Emergency department visits for psychiatric care during the first lockdown in Melbourne

Working alongside next of kin to enhance discharge: A quality improvement collaboration to co-design discharge for mental health patients

OBJECTIVES

Mental health (MH) patients seen in the emergency department (ED) setting are often viewed in isolation, outside of the context of their loved ones, the next of kin (NOK). This is especially problematic when a patient is detained under the mental health act. This project aimed to improve this engagement.

METHODS

A sense of urgency was created from a guiding coalition of the local MH and ED executive of a rural hospital. The vision was communicated to the team for action. This was then institutionally incorporated as best practice during a 3 month trial.

RESULTS

NOK were engaged more frequently as a result of this quality improvement strategy, rising to 90.8% (2021) from 63.2% (2020) compared to the previous year χ2 (1, N=166) =18.75, p = .000015. Admissions for all MH patients from the emergency department fell to 28.3% (2021) from 39% (2020) χ2 (1, N=652) =8.32, p = .0039.

CONCLUSIONS

Working with NOK is a best practice strategy that was embraced by clinicians when highlighted. This resulted in less restrictive practice and more community treatment. Creating a frame for the patient that is standardised, provides containment and co-designs future health care is beneficial.

COVID-19 restrictions and visitations to an Israeli psychiatric emergency department: A four-lockdowns retrospective study

We examine the volume and characteristics of psychiatric ED visitations through a perspective of four COVID-19 lockdowns. All adult visitations to the ED of Shalvata Mental Healthcare center (Israel) during 2020-2021 were retrieved and statistically analysed and data from 2017 to 2019 was considered as control. Voluntary and involuntary ED visitations were considered, separately and combined. We find that the significant decrease in the volume of voluntary ED visitations during the 1st lockdown was quickly overturned, roughly returning to the pre-pandemic state following its conclusion. In parallel, the volume of involuntary ED visitations has dramatically increased, with the most striking levels observed during the second and third lockdowns. Elapsed time since the first occurrence of COVID-19 in Israel and the level of governmental restrictions is significantly associated with the increase in the volume of ED visits and admissions, the admission rate and the rate of involuntary visits. The prolonged consequences associated with the pandemic and the measures taken to control it suggest that it is unreasonable to expect a return to normal ED utilization in the near future. As such, alternatives to strict lockdowns should be favored when possible and urgent strengthening of psychiatric care is warranted.

Rapid review and commentary on the clinical implications of the population mental health consequences of the COVID-19 pandemic in Australia

OBJECTIVE

To provide a rapid clinical review and commentary for psychiatrists on the population mental health consequences of the COVID-19 pandemic in Australia, including evidence-based findings and interventions.

CONCLUSIONS

Whilst there was evidence of collective psychological resilience during the first 2 years of the COVID-19 pandemic, younger women, carers for those with COVID-19, and those with more household chores, childcare needs and higher economic strain, were at more risk. Interventions should therefore target people with these socio-demographic risk factors, as well as severe COVID-19 survivors, their relatives and frontline workers. However, the rapid spread of the Omicron SARS-CoV-2 variant has the potential for greater impacts on population mental health. Innovations in telehealth and online therapy should be incorporated into standard care. Ongoing research is needed to assess who remains most vulnerable to negative mental health impacts of the current pandemic, and especially the longer term outcomes of mental ill health. Further research should also investigate evidence-based approaches to resilience and well-being. Prospective risk/benefit analyses of infection control measures, economic effects and mental health consequences are needed.

Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic

Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020-5/24/2020 "first-wave") and second (9/15/2020-3/1/2021 "second-wave") wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.

Real-world performance of Victorian hospitals during the COVID-19 lockdowns

OBJECTIVE

Victoria has low numbers of general adult psychiatric beds per capita by Australian and international standards. Hospital key performance indicators (KPIs) such as bed occupancy rates, emergency department waiting times and inpatient lengths of stay are proximal measures of the effects any shortfall in beds. We investigate the real-world performance of Victorian hospitals during the first year of the COVID-19 pandemic and the extended lockdowns in 2020.

CONCLUSIONS

The Victorian inpatient psychiatric system is characterised by high bed occupancies in many regions, extended stays in emergency departments awaiting a bed, and short inpatient lengths of stay, except for patients with excessively long stays on acute units (over 35 days) who are unable to be admitted to non-acute facilities. At the end of 2020, bed occupancies were high (above 90%) in 10 regions, with three regions having bed occupancies over 100%. However, state-wide average bed occupancy improved between 2019 (94%) and 2020 (88%). Other KPIs remained steady because acute hospitals did not experience the expected pandemic mental health demand-surge. For a more complete picture of the impact of the pandemic, Australia needs interconnected, centralised data systems.