easing of quarantine measures. Other locations have reported significant decreases in psychiatric emergency department attendance: in Northern Portugal attendance was approximately 36 cases per day in 2019, but fell to 17 as a result of the pandemic [ 3 ], in Cambridge, UK, cases per day fell from 342 to 242 [ 2 ], and in Yale-New-Haven, US, cases fell from 24 to 18 cases per day [ 4 ]. ED attendances in general across England have also fallen [ 10 ].…”

Psychiatric emergency services and non-acute psychiatric services utilization during COVID-19 pandemic

“…The very similar reports come from North America. Goldenberg and Parwani in their recently published paper concluded that the rapid establishment of telepsychiatry preserved or even expanded access to treatment and thereby, among other reasons, the emergency visits declined [1].…”

Les urgences psychiatriques pendant l’état d’urgence sanitaire

“…Ce phénomène est constaté dans d’autres centres d’urgences psychiatriques, notamment à l’hôpital de Yale-New-Haven (YNHH), dans le Connecticut aux États-Unis, avec une baisse de 30 % de la fréquentation [5] et, en Allemagne, dans la ville de Mannheim avec une baisse de 26 % [6] .…”