Psychiatric Care Services Research Articles

Clinician Perspectives on Palliative Care for Older Adults With Serious Mental Illnesses: A Multisite Qualitative Study

ObjectivesApproximately 5.5% of the population live with serious mental illnesses (SMI). Older adults with SMI experience a high burden of serious medical illnesses and disparities in advance care planning, symptom management, and caregiver support. The objectives of this study are to explore interdisciplinary clinician perspectives on the palliative care needs of older adults with SMI and serious medical illnesses. Design, setting, and participantsThis qualitative study utilized thematic analysis of semi-structured interviews of interdisciplinary clinicians practicing palliative care, geriatrics, or geriatric/consultation-liaison psychiatry at four hospitals within an urban health system. MeasurementsThemes related to care of older adults with serious mental illness and serious medical illness with respect to clinician experiences, challenges in care, and opportunities to improve care. ResultsThe authors interviewed 45 clinicians. Major themes identified were: (1) Current paradigms of palliative care do not meet the needs of patients with SMI; (2) Clinicians are motivated to care for this population but require more training and interdisciplinary practice; (3) There is a need for structural integration of psychiatric and palliative care services. ConclusionsThe study underscores the inadequacy of current palliative care models in meeting the unique needs of older adults with SMI. Models of integrated psychiatric and serious illness care and enhanced training are needed to improve the delivery of palliative care. Integrated care models and workforce development at the interface of serious illness care and psychiatric have the potential to improve outcomes for this vulnerable population.

Effects of Patient‐Initiated Brief Admissions on Psychiatric Care Consumption in Borderline Personality Disorder: ARegister‐Based Study

ABSTRACTPrevious studies have reported that patients with borderline personality disorder (BPD) often have negative experiences in psychiatric inpatient care. To address this issue, a novel intervention known as patient‐initiated brief admission (PIBA) has been developed. PIBA offers a constructive approach to crisis management in situations of heightened anxiety, as well as during instances of self‐harm and suicidal ideation. The intervention allows patients to directly contact the psychiatric ward to initiate a brief admission lasting 1–3 days. This easily accessible care option during a crisis has the potential to prevent harm to the patient and reduce the need for prolonged hospital stays. The aim of the present study is to investigate the effects of PIBA on psychiatric care consumption among patients diagnosed with BPD. This retrospective register‐based study includes data from both inpatient and outpatient care registries for patients diagnosed with BPD. Data were extracted from the National Board of Health and Welfare in Sweden. The study period encompasses 2013–2020, with the PIBA intervention occurring between 2016 and 2019. The sample included 107 patients in the PIBA group and 5659 matched controls. Data were analysed using a difference‐in‐differences (DiD) approach through ordinary least squares (OLS) regression and ordinal logistic regression. Throughout the 3‐year follow‐up, both groups exhibited a reduction in the number of days of utilisation of psychiatric inpatient care services. The DiD analysis indicated an additional decrease of 1.5 days at the 6‐month mark for the PIBA group (β = −1.436, SE = 1.531), expanding to 3 days fewer at the 12‐month follow‐up (β = −3.590, SE = 3.546), although not statistically significant. For outpatient care, the PIBA group displayed an increase in the number of visits, averaging to half a visit more every 6 months (β = 0.503, SE = 0.263) compared with the controls. Statistically significant differences were observed for two out of six measurements at the 12‐month (β = 0.960, SE = 0.456) and 18‐month follow‐up period (β = 0.436, SE = 0.219). The PIBA group had a statistically significant lower odds of experiencing extended lengths of inpatient care days after the index date than the controls (OR 0.56, 95% CI: 0.44–0.72). In conclusion, PIBA was associated with a significant reduction in the length of individual hospital stays, but not in the overall number of inpatient care days. PIBA may be linked to a shift from longer inpatient care utilisation to outpatient care utilisation. These findings suggest that PIBA may reduce the risk of prolonged hospitalisations for patients who have access to the intervention. Future research should explore the impact of PIBA on healthcare costs and cost‐effectiveness, both in relation to health care for the individual and cost‐effectiveness in relation to recovery and health.

Suicidal behavior in homeless population and its relationship with experienced aggressions: A seven-year longitudinal study.

IntroductionSuicide is a serious and complex public health issue that affects millions of people worldwide. Among the most vulnerable populations are homeless individuals (HIs), whose suicide rate is significantly higher than that of the general population.ObjectivesThe aim of this study was to analyze mortality and suicidal behavior in a cohort of HIs during a seven-year follow-up. Additionally, the study sought to identify variables linked to mortality in this population.MethodsThe study was conducted in the province of Girona, Spain, and included 154 HIs who were literally experiencing homelessness. Self-report questionnaires were used to gather sociodemographic data, assess suicide risk, and measure the severity of substance dependence. The follow-up was carried out between 2015 and 2022, collecting data on mortality, suicide attempts, episodes of overdose, and violence experienced from public health services (psychiatric and primary health care services).Results During the seven-year follow-up, 23 individuals (14.3% of the sample) passed away, with an average age at the time of death of 52.6 years. The main causes of death were cancer, suicide (excluding overdose), and accidental overdose. Methods used for suicide included drug overdose, jumping, and vein slashing. All deceased individuals had scores above the threshold on the Plutchik Suicide Risk Scale and had reported previous suicide attempts.Individuals who experienced violence during the follow-up period exhibited more severe suicidal ideation, more suicide attempts, and more non-lethal overdose episodes. Substance dependence, particularly cocaine dependence and dual pathology, was significantly associated with higher mortality.ConclusionsThis study reveals a high mortality rate among HIs, especially due to suicide and accidental overdose. The most significant variables related to mortality were suicidal ideation, the number of previous non-lethal overdoses, and substance use disorders, with cocaine dependence being prominent. The results underscore the need for specific prevention and treatment programs to address suicide risk factors and improve the mental health of homeless individuals. The importance of conducting interventions in specialized centers that detect and address suicide risk in this vulnerable population is also emphasized.Disclosure of InterestNone Declared

Tensions and change in liminal spaces – Young people in Swedish out-of-home care

The objective of this paper is to further the understanding of young people’s experiences of out-of-home care (OHC). The focus will be on the tension between negative and positive experiences of OHC, refracted through the concept of liminality. The study is based on semi-structured interviews with 10 young people aged 15–22 (7 women, 3 men) with long-term contact with social services and psychiatric care. OHC can be experienced as a liminal space in both a negative and a positive sense. It is negative when perceived as containment rather than meaningful treatment. It can also be a negative experience when connected to fear, a lack of influence, and uncertainty in terms of being in between the social services and psychiatric care. It is positive when it is perceived as a turning point that enables positive change. It is then connected to feelings of meaningfulness, being respected, hope, and empowerment. The young people participating in the study also connect their experiences of OHC to a context of greater austerity in the welfare state. They reflect upon the benfits of OHC in terms of costs for society, but also the costs for the young person if the OHC is not perceived as meaningful support leading towards positive change. The participants have complex, interrelated needs and problems, and they also experience institutional gaps between psychiatric care and social services. It is important to overcome these gaps, so that young people are not located in ‘in-between spaces’ in terms of service provision.

Оценка взглядов медицинского персонала на эффективность оказания психиатрической помощи в Московской области.

Relevance. The reorganization and modernization of the psychiatric service in Moscow (from 2010) and in Moscow region (from 2021) was carried out. The reforms were carried out in accordance with WHO regulations and consisted in reducing the medical care provided in a hospital setting and expanding the outpatient link. Aim. Asessing the perceptions of employees on the effectiveness of providing assistance in the profile of “psychiatry” in the Moscow region after its restructuring. Methods. An anonymous survey of employees of the psychiatric service in the Moscow region was conducted regarding the transformations carried out (N=236). Results and discussions. The reforms have been positively assessed by the healthcare workers interviewed. According to them, the provision and equipment of clinics with modern examination methods and equipment has improved. The reorganization has led to a better quality of medical care and accessibility at the local level, the number of beds in day hospitals has increased and the conditions of patients’ stay in medical organizations improved. Existing protocols for the provision of mental health services to the public need to be regularly updated, as most respondents indicated. Also, as mentioned by interviewees, both the psychiatric care service as a whole and psychiatric care in a hospital separately needed an increase in funding. In the course of the study, respondents noted that further modernization of the psychiatric service should primarily be carried out in the following areas: unification into a single complex of a psychoneurological dispensary and a psychiatric hospital, expansion of the volume of outpatient care, development and improvement of coordination between general somatic care and help in the “psychiatry” profile, development of medical care based on general somatic hospitals. Conclusion. The majority of respondents positively assessed the reforms carried out in the Moscow region in the field of assistance in the profile of “psychiatry”. Further modernization of the psychiatric service should include the development and improvement of coordination between general somatic care and assistance in the “psychiatry” profile, the expansion of the volume of outpatient care, the best use of resources based on the needs of the population.

Operation of Mental Health Centres (CZP) in Poland during the SARS-CoV-2 pandemic.

The aim of the study is to characterise the changes in the operation of the Mental Health Centers (CZPs) in Poland during the SARS-CoV-2 pandemic. Changing the concept of psychiatric care and moving towards a community model under the CZPs is, inter alia, no need to present and implement strictly defined schedules by service providers, which allows to respond to the current needs of patients and allows for the adaptation of the conditions and methods of providing psychiatric care services in Poland during pandemic. On the basis of the experiences from the pandemic period, recommendations were presented the aim of which is improving work organisation of the CZPs in Poland. A new map of mental health services' organisation following the peak of the pandemic in Poland is urgently needed. Well-functioning community care fosters good understanding of patients' needs, which means that even in a situation of, for instance, there is no element of surprise and there are known channels and methods of reacting to an emergency situation. The pilot CZPs quickly and easily adapted their response methods to the changing or new needs/new circumstances. As part of the activities in the field of psychiatric care reforms in Poland, it seems appropriate, at the present stage, to use all observations and information on the operation and organisation of work of entities that were included during pandemic in the CZP pilot programme in order to continuously improve the functioning of a new model of mental healthcare.

Soothing spaces and techniques in psychiatry

The development of alternatives to seclusion and restraint is a priority for psychiatric care services. Among them, the implementation of soothing spaces is currently experiencing considerable growth.

Involuntary psychiatric treatment during the COVID-19 pandemic. An international qualitative study.

During the COVID-19 pandemic, studies report that in the first few months of the lockdown there was a decrease in requests for mandatory psychiatric treatment, while, in contrast, following the second wave, the number of cases increased. This study investigates the use of compulsory psychiatric treatments internationally in the first and subsequent phases of the pandemic. Sixteen key people were interviewed: eight mental health care professionals and eight scholars in Italy, Greece, China and Chile. Participants were asked to discuss their experience of the motivations, diagnoses and management of patients undergoing an involuntary psychiatric hospitalization. The analysis through Grounded Theory highlighted four themes: (a) the culture of psychiatric care services, (b) the effect of the pandemic on involuntary hospitalizations, (c) exceptional management of hospitalization, and (d) policies and suggestions for more inclusive mental health treatments. During the first wave, respondents reported a decrease in the use of involuntary treatments, while a gradual increase was seen in the following months. Italy extended compulsory psychiatric treatment to a group of new users, including young people and adolescents with acute crises; in other contexts, the main users are chronic psychiatric patients.

Association between participation in the Northern Finland Birth Cohort 1966 study and use of psychiatric care services.

In most population-based epidemiological follow-up studies the aim is not to intervene in the life of the participants. Although the idea is not to intervene, being a member of the longitudinal follow-up study and studies conducted during follow-up may affect the target population. A population-based study including mental health enquiries might reduce the unmet need for psychiatric treatment by motivating people to seek treatment for their psychiatric ill-health. We examined the use of psychiatric care services in the population born in the year 1966 in Northern Finland, of whom 96.3% are participants in the prospective Northern Finland Birth Cohort 1966 (NFBC1966). As a study cohort we used people born in 1966 in Northern Finland (n = 11 447). The comparison cohort included all the people born in the years 1965 and 1967 in the same geographical area (n = 23 339). The follow-up period was from age 10 to 50 years. The outcome measure was the use of psychiatric care services, which was analysed using Cox Proportional Hazard regression and Zero-Truncated Negative Binomial Regression. People born in 1966 in Northern Finland did not differ from those born in 1965 and 1967 in terms of the outcome measure. We found no association between participation in an epidemiological follow-up study and the use of psychiatric care services. The NFBC1966 may be regarded as a representative at the population level in terms of psychiatric outcomes despite the personal follow-up of the birth cohort. The associations of participation in epidemiological follow-up studies have previously been under-examined, and the results need to be replicated.

TELEPSICHOLOGYY AND OTHER CUTTING-EDGE TECHNOLOGIES IN COVID-19 PANDEMIC: BRIDGING THE DISTANCE IN MENTAL HEALTH ASSISTANCE

IntroductionBackground: At the end of 2019, a novel coronavirus (COVID-19) was identified in China. The high potential of human-to-human transmission led to subsequent COVID-19 global pandemic. Public health strategies, including reduced social contact and lockdown have been adopted in many countries. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, resulting in loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines a relevant obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare.ObjectivesIn this paper, we discuss the potential role of Telepsichologyy (TP) and other cutting-edge technologies in the management of mental health assistance.MethodsWe narratively review the literature to examine the advantages and risks related to the extensive application of these new therapeutic settings, along with the possible limitations and ethical concerns.ResultsTelemental health services may be particularly flexible and appropriate for the support of patients, family members and healthcare providers during this COVID-19 pandemic. The integration of TP with other technological innovations (eg, mobile apps, virtual reality, big data and artificial intelligence (AI)) opens up interesting future perspectives for the improvement of mental health assistance.ConclusionsTelepsichologyy is a promising and growing way to deliver mental health services; but it is still underused. The COVID-19 pandemic may serve as an opportunity to introduce and promote, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.Disclosure of InterestNone Declared

Quality in Psychiatric Care in the Community Mental Health Setting from the Perspective of Patients and Staff.

The current paradigm of mental health care focuses on care provided in the community, increasingly moving away from hospital care models that involve considerable economic burden. Patient and staff perspectives on the quality of psychiatric care can highlight strengths and areas for improvement to ensure better care provision. The aim of this study was to describe and compare perceptions of quality of care among patients and staff in community mental health services and to determine possible relationships between these perceptions and other study variables. A comparative cross-sectional descriptive study was conducted in a sample of 200 patients and 260 staff from community psychiatric care services in the area of Barcelona (Spain). The results showed high overall levels of quality of care from patient (m = 104.35 ± 13.57) and staff (m =102.06 ± 8.80) perspectives. Patients and staff both gave high scores to Encounter and Support factors, while factors concerning patient Participation and Environment received the lowest scores. Continuous assessment of the quality of psychiatric care in the community setting is essential to ensure the highest quality of care, taking the perspectives of those involved into account.

Association between continuity of care and treatment outcomes in psychiatric patients in Germany: a prospective cohort study

BackgroundContinuity of care is considered an important treatment aspect of psychiatric disorders, as it often involves long-lasting or recurrent episodes with psychosocial treatment aspects. We investigated in two psychiatric hospitals in Germany whether the positive effects of relational continuity of care on symptom severity, social functioning, and quality of life, which have been demonstrated in different countries, can also be achieved in German psychiatric care.MethodsProspective cohort study with a 20-months observation period comparing 158 patients with higher and 165 Patients with lower degree of continuity of care of two psychiatric hospitals. Patients were surveyed at three points in time (10 and 20 months after baseline) using validated questionnaires (CGI Clinical Global Impression rating scales, GAF Global Assessment of Functioning scale, EQ-VAS Euro Quality of Life) and patient clinical record data. Statistical analyses with analyses of variance with repeated measurements of 162 patients for the association between the patient- (EQ-VAS) or observer-rated (CGI, GAF) outcome measures and continuity of care as between-subject factor controlling for age, sex, migration background, main psychiatric diagnosis group, duration of disease, and hospital as independent variables.ResultsHigher continuity of care reduced significantly the symptom severity with a medium effect size (p 0.036, eta 0.064) and increased significantly social functioning with a medium effect size (p 0.023, eta 0.076) and quality of life but not significantly and with only a small effect size (p 0.092, eta 0.022). The analyses of variance suggest a time-independent effect of continuity of care. The duration of psychiatric disease, a migration background, and the hospital affected the outcome measures independent of continuity of care.ConclusionOur results support continuity of care as a favorable clinical aspect in psychiatric patient treatment and encourage mental health care services to consider health service delivery structures that increase continuity of care in the psychiatric patient treatment course. In psychiatric health care services research patients’ motives as well as methodological reasons for non-participation remain considerable potential sources for bias.Trial registrationThis prospective cohort study was not registered as a clinical intervention study because no intervention was part of the study, neither on the patient level nor the system level.

Being a caregiver in the management of chronic mental illness: A phenomenological qualitative research

Research aim/problem: This research was performed to evaluate the caring experiences of caregivers’ of individuals diagnosed mental illness. Method: This qualitative study was performed with 13 caregivers who care for individuals who had chronic mental illness at inpatient units and community mental health center of a hospital serving in the Aegean Region of Turkey. The data collection process was performed by introductory form, semi-structured interview forms were used during interviews as face-to-face in-depth interviews. Results: The sample population was comprised of 13 caregivers. The participants’ average age was 45.6 (min: 29–max: 62), of which 5 were single, 8 were women, 2 had a graduate degree, 8 had children. Participants had an average of 10 years of caring period (min: 3- max:22) and %61.5 had a support during a patient care. According to the results, five themes were determined related to experiences of caregivers. Themes were “difficulties related to caring, experiences related to social life, experiences related to emotional issues, positive aspects and experiences related to family matters”. Subthemes of this study were controlling behaviors, treatment follow up, controlling disease symptoms, planning future, stigmatization, restrictions on social life, emotional expression, ambivalant emotion, crisis management, sharing similar experiences, effectiveness of education, family support, daily routines, family roles. Conclusion: In this research, difficulties of the caregiving process are management of emotional and behavioral problems, maintaining treatment, stigma, social limitations, changes in family dynamics ve concerns about the future. Educational activities and sharing similar experiences with other caregivers were determined as positive experiences. Supporting caregivers in chronic mental illnesses can improve care quality by reducing the burden of care. It is important to plan effective interventions for caregivers, to implement psychoeducational programs and to provide home psychiatric care services.

The Concept of Recovery – a Contribution to the Development of Community Mental Health Services

Mental health, along with physical and social well-being, constitutes the general health of an individual, and it is considered that there is no health without mental health. According to the dual model of mental health, the mental state of an individual does not depend solely on the presence of a diagnosis of mental illness, but also on the subjective feeling of well-being. This means that a person with a mental disorder or illness can have good mental health and vice versa. New approaches in the protection of mental health and the treatment of people with mental illnesses are based on the principles of empowerment, recovery, social inclusion, human rights, multidisciplinarity and multisectoral cooperation. The aim of this paper is to present the concept of recovery of people with mental health problems, starting from a holistic understanding of mental health. Recovery is understood as a process that involves an individual who has hope and is aimed at overcoming psychological suffering, but also experts who shape and conduct their professional procedures with the aim of creating conditions for increasing the well-being and productivity of the individual. Also, the approach to recovery is incorporated into the development and organization of modern Community mental health care services. Under this aspect, the paper will present the development of psychiatric care and Community mental health services on the example of Centers for mental health in Bosnia and Herzegovina. Despite the knowledge and clear documents that focus on mental health care and support services for everyone in the community, there are significant challenges in implementing that type of mental health care system.

Biographical Study with Hermeneutic Approach in Psychiatric Care Delivered at Community Mental Health Centers

When the literature studies on the services provided in community mental health centers (CMHCs) are carefully evaluated, it is seen that there are research results with positive feedback. On the other hand, a structured daily work standard has not yet been reached regarding the psychiatric care services provided in the increasing number of centers. In order to establish such a standardized work, there is a need for nurses to carry different approaches to the services they provide to sick individuals to their practice areas. Biography study, which can be defined in general terms as the use of the possibilities available to the individual in the process of coping with the events affecting his/her life, is compatible with the need for the formation of community mental health centers and the understanding of multidisciplinary work as such an application area. In this article, the introduction of biography work, its transfer to psychiatric care practice services in CMHC and the interpretation of the individual's life story narrative with a hermeneutic approach are discussed.

Advanced Nursing Practice (ANP) in the practice of mental health nursing in Germany: A phenomenological study

Advanced Nursing Practice (ANP) in the practice of mental health nursing in Germany: A phenomenological study Abstract. Background: The wide variety and constantly changing selection of offered psychiatric care services, in combination with the demand for high quality nursing practice supports the integration of Advanced Practice Nurses (APN). The literature presents a multifaceted picture of APNs working in psychiatric services. Individually chosen emphasis was especially prevalent in the field of care. Gaps in research persist concerning the clinical scope of responsibility. Aim: How does the ANP phenomenon find expression in German clinical psychiatric practice? Method: The dataset comprises problem-focused interviews with three expert APNs from different hospitals. The interviews took place between April and October 2019. Applied phenomenology was used to analyze and interpret the dataset. Results: Soft skills and clinical leadership are pivotal competencies for APNs to perform efficiently in clinical practice. Profound life and work experience are key factors in terms of impact. Conclusions: To perform efficiently, APNs require professional and methodological knowledge at a master's level, profound soft skills as well as clinical leadership expertise. Higher education and further curricular training are required. Establishing APNs in clinical psychiatric practice depends primarily on the decisions of managers in nursing. The management of nursing needs to adopt new care structures that allow APNs to implement their qualifications in the psychiatric care system.

Integrated Health and Social Services for People With Chronic Mental Health Problems: People Are More Important Than Processes. Insights From a Multiple Case Study in Swedish Psychiatry.

Three mental health organizations, one merged with, one formally cooperating with, and one without formal links to social services were analyzed through the experience of staff, patients and relatives in order to elucidate what approaches best promoted service coordination. Seventeen staff and eight patients or relatives, recruited from the three organizations, participated in semi-structured interviews, guided by pre-selected categories derived from previous research about coordination and care processes. Directed content analysis was used to identify and categorize meaning units. Both staff and patients raised the same concerns. Organized collaboration between psychiatric care and social services addressed only some of patients' challenges. More important was patient access to financial and social assistance. The organizational arrangements were not referred to, whereas case management was seen as crucial. In many instances relatives have to act as case managers. Service integration in mental health has to include, in addition to social services, other authorities like social insurance and employment agencies. A case manager knowledgeable about all welfare services is best positioned to promote that “extended integration”. Relatives often have to take this responsibility to support this fragile group of patients. This observed importance of case management is supported by previous research in mental health and primary care. The role of relatives should be acknowledged and supported by those services.

Effects of the COVID-19 Pandemic on Patients with Schizophrenia Spectrum Disorders

Objective: To evaluate the mental health of patients with schizophrenia spectrum disorders with the prolongation of the pandemic. Materials and Methods: This descriptive cross-sectional study was conducted between August-October 2020. Fifty-two patients with schizophrenia spectrum disorders who were hospitalized prior to the onset of the pandemic between March 2019-March 2020 at the inpatient clinic were reassessed during the pandemic. The Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression-Severity (CGI-S) Scale, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Fear of COVID-19 Scale were used to evaluate psychopathology during the pandemic. The PANSS and the CGI severity scores at discharge from the inpatient clinic for each patient were obtained from the medical records review for comparison along with sociodemographic variables. Results: A total of 34 patients, 33 with schizophrenia (97.1%) and 1 with schizoaffective disorder (2.9%) were included. There was no significant difference between the pre- and during the pandemic assessments in the PANSS total and the CGI severity scores. The PANSS total, the CGI, HAM-D, HAM-A and the Fear of COVID-19 scale scores, medical comorbidity and utilization of psychiatric health care services were significantly higher in patients who reported subjectively increased psychiatric symptoms during the pandemic. There was no significant difference in the change of PANSS total and CGI scores between the two groups. Fear of COVID-19 Scale and HAM-A scores were correlated positively. Conclusion: During pandemic increase in psychiatric symptoms may be related not only to psychosis but also depression, anxiety. According to the results of patients who reported subjectively increased psychiatric symptoms during the pandemic, while the psychotic symptoms did not worsen during the pandemic, patients with higher anxiety or depression scores reported an increase in their symptoms and were more likely to seek help.

An Audit of Adherence to the Pre-Referral Process for Acute Inpatient Admissions in a Male and a Female Acute Inpatient Unit Over Six Months in Birmingham and Solihull Mental Health Foundation Trust (BSMHFT)

AimsIn view of the limited number of acute inpatient beds relative to demand in England, a thorough assessment prior to referral is paramount in ascertaining clinical need. A comprehensive risk assessment is crucial in light of patient safety and assessing risk to others. Moreover, the appropriateness of an acute bed should be considered, and whether psychiatric intensive care or forensic services may be more appropriate for the patient. In line with this, the Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) admissions policy details standards of the assessment prior to referral to acute inpatient services. Pre-referral assessment should be carried out by a multidisciplinary team including a senior doctor. It should include rationale and plan of care for admission, risk assessment and section status on admission alongside type of bed being requested. Referrals are accepted from multiple teams including Home Treatment, the Place of Safety and Liaison Psychiatry. Aim: To audit adherence to the pre-referral policy for acute inpatient admissions to a male and female ward in BSMHFT, including comprehensive assessment, plan of care and consideration of appropriate bed type.MethodsA retrospective audit of pre-referral documentation for all admissions from April to September 2019 to a male and separate female acute inpatient unit at the Zinnia Centre, Birmingham was carried out. This included 83 male admissions and 82 female admissions. Documentation was reviewed on the clinical system Rio. Parameters reviewed included assessing clinician, assessment summary, capacity assessment, consideration of bed type, plan of care and section details.ResultsOverall, almost half of admissions (49%) were assessed by a full Mental Health Act team, 34% by a senior psychiatric doctor and the remainder by psychiatric nurses in the referring department. An up-to-date assessment summary was completed in the majority of cases (67%) prior to referral. Risk assessments were completed in 82% of cases. 35% of cases included a detailed plan of care which met audit standards. Capacity assessment alongside outcome was documented in 13% of cases. The type of bed was only considered in 13% of cases.ConclusionWhilst assessment and risk documentation was completed in the majority of cases, few cases had a clear plan of care and appropriateness of bed type was rarely considered in assessment. Greater adherence to the pre-referral process could facilitate treatment decisions during admission and seek to ensure a safer inpatient environment.

Tunisian’s largest Psychiatric emergency department in the context of the COVID-19 lockdown

IntroductionGeneral Lockdown was first declared in Tunisia from March 20th to May 4th 2020 to contain the spread of COVID19 pandemic, the last sanitary lockdown period was declared from July 12th to august 1st in 2021. Psychiatric emergency access and consultation has been affected by the confinement. RAZI Hospital Emergency Department (RHED) is the only emergency department in Tunisia specialized in psychiatry. Thus making it the most representative psychiatric emergency health care service in Tunisia.ObjectivesTo assess changes in patients flow and admission rates in RHED in the context of the COVID-19 lockdownMethodsWe examined emergency room records and the hospital’s computer admission database during the first and the last COVID19 lockdowns and compared it to the same period of the previous year.ResultsThe number of consultations was significantly lower in 2020 lockdown (N = 577) compared the same period in 2019 (N = 1525) (p<10−3). We observed a drop in RHED emergency hospitalization rate from 45.57% to 29.81% during this study period. The number of consultations per day was significantly lower during the first lockdown (N= 12.44) compared to the last lockdown (N=26.61) (p<10−3), the hospitalization rate rose from 29.81% during the first lockdown to 44.36% during the last.ConclusionsFear of COVID19 contamination and lockdown limitation had a huge impact on RHED visits and admissions. Medical team had to adjust in order to prevent further delay in acute psychiatric care.DisclosureNo significant relationships.