TY - JOUR
T1 - Acute mental health presentations before and during the COVID-19 pandemic
AU - Mukadam, Naaheed
AU - Sommerlad, Andrew
AU - Wright, Jessica
AU - Smith, Abigail
AU - Szczap, Aleksandra
AU - Solomou, Solomis
AU - Bhome, Rohan
AU - Thayalan, Roshan
AU - Abrol, Esha
AU - Aref-Adib, Golnar
AU - Maconick, Lucy
AU - Aubrey-Jones, Dominic
AU - Tugrul, Senem
AU - Knowles, Melanie
AU - Menys, Helen
AU - Sathanandan, Shivanthi
AU - Moslehi, Sarah
AU - Huntley, Jonathan
AU - Liu, Kathy
AU - Bazo-Alvarez, Juan Carlos
N1 - Publisher Copyright:
© The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.
PY - 2021/7
Y1 - 2021/7
N2 - Background A number of community based surveys have identified an increase in psychological symptoms and distress but there has been no examination of symptoms at the more severe end of the mental health spectrum. Aims We aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the COVID-19 pandemic. Method We analysed electronic data between January and April 2020 for 2534 patients referred to acute psychiatric services, and tested for differences in patient demographics, symptom severity and use of the Mental Health Act 1983 (MHA), before and after lockdown. We used interrupted time-series analyses to compare trends in emergency department and psychiatric presentations until December 2020. Results There were 22% fewer psychiatric presentations the first week and 48% fewer emergency department presentations in the first month after lockdown initiated. A higher proportion of patients were detained under the MHA (22.2 v. 16.1%) and Mental Capacity Act 2005 (2.2 v. 1.1%) (χ2(2) = 16.3, P < 0.0001), and they experienced a longer duration of symptoms before seeking help from mental health services (χ2(3) = 18.6, P < 0.0001). A higher proportion of patients presented with psychotic symptoms (23.3 v. 17.0%) or delirium (7.0 v. 3.6%), and fewer had self-harm behaviour (43.8 v. 52.0%, χ2(7) = 28.7, P < 0.0001). A higher proportion were admitted to psychiatric in-patient units (22.2 v. 18.3%) (χ2(6) = 42.8, P < 0.0001) after lockdown. Conclusions UK lockdown resulted in fewer psychiatric presentations, but those who presented were more likely to have severe symptoms, be detained under the MHA and be admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID- 19 waves.
AB - Background A number of community based surveys have identified an increase in psychological symptoms and distress but there has been no examination of symptoms at the more severe end of the mental health spectrum. Aims We aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the COVID-19 pandemic. Method We analysed electronic data between January and April 2020 for 2534 patients referred to acute psychiatric services, and tested for differences in patient demographics, symptom severity and use of the Mental Health Act 1983 (MHA), before and after lockdown. We used interrupted time-series analyses to compare trends in emergency department and psychiatric presentations until December 2020. Results There were 22% fewer psychiatric presentations the first week and 48% fewer emergency department presentations in the first month after lockdown initiated. A higher proportion of patients were detained under the MHA (22.2 v. 16.1%) and Mental Capacity Act 2005 (2.2 v. 1.1%) (χ2(2) = 16.3, P < 0.0001), and they experienced a longer duration of symptoms before seeking help from mental health services (χ2(3) = 18.6, P < 0.0001). A higher proportion of patients presented with psychotic symptoms (23.3 v. 17.0%) or delirium (7.0 v. 3.6%), and fewer had self-harm behaviour (43.8 v. 52.0%, χ2(7) = 28.7, P < 0.0001). A higher proportion were admitted to psychiatric in-patient units (22.2 v. 18.3%) (χ2(6) = 42.8, P < 0.0001) after lockdown. Conclusions UK lockdown resulted in fewer psychiatric presentations, but those who presented were more likely to have severe symptoms, be detained under the MHA and be admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID- 19 waves.
KW - community mental health teams
KW - depressive disorders
KW - self-harm
KW - Suicide
UR - http://www.scopus.com/inward/record.url?scp=85117933609&partnerID=8YFLogxK
U2 - 10.1192/bjo.2021.970
DO - 10.1192/bjo.2021.970
M3 - Article
AN - SCOPUS:85117933609
SN - 2056-4724
VL - 7
JO - BJPsych Open
JF - BJPsych Open
IS - 4
ER -