Urgent Psychiatric Consultations at Mental Health Center during COVID-19 Pandemic: Retrospective Observational Study

Abstract

The coronavirus pandemic and related social distancing measures have brought about dramatic changes in people's lives. In particular, health workers have been forced to change their activities both for the different needs of patients and for preventive measures against the spread of the virus. This study is aimed at comparing the urgent psychiatric consultations (UPC) performed at the outpatient Mental Health Center (MHC) of Modena during the coronavirus outbreak period, from 1 March to 31 August 2020, with the same period in 2019. We retrospectively collected in a database the demographic and clinical characteristics of patients who required UPC in the MHC during the 6-month observation periods in both 2019 and 2020. Data were statistically analyzed. We analyzed 656 urgent psychiatric consultations in 2019 and 811 in 2020, requested by 425 patients in 2019 and 488 in 2020, respectively. In the pandemic period, we observed an increase in the total and daily number of UPC which were more frequently required by patients in care at local outpatient services in comparison with the previous period. During 2020, an increased number of UPC was carried out remotely and the outcome was more frequently represented by discharge at home, avoiding hospitalization as much as possible. In the course of the coronavirus pandemic, MHC had to face an increased demand for clinical activity especially from the most clinically and socially vulnerable patients, who more frequently required UPC in outpatient psychiatric services.

Psychiatric Emergencies During the Covid-19 Pandemic: A 6-Month Observational Study

“…Some of these, in fact, could only be carried out through telephone contact, such as consultancy with one’s nurse of reference, whereas other activities were totally suspended until the end of the state of emergency, such as group activities and semi-residential activities. 34 , 46 In accordance with some recent studies, despite remote interviews and telephone calls, the patient population taken into care by the outpatient services has received less psychological support and psychiatric treatments. 49 Concerns about tele-psychiatry have been expressed by both users and especially by professionals, reporting the loss of personal contact, which can limit the building of therapeutic relationship, although it can represent the only instrument now available to maintain the continuity of care in a regular setting.…”

“… 42 On the other hand, in 2020, we reported the increase of UPCs required by the most vulnerable people due to their clinical and/or social conditions, as suggested by the higher number of people living in psychiatric facilities and already treated in MHC, in line with the results of our previous study implemented in the outpatient Mental Health Center of Modena in the same period. 46 Although apparently in contrast with the general trend of UPCs, these results highlight the greater fragility of patients suffering from psychiatric pathology during pandemic, for whom ER remained the only place where they could ask for help, as suggested by other studies. 12 , 23 , 44 Patients staying at the facilities may have suffered from problems related to “forced coexistence”, 24 hours a day, with other residents due to the inevitably severe lockdown, applied in Italy especially from March to May 2020 to prevent the spread of the virus.…”

“…[41][42][43][44][45] Differently, we observed an increase in the total and daily number of the UPCs performed at the outpatient Mental Health Center of Modena during the coronavirus outbreak period, from 1 March to 31 August 2020, in comparison with the same period in 2019, often required by the most clinically and socially vulnerable patients in care at local outpatient services. 46 The emergency conditions have led the health system to reorganize the Emergency Departments, imposing filter to accesses which, in turn, has reduced all accesses to the emergency rooms other than for COVID-19 infection due to the risk of contagion. This reduction, which appeared in particular in the first month of the pandemic explosion in Italy, March 2020, was therefore an expected result that has been confirmed by another Italian study.…”

The Impact of COVID-19 Pandemic on Psychiatric Emergencies in Two Different Settings: Emergency Room and Community Mental Health Service

“…In particular, a French study reported an approximately 50% decrease in consultations performed for psychiatric emergencies in three different psychiatric centers in Paris, with an increase of consultations for only psychotic disorders in the pandemic period compared to 2019 ( 36 ). The reduction in the number of psychiatric consultations in outpatient services during the first period of 2020 compared with the same period in 2019 was also confirmed by Italian studies ( 37 , 38 ). A German study reports the reduction of psychiatric emergency consultations during March 2020 compared with March 2019, particularly for chronic affective psychiatric disorders ( 32 ).…”

Impact of the first COVID-19 outbreak on mental health service utilisation at a Dutch mental health centre: retrospective observational study

“…However, recent studies of psychiatric emergency contacts show that regular out-patient contacts have decreased in all psychiatric patients since the pandemic, as a result of restricted face-to-face regulations, hinting at an non-selective decrease of admission rate for all psychiatric patients. [44][45][46] Finally, our results cannot be generalised to all other mental healthcare settings because of inherent differences in mental health service provision across the globe.…”