Abstract
The COVID-19 pandemic forced the rapid implementation of changes to practice in mental health services, in particular transitions of care. Care transitions pose a particular threat to patient safety. This study aimed to understand the perspectives of different stakeholders about the impact of temporary changes in practice and policy of mental health transitions as a result of coronavirus disease 2019 (COVID-19) on perceived healthcare quality and safety. Thirty-four participants were interviewed about quality and safety in mental health transitions during May and June 2020 (the end of the first UK national lockdown). Semi-structured remote interviews were conducted to generate in-depth information pertaining to various stakeholders (patients, carers, healthcare professionals and key informants). Results were analysed thematically. The qualitative data highlighted six overarching themes in relation to practice changes: (a) technology-enabled communication; (b) discharge planning and readiness; (c) community support and follow-up; (d) admissions; (e) adapting to new policy and guidelines; (f) health worker safety and well-being. The COVID-19 pandemic exacerbated some quality and safety concerns such as tensions between teams, reduced support in the community and increased threshold for admissions. Also, several improvement interventions previously recommended in the literature, were implemented locally. The practice of mental health transitions has transformed during the COVID-19 pandemic, affecting quality and safety. National policies concerning mental health transitions should concentrate on converting the mostly local and temporary positive changes into sustainable service quality improvements and applying systematic corrective policies to prevent exacerbations of previous quality and safety concerns.
Highlights
The COVID-19 pandemic forced the rapid implementation of changes to practice in mental health services, in particular transitions of care
Our findings suggest that the COVID-19 pandemic (in particular, the first UK lockdown) has enforced major changes in mental healthcare transition practices and policies that have exacerbated existing patient care quality and safety concerns or have highlighted
Providing the resources and the responsibility to local health and care teams to create their own discharge planning policies has led the rapid implementation of interventions that reflected the need of their wards
Summary
The COVID-19 pandemic forced the rapid implementation of changes to practice in mental health services, in particular transitions of care. The coronavirus disease 2019 (COVID-19) pandemic forced the rapid implementation of several practice changes in mental health services in ad hoc ways[9] and amendments in the operationalisation of the Mental Health Act.[10] NHS England and NHS Improvement guidance at the beginning of the pandemic suggested ‘providers may need to make difficult decisions in the context of reduced capacity and increasing demand. These decisions will need to balance clinical need (both mental and physical), patient safety and risk’.11,12. Expedited discharges from mental health services to social/
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