The Impact of COVID-19 on Psychiatric Emergency and Inpatient Services in the First Month of the Pandemic in a Large Urban Mental Health Hospital in Ontario, Canada

Abstract

The World Health Organization characterized COVID-19 (coronavirus disease 2019) as a pandemic on March 11, 2020 (WHO). Within a couple of days, all Canadian provinces announced the implementation of social distancing measures. We evaluated the immediate effect of COVID-19 on psychiatric emergency and inpatient services in Canada's largest psychiatric hospital in the first month of the pandemic. We extracted data from the electronic medical records of the Center for Addiction and Mental Health in Toronto, Canada. We compared emergency department visits, inpatient occupancy rates, and length of stay in March 2019 and March 2020, and during the first and second half of March 2020. There was a decrease in the number of emergency department visits and inpatient occupancy rates in March 2020 compared to March 2019. There was also a significant decrease in the number of emergency department visits and inpatient occupancy rates in the second half of March 2020 compared to the first half. Our findings suggest that the pandemic was followed by a rapid decrease in the usage of psychiatric emergency and inpatient services in a large mental health hospital. Future studies will need to assess whether this decrease will be followed by a return to baseline or an increase in need for these services.

Changes in Psychiatric Inpatient Service Utilization During the First and Second Waves of the COVID-19 Pandemic

“…The overall PEV reduction of 16% during the first COVID-19 wave and 15% during the second wave was substantial. This reduction, however, was not as extensive as in many other studies (8,13,14). For example, a 27% overall reduction in PEVs was observed at an urban hospital in Ontario (12) and a 56% reduction within 2 months during full lockdown in Italy (8).…”

“…Acute psychiatric services have been affected during the first wave of the pandemic with a reported 13-56% decrease across countries in adult psychiatric emergency room visits (PEVs) (8)(9)(10)(11)(12)(13)(14)(15). A similar decrease in psychiatric admission rates to inpatient services has been reported between 10 and 41% (13,16,17).…”

“…Acute psychiatric services have been affected during the first wave of the pandemic with a reported 13-56% decrease across countries in adult psychiatric emergency room visits (PEVs) (8)(9)(10)(11)(12)(13)(14)(15). A similar decrease in psychiatric admission rates to inpatient services has been reported between 10 and 41% (13,16,17). The decreased rates have not been uniform for all groups and, for example in Sweden, higher rates of admission have been reported during the first wave of the COVID-19 pandemic among patients with psychotic disorders and emotionally unstable personality syndrome (12).…”

COVID-19 and Youth Psychopathological Distress in Umbria, Central Italy: A 2-Year Observational Study in a Real-World Setting

“…Indeed, previous studies highlighted that the number of admissions to psychiatric care facilities showed trends similar to the pre-COVID-19 outbreak period ( 39 ). This result could be due to an adaptation of mental services to give help during the pandemic, especially implementing digital mental health services ( 40 ), while it is in contrast with other findings, e.g., those concerning the decrease of new accesses to psychiatric emergency units ( 41 – 43 ). Based on the stated above, access to care during the COVID-19 emergency should be further investigated since it represents a complex issue that relies on several possible determinants ( 44 ).…”

“Effect of the SARS-COV-2 pandemic outbreak on the emergency department admission for an acute psychiatric condition”

“…A recent large US cross-sectional study extending until October 2020 showed that at the outbreak of the pandemic, visits for mental health conditions increased in proportion to the decline in overall visits in the ED ( Holland et al, 2021 ). In addition, considering only the initial months of the pandemic may not be sufficient to provide definitive indications about the impact of SARS-CoV-2 on acute psychiatric pathology, as it is known how disastrous events can cause an increase in mental health problems not only in the short term but especially in the long term ( Holland et al, 2021 ; Kim et al, 2021 ).…”