Psychiatric inpatient services in Ontario, 2019–2021: a cross-sectional comparison of admissions, diagnoses and acuity during the COVID-19 prerestriction, restriction and postrestriction periods

Abstract

T he World Health Organization declared COVID-19 a pandemic on Mar. 11, 2020. 1 Despite increases in anxiety and depression in the general population during the pandemic, 2-4 psychiatric services were often limited to urgent care, resulting in fewer admissions during the initial period of restrictions. [5][6][7][8] Within 12 weeks, admission rates approached prerestriction levels; 9-11 however, there is little research into whether this apparent recovery continued in the long term. Furthermore, increased rates of psychosis and mania [12][13][14] and suicidal behaviour 9,10 suggest increased acuity of the admission population, which is important information for planning clinical services (e.g., staffing ratios, skill sets, interventions). Evidence of increased involuntary admissions 6,15-17 also suggests an added burden to hospitals given their association with acute illness and aggression, 18,19 longer stays, readmissions 20 and use of restraints. 21 In Ontario, Canada, rates of admission to psychiatric hospitals for psychotic and substance-related disorders approximated prerestriction levels by the time initial COVID-19 restrictions were eased, in June 2020. 11 In contrast, admissions for mood-, trauma-and stressor-related disorders had not yet returned to normal. 11 Involuntary admissions were increasing before COVID-19, 18 but whether this trend has continued is unclear. Thus, there is a need to examine whether changes in

Adult psychiatric inpatient admissions and length of stay before and during the COVID-19 pandemic in a large urban hospital setting in Vancouver, British Columbia

“…Across Canada, mental health and substance use service utilization during the pandemic has mostly suggested a decline in emergency department and hospital visits ( 18 , 19 ) with hospitalization rates returning to pre-pandemic levels by March 2021 ( 20 ). Evidence from Ontario, Canada using population-level administrative data found psychiatric-related hospital admissions did not return to pre-restriction rates ( 21 ) and while overall volumes may have decreased, monthly increases were observed for specific mental disorders post pandemic ( 22 , 23 ). In British Columbia (BC), Canada COVID-19 mental-health related service use rose sharply during 2020, but quickly stabilized; however, other types of mental health service use and drug dispensation continued to rise significantly into 2021 ( 24 ).…”