Psychiatric liaison service referral patterns during the UK COVID-19 pandemic: An observational study

Sampson, Elizabeth L; Wright, Jessica; Dove, James; Mukadam, Naaheed

doi:10.1016/j.ejpsy.2021.05.003

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…Despite efforts to develop alternatives, mental health presentations to the ED have been reported to be on the rise across the US 4 , Australia 5 and England 6 . Attendances are reported to have risen again following a dip during the early phases of the COVID 19 pandemic 7,8 .…”

Section: Mental Health Presentations In the Emergency Department Of T...mentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best approaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision‐making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low‐ and middle‐income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low‐resource settings may lead to wider learning from locally embedded strategies.

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Section: Mental Health Presentations In the Emergency Department Of T...mentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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“…Mental health crisis services have been described as being themselves in crisis, experiencing pressure from busy emergency departments and wards operating at or beyond capacity, including during the COVID-19 pandemic. 1,[3][4][5]7,8 As such, these findings are of interest and relevance to many stakeholders; those designing and commissioning services, service providers, clinicians, patients, carers and bodies assessing the quality of services (e.g. the Care Quality Commission in the UK).…”

Section: Main Findingsmentioning

confidence: 99%

“…6 Although a decrease in emergency department presentations was initially reported during the COVID-19 pandemic, numbers have since risen again. 7,8 This is despite broad consensus that the emergency department is an unsuitable, non-therapeutic environment for people experiencing a crisis in their mental health. 9 Furthermore, in Europe, the number of in-patient psychiatric beds has decreased.…”

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confidence: 99%

Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis

et al. 2022

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Background Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units. Aims This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units. Method We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies – of Interventions and Risk of Bias in Randomized Trials. Results Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI −261.24 to −67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43–0.68; P < 0.001). Conclusions Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.

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“…For example, Butler et al found a 40% reduction of liaison psychiatry consultations during the first wave ( 23 ). Other studies report a marked decrease of referrals, specifically during March 2020, which returned to normal afterward ( 37 ). These data contrast with studies during the second wave in which the number of liaison psychiatry consultations increased by 18.8% ( 22 ).…”

Section: Discussionmentioning

confidence: 94%

Liaison Psychiatry During the Peak of the Coronavirus Pandemic: A Description of Referrals and Interventions

et al. 2021

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Introduction: The novel coronavirus SARS-CoV-2 belongs to the coronavirus family, a group of viruses that can cause upper respiratory infections in humans. Among other symptoms, it can present as an asymptomatic infection or as a more severe disease requiring hospitalization. Neuropsychiatric symptoms have been described in the acute phase of the illness and as long-term repercussions. We describe the characteristics and interventions in those COVID-19 patients referred to our liaison psychiatry service.Materials and Methods: This is a cross-sectional descriptive study. This study was carried out within the Department of Psychiatry of Cruces University Hospital (Basque Country, Spain). Data from each psychiatric consultation within our consultation-liaison service were consecutively obtained for 1 month from March 17 to April 17, 2020. We recruited data regarding clinical and referral characteristics and psychiatric interventions.Results: Of a total of 721 SARS-CoV-2 hospitalizations, 43 (5.6%) patients were referred to our psychiatry liaison service. The median age was 61 years old, and 62.8% were women. The infectious disease department was the most frequent petitioner (37.2%), and the most common reason for referral was patient anxiety (25.6%). A total of 67.4% of patients received psychological counseling and 55.8% received some pharmacological approach, with a median of 3.7 visits/calls per patient. In addition, 20.3% needed a medication switch due to potential interactions between psychotropics and drugs used to treat SARS-CoV-2.Discussion: In our study, up to 5.6% of SARS-CoV-2 hospitalized patients needed a psychiatric evaluation, especially for anxiety and mood symptoms. Psychosocial factors associated with the pandemic, drugs used to treat the infection, or a direct causative effect of the virus may explain our findings.

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Psychiatric liaison service referral patterns during the UK COVID-19 pandemic: An observational study

Cited by 7 publications

References 11 publications

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis

Liaison Psychiatry During the Peak of the Coronavirus Pandemic: A Description of Referrals and Interventions

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