Inpatient Psychiatry During COVID-19: A Systems Perspective

COVID-19 Mitigation Activities in Inpatient Psychiatry Were Associated With Patient-Reported Institutional Betrayal, Changes in Trust, and Fear of Getting Sick

Institutional betrayal occurs when the institutions that people depend on fail to protect them from harm, which was exemplified by a failure to manage COVID-19 risks. Inpatient psychiatry provides a rich context for which to understand the effects of institutional betrayal, and this is amplified in the context of the COVID-19 pandemic. Using a retrospective cohort design, we administered an online survey to former patients (n = 172) of inpatient psychiatry hospitalized at the height of the COVID-19 pandemic (March 2020 to February 2021) to understand the relationship between facilities' use of COVID-19 mitigation activities (ie, offering or requiring face masks, keeping patients and staff 6 feet apart, access to hand sanitizer, use of telemedicine for clinical consults, and routine cleanliness of the unit) and former patients' reports of institutional betrayal, changes in their trust in mental healthcare providers, fear of getting sick, and having contracted or witnessed someone else contract COVID-19. The quantity of COVID-19 mitigation activities was monotonically negatively associated with the probability of reporting any betrayal, the probability of reduced trust in mental healthcare providers, and the probability of being afraid of getting sick always or most of the time while hospitalized. COVID-19 mitigation activities either directly affected these psychological outcomes, or facilities that engaged in robust mitigation had greater cultures of safety and care quality. Additional qualitative work is needed to understand these mechanisms.

A retrospective review of COVID-19 testing and mitigation strategies at a psychiatric hospital and subsequent COVID-19 acquisition

BACKGROUND

Behavioral health settings present increased challenges in preventing the transmission of infectious agents. Characterizing the relative effectiveness of various strategies, including testing for asymptomatic carriage of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, will inform transmission reduction efforts in behavioral health settings.

METHODS

A single-center retrospective study was conducted in an inpatient behavioral health hospital by reviewing COVID-19 mitigation and testing strategies with information collected from discharges between July 1, 2020 and February 28, 2021.

RESULTS

During the study period, there were 3,694 total discharges and 3,229 unique admitted patients, including 86 (2.7%) patients who had positive SARS-CoV-2 polymerase chain reaction test results. Preadmission testing from noncongregate care settings (38, 44.1%), and testing after an in-hospital exposure (27, 31.4%) were the most common indications for testing among patients with a positive test. Up to 29 (33.7%) potentially acquired the infection during their hospitalization. Asymptomatic screening tests identified approximately two-thirds (55, 64.0%) of potentially contagious patients.

CONCLUSION

Asymptomatic screening testing on admission and after exposure and universal masking were strong interventions to prevent SARS-CoV-2 transmission in this investigation Future studies of SARS-CoV-2 and other pathogens in behavioral health settings should endeavor to characterize the effectiveness of infection prevention interventions.

Impact of the COVID-19 pandemic on acute mental health admissions in Croatia

Background

The pandemic of COVID-19 had a profound impact on our community and healthcare system. This study aims to assess the impact of COVID-19 on psychiatric care in Croatia by comparing the number of acute psychiatric cases before coronavirus disease (2017-2019) and during the pandemic (2020-2022).

Materials and methods

The paper is a retrospective, comparative analyzes of the hospital admission rate in Diagnosis Related Group (DRG) classes related to mental diseases, and organic mental disorders caused by alcohol and drug use. This study used DRG data from all acute hospitals in Croatia accredited to provide mental health care services and relevant publicly available data from the Croatian Institute of Public Health (CIPH) and the Croatian Health Insurance Fund (CHIF). All hospital admissions for acute psychiatric patients in Croatia were tracked during both periods under study.

Results

During the pandemic, the average number of all such cases decreased by 28% in secondary and tertiary hospitals, and by 11% in specialist psychiatric hospitals. It was also found that during COVID-19, there was a decrease in case numbers in DRG classes related to major affective disorders and anxiety, alcohol, and drug intoxication (31, 48, 34 and 45%, respectively). However, the same period saw an increase in hospital activity for eating disorders and for involuntary admissions related to schizophrenia and paranoia (30, 34 and 39% respectively). There were no changes in the admission rate for cases related to opioid use.

Conclusion

The COVID-19 pandemic resulted in both a steep decrease in the overall number of psychiatric cases inpatient treatment at mental health facilities and their DRG casemix. Increasing our understanding of how pandemics and isolation affect demand for psychiatric care will help us better plan for future crises and provide more targeted care to this vulnerable group.

Building and Landing the Plane While Flying: How New York State Addressed the Needs of People With Serious Mental Illness During the COVID-19 Pandemic

New York State was the epicenter for COVID-19 in Spring 2020 when little was known about the pandemic. Dire circumstances necessitated New York State’s (NYS) public mental health system to rapidly pivot, adapt, and innovate its policies and procedures to ensure continuous high-level care to individuals with serious mental illness (SMI), a population especially vulnerable to both the physical and psychosocial sequelae of COVID-19. NYS rapidly adopted emergency measures to support community providers, expanded the capacity of its State-Operated facilities, created policies to promote improved infection control access, collaborated to enhance the public–private continuum of service to support people with SMI, and broadened the use of new technologies to ensure continued engagement of care.