Emergency Mental Health Services Research Articles

Non-suicidal self-injury at a Canadian paediatric emergency department.

Our primary objective was to determine agreement between non-suicidal self-injury recorded at triage and during subsequent mental health assessment. The secondary objective was to describe patients who reported non-suicidal self-injury. This is a health records review of patients aged 12-18years who had an Emergency Mental Health Triage form on their health record from an ED visit June 1, 2017-May 31, 2018. We excluded patients with diagnoses of autism spectrum disorder or schizophrenia. We abstracted data from the Mental Health Triage form, Emergency Mental Health and Addictions Service Assessment forms and Assessment of Suicide and Risk Inventory. We calculated Cohen's Kappa coefficient, sensitivity, and negative predictive value to describe the extent to which the forms agreed and the performance of triage for identifying non-suicidal self-injury. We compared the cohort who reported non-suicidal self-injury with those who did not, using t-tests, Wilcoxon rank-sum tests, and chi-square tests. We screened 955 ED visits and included 914 ED visits where 558 (58.4%) reported a history of non-suicidal self-injury. There were significantly more females in the group reporting non-suicidal self-injury (82.1%, n = 458) compared to the group not reporting non-suicidal self-injury (45.8%, n = 163). Patients reporting non-suicidal self-injury did so in triage and detailed Mental Health Assessment 64.7% of the time (Cohen's Kappa Coefficient 0.6); triage had sensitivity of 71.5% (95% CI 67.3-75.4) and negative predictive value of 71.2% (95% CI 68.2-74.0). Cutting was the most common method of non-suicidal self-injury (80.3%). Screening at triage was moderately effective in identifying non-suicidal self-injury compared to a detailed assessment by a specialised mental health team. More than half of children and adolescents with a mental health-related concern in our ED reported a history of non-suicidal self-injury, most of which were female. This symptom is important for delineating patients' coping strategies.

Comorbidities, healthcare use, and contact with healthcare transition services in older veterans after incarceration.

The Health Care for Reentry Veterans (HCRV) program was established to support community reintegration for veterans after incarceration. Yet, it is unclear how those with and without HCRV contact differ. We sought to evaluate differences in medical and psychiatric conditions and healthcare utilization among mid-to late-life reentry veterans who did and did not receive HCRV outreach. Study participants were veterans aged ≥50 years who qualified for Medicare fee-for-service, had experienced incarceration for ≥1 year, and were released from incarceration between October 1, 2006, and September 30, 2018 (N = 9733). Using VA and Medicare claims data, we compared prevalence of medical and psychiatric diagnoses, and use of emergency, inpatient, and outpatient medical and mental health services up to 12 months after release between those with and without HCRV contact. Veterans with HCRV contact (35.5%) had significantly higher rates of psychiatric conditions and medical conditions related to substance use (e.g., liver disease) compared to veterans without HCRV contact. Average time between release and first healthcare service use was significantly lower for HCRV veterans (36.5 ± SD 59.5 days) versus non-HCRV veterans (58.9 ± SD 77.5 days) and HCRV veterans were more likely to utilize the emergency department, inpatient and outpatient mental health services, and inpatient medical services. HCRV reaches older reentry veterans with a large burden of mental health and substance use disorders. However, levels of multimorbidity were high among all older reentry veterans, pointing to a need to develop specialized geriatric models of care for this reentry population.

Associations between humiliation, shame, self-harm and suicidality among adolescents and young adults: A systematic review.

Suicide is the second leading cause of death among young people worldwide. Research indicates that negative social contexts involving familial and peer relationships have far-reaching influences on levels of suicidality in later life. While previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent suicidality, this systematic review examines the prevalence of, and association between the processes of humiliation and shame in later self-harm, suicidal ideation, and suicide among adolescents and young adults. A systematic literature search of databases including MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase was conducted to identify potential studies. ProQuest was searched to identify relevant grey literature research. A combination of MESH terms and keywords was used. All original quantitative studies published in English that examined the prevalence, or association between humiliation or shame and suicidal behaviours and/or death by suicide were included. Studies were assessed for methodological quality using Joanna Briggs Institute critical appraisal tools. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843]. Narrative synthesis was performed. A total of 33 studies reporting the prevalence of, or association between humiliation (n = 10) or shame (n = 23) and suicidal thoughts/behaviours were included. The prevalence of humiliation among those with any suicidality ranged from 18% to 28.1%, excluding an outlier (67.1%), with two studies presenting a significant association between humiliation and self-harm in their fully adjusted analyses. The studies that outlined humiliation and suicidal thinking (intent/suicide plan) had no association after adjustment for confounders. For shame, half of the studies found an association in adjusted models (n = 10), and this was evident for both suicidal ideation and self-harm. To our knowledge, this is the first study to attempt a systematic review on this topic. The dearth of research in this field of enquiry is reflective of unique challenges associated with assessments of humiliation and shame in various clinical settings amongst adolescent and young adult populations. Nonetheless, given the importance and relevance of the psychological imprint of humiliation in youth morbidity and mortality in the field of mental health, it is timely to attempt such a systematic review. In light of the associated role of humiliation and shame in self-harm and suicidality among young people, we recommend that these processes need to be explored further via prospective studies and assessed as part of a comprehensive bio-psycho-social assessment when focusing on life stressors for adolescent and young adults presenting with suicidality to emergency departments and mental health services.

Management of pediatric emergencies during natural disasters: The 2023 earthquake in Turkey

The earthquake that occurred in the southeastern region of Türkiye on February 6, 2023 resulted in extensive destruction, affecting 11 provinces and causing a death toll of almost 50,000 individuals. This review emphasizes the unique vulnerabilities that children face in the aftermath of earthquakes and stresses the significance of having preparedness plans specifically tailored to their needs. It is crucial to provide immediate emotional support to children and help them restore their normal routines in order to ensure their well-being. Additionally, emergency nutrition care and mental health services play a vital role in maintaining their long-term health. The disruption of healthcare services also increases the risk of infectious diseases, underscoring the urgency of vaccination efforts. It is crucial that healthcare providers should undergo training and collaborate with each other to adopt a comprehensive approach to pediatric disaster care.

Using machine learning to mine mental health diagnostic groups from emergency department presentations before and during the COVID-19 pandemic

PurposeThe COVID-19 pandemic had a profound negative effect on mental health worldwide. The hospital emergency department plays a pivotal role in responding to mental health crises. Understanding data trends relating to hospital emergency department usage is beneficial for service planning, particularly around preparing for future pandemics. Machine learning has been used to mine large volumes of unstructured data to extract meaningful data in relation to mental health presentations. This study aims to analyse trends in five mental health-related presentations to an emergency department before and during, the COVID-19 pandemic.MethodsData from 690,514 presentations to two Australian, public hospital emergency departments between April 2019 to February 2022 were assessed. A machine learning-based framework, Mining Emergency Department Records, Evolutionary Algorithm Data Search (MEDREADS), was used to identify suicidality, psychosis, mania, eating disorder, and substance use.ResultsWhile the mental health-related presentations to the emergency department increased during the COVID-19 pandemic compared to pre-pandemic levels, the proportion of mental health presentations relative to the total emergency department presentations decreased. Several troughs in presentation frequency were identified across the pandemic period, which occurred consistently during the public health lockdown and restriction periods.ConclusionThis study implemented novel machine learning techniques to analyse mental health presentations to an emergency department during the COVID-19 pandemic. Results inform understanding of the use of emergency mental health services during the pandemic, and highlight opportunities to further investigate patterns in presentation.

Peer support for discharge from inpatient to community mental health care: the ENRICH research programme

Peer support for discharge from inpatient to community mental health care: the ENRICH research programme

Dissociative symptoms among community health service users in Hong Kong: a longitudinal study of clinical course and consequences

ABSTRACT Background: Previous studies have demonstrated the high prevalence of dissociative symptoms and their association with considerable healthcare costs. However, there is a lack of studies that describe whether dissociative symptoms persist and lead to other clinical outcomes over time in the community. Objectives: This study investigated the persistence, predictors, and consequences of dissociative symptoms in the community. Methods: We analyzed longitudinal data in a sample of community health service users in Hong Kong (N = 173). Results: A relatively high proportion (63.6%) of participants with baseline dissociative symptoms continued to exhibit dissociative symptoms after approximately 9 months. Baseline non-betrayal trauma predicted subsequent dissociative symptoms (β = .141, p = .024). Participants with baseline dissociative symptoms were more likely to have received subsequent emergency mental health services (9.1% vs 0.7%, p = .005). Baseline dissociative symptoms significantly predicted subsequent post-traumatic symptoms (β = .165 to .191, p < .05) and difficulty in social and occupational participation (β = −.152 to −.182, p < .05) even after controlling for baseline scores, trauma exposure, and use of professional support. The predictive role of dissociative symptoms on subsequent disturbances in self-organization symptoms and social participation difficulty remained significant after applying the Bonferroni correction. Conclusions: This is one of the very few studies showing that dissociative symptoms are persistent to a certain degree and could predict other symptoms and subsequent impairments even in community settings. Factors that affect the trajectory of dissociative symptoms should be further investigated. Regular screening for dissociative symptoms is recommended. Considering its prevalence, persistence, and clinical and social consequences, dissociation should be given greater public health attention.

A scoping review of trauma informed approaches in acute, crisis, emergency, and residential mental health care

Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes.We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included.Most studies (n = 23) were conducted in the USA and were based in acute mental health services (n = 16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n = 7) and the Sanctuary Model (n = 6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively.TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps.

National Trends in Mental Health–Related Emergency Department Visits Among Youth, 2011-2020

There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.

How to Reach a Mobile Crisis Team: Results From a National Survey.

Back to table of contents Previous article Next article DatapointsFull AccessHow to Reach a Mobile Crisis Team: Results From a National SurveyRachel Odes, Ph.D., R.N., Deepa Manjanatha, M.P.H., Preston Looper, M.S., L.P.C.-S., Megan McDaniel, B.A., Matthew L. Goldman, M.D., M.S.Rachel OdesSearch for more papers by this author, Ph.D., R.N., Deepa ManjanathaSearch for more papers by this author, M.P.H., Preston LooperSearch for more papers by this author, M.S., L.P.C.-S., Megan McDanielSearch for more papers by this author, B.A., Matthew L. GoldmanSearch for more papers by this author, M.D., M.S.Published Online:20 Mar 2023https://doi.org/10.1176/appi.ps.20220449AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The rollout of the 988 Suicide & Crisis Lifeline in July 2022 has raised urgent questions surrounding the infrastructure available to support callers during and after a call for help (1, 2). Currently, 988 callers are routed to their local National Suicide Prevention Lifeline (NSPL). From there, call-takers may provide counseling or initiate a referral. Should a caller urgently need in-person support, deployment of a mobile crisis team (MCT) would be a useful option (3). MCTs comprise behavioral health providers, medical staff, and sometimes law enforcement (in co-responder models) (4). MCTs are widely used, but a systematic description of their deployment and functioning is needed.Data Source and MethodsDuring 2021–2022, we conducted a survey of U.S. MCTs, defining an MCT broadly to include co-responder models, clinician-led teams, and teams including medical personnel. We recruited a convenience sample of participants who led or worked in an MCT through national Listservs, social media, and personal invitation. We asked participants about their program’s key features and then calculated descriptive statistics. After analysis of missing and duplicate data, we included 554 responses. Respondents could skip questions and respond anonymously.ResultsRespondents were in 45 states, and most described their roles as either MCT program director (N=237 of 501, 47%) or MCT clinician (N=105 of 501, 21%). Figure 1 depicts responses to the question of how respondents’ MCTs can be deployed. Of the 474 respondents who answered the question, nearly one-third (32%, N=154) reported that their MCTs could be deployed by calling the NSPL. The most commonly reported channel for reaching an MCT was to call teams directly (N=306, 65%), and the second most common was calling 911 (N=256, 54%).Figure 1. Phone number or agency that community members could call to deploy a mobile crisis team (MCT) in respondents’ programs (N=474)aaRespondents could choose more than one option.ImplicationsAlthough access to MCTs is an essential component of emergency mental health services, MCTs in many communities cannot be reached via 988. As federal and local agencies continue to implement 988-related changes, they should consider linking call centers to MCTs. The national 988 implementation sets the stage to establish a simplified point of access for mental health support and will hopefully streamline the process of connecting clients to services (5). As communities continue to integrate 988 calls into their service continuum, it should be recognized that current services are frequently fragmented and that it is important to communicate to community members how they can reach an MCT when needed.National Clinician Scholars Program, University of California, San Francisco, San Francisco (Odes); San Francisco Department of Public Health, San Francisco (Manjanatha, McDaniel, Goldman); Full Tilt Strategies, L.L.C., Colleyville, Texas (Looper); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman).Send correspondence to Dr. Goldman ([email protected]). Tami L. Mark, Ph.D., and Alexander J. Cowell, Ph.D., are editors of this column.Dr. Goldman is a paid research consultant to the National Council for Mental Wellbeing, Peg's Foundation, the University of California, Davis, and the Research Foundation for Mental Hygiene, Inc. The other authors report no financial relationships with commercial interests.

Design, development and randomised controlled trial protocol of a smartphone-delivered version of ‘SOLAR’ for emergency service workers to manage stress and trauma

IntroductionEmergency service workers are routinely exposed to stress and trauma, and there is a need to address mental health symptoms early to prevent chronic impairment and/or psychiatric disorder. Digital health...

Barriers and facilitators of access and utilization of mental health services among forensic service users along the care pathway

BackgroundThe verdict of Not Criminally Responsible on account of a Mental Disorder (NCRMD) is increasingly used to access specialized mental health services in Canada and elsewhere. This situation highlights the importance of ensuring timely access to services in the community to prevent violence and justice involvement. The objective of the present study is to identify individual and contextual barriers and facilitators of access to mental health services during the period preceding an offense leading to a verdict of NCRMD.MethodsThe sample includes 753 people found NCRMD in Québec, Canada. All episodes of mental health hospitalizations and service use before the index offense were identified using provincial administrative health data, for an average period of 4.5 years. Access was conceptualized as a function of the possibility of seeking, reaching and receiving appropriate health care services, based on Lévesque and colleagues patient-centred model of access to care.Generalized linear models were computed to identify the individual and contextual predictors of: (1) seeking mental healthcare (at least one contact with any type of services for mental health reasons); (2) reaching psychiatric care (at least one contact with a psychiatrist); (3) receiving psychiatric care, operationalized as (3a) continuity and (3b) intensity. Factors associated with volume of emergency mental health services were examined as exploratory analysis.ResultsGeographical considerations were highly important in determining who reached, and who received specialized mental health care – above and beyond individual factors related to need. Those who lived outside of major urban centres were 2.6 times as likely to reach psychiatric services as those who lived in major urban centres, and made greater use of emergency mental health services by 2.1 times. Living with family decreased the odds of seeking mental healthcare by half and the intensity of psychiatric care received, even when adjusting for level of need.ConclusionsFindings support efforts to engage with the family of service users and highlights the importance of providing resources to make family-centred services sustainable for health practitioners. Health policies should also focus on the implementation of outreach programs, such as Forensic Assertive Community Treatment teams as part of prevention initiatives.

Non-medical prescribing considerations in emergency mental health services

The emergency mental health practitioner's job involves providing immediate care to patients who are suffering a mental health crisis. Independent nurse prescribing supports this service through timely access to pharmacological and non-pharmacological measures or cognitive behavioural strategies. This case study involves a service user diagnosed with bipolar type II disorder who presents with suicidal ideation, and outlines the prescribing options available for short-term crises and long-term risk management. There is a complex balance of appraising physical and mental health including capacity, assessment of risk of self-harm and harm to others, and working in consultation to optimise adherence and concordance. The authors highlight the importance of using a person-centred approach, which includes family, carers and their wider support network, to develop a therapeutic relationship which promotes positive outcomes. This is further supported by utilising the most recent and up-to-date policy, guidelines and legislation, including local and national policies.

What can we say about the impact of teleconsultations on preventing psychiatric inpatient treatment during COVID-19 pandemic?

IntroductionTelepsychiatry was proved effective and satisfactory in settings like the emergency department and mental health services, but its use is historically restricted. Although there are several studies about telepsychiatry pros and cons, more is needed to know about its effect on patient’s follow-up and its influence on inpatient treatment rates, specifically during COVID-19 pandemic.ObjectivesThe aim is to look for an eventual change on psychiatric inpatient admissions, during COVID-19 pandemic, when psychiatric patients are in follow-up through teleconsultation.MethodsWe compared the number of hospitalizations for 3 different 6 months periods of time: the 2nd semester of 2019 with no teleconsultations, March-August 2020 only with teleconsultations (except some few 1st consultations) and the 1st semester of 2021 with face-to-face and teleconsultations. A one-way repeated measures ANOVA was conducted on a 1050 patients sample.ResultsThe statists showed that the type of approach in consultations didn’t lead to statistically significant differences in hospitalizations (F test-statistic = 0.33086, p = 0.718345).ConclusionsThere is a plethora of advantages about telepsychiatry and it was already shown to be as effective as in-person contact. Some articles show an association of telepsychiatry with a decrease in hospitalization rates, but mostly display similar clinical outcomes. In this study, the authors found that the results follow the latter tendency, although we must consider the COVID-19 pandemic as a possible decompensation and worsening clinical factor. More studies on this matter are important to better understand the potential benefits (and risks) of this treatment setting.DisclosureNo significant relationships.

Alternatives to emergency departments for mental health crisis - a system wide approach can lead to better patient outcomes

IntroductionIn Camden and Islington (North Central London) we have restructured our emergency mental health services significantly. Prior to January 2020 all emergency mental health presentations, including those detained in public by the police (S136) were supported through our three emergency departments and their respective liaison mental health teams. In January 2020 a new ‘Health Based Place of Safety’ (for those detained by police) was opened to avoid people spending time in emergency departments unnecessarily. When the COVID-19 pandemic first took hold in the UK in March 2020 a second unit, a ‘Mental Health Crisis Assessment Service’ (MHCAS) was set up again away from the acute sites, encouraging people in MH crisis to attend a designated MH ED away from the acute sites. This study aims to review the system and patient outcomes since the development of the pathway.ObjectivesRelieving pressures on ED by reduction in patient numbers that could be better supported elsewhere and free up resource for alternative assessments and patient needs.MethodsA retrospective cohort study to review the outcomes of the new system in relation to emergency mental health crisis presentations. Comparison to be made with ED data for 2 years prior to new system.ResultsPending final results but initial data suggests 25% reduction in ED presentation for MH cause with new system. Reduction in psychiatric inpatient admissions of between 3-5%.ConclusionsCreative system wide initiatives to provide alternatives to emergency departments for people in emergency mental health crisis can lead to significantly improved patient outcomes and experience.DisclosureNo significant relationships.

Demographics of mental healthcare presentations in a northwest Ontario emergency department.

Providing emergency mental health services for populations in remote rural areas of Canada is challenging. Program needs are distinct. We describe the emergency mental health workload and service needs at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) in northwest Ontario. Emergency department (ED) data were collected for mental health, addiction and self-harm diagnoses (MHA) in 2018/2019. Comparisons were made to similar sized provincial hospitals and EDs. Mental health admissions data from Oct 1, 2018 to Dec 31, 2019 were manually collected from hospital medical charts for demographics, suicide attempts/ideation and frequency of applications for Form 1 psychiatric assessment. The volume of MHA ED visits as a percentage of total ED visits was 4 times higher at SLMHC when compared to both the 67 other Ontario level C hospitals (< 100 beds) and the 15 level C hospital with a similar volume of ED visits (15,000-20,000), (15% vs 4%). Self-harm presentations were 308 at SLMHC versus an average of 42 ± 37 at the 15 level C hospitals with a similar ED volume. From Oct 1, 2019 to Dec 31, 2019, there were 49 patients requiring a Form 1, with an average wait time of 55h before transfer to a schedule 1 facility. There is an increased level of mental health, addiction and self-harm presentations in this northern ED. Lack of alternative resources indicate the need for the development of an integrated model of mental health care service. Reliance on the ED for crisis management indicates the need for the development of more regionally relevant models of care.

Changes in the utilisation of acute hospital care in Ireland during the first wave of COVID-19

BackgroundReduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study was to quantify and characterise changes in acute hospital healthcare utilisation during the first wave of COVID-19 in Ireland to inform healthcare service planning and public health policy.MethodsA retrospective, population-based, interrupted time-trend study was conducted, using two national datasets, from 6th January to 5th July 2020.ResultsComparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed that there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%). Reductions were greatest at the peak of population restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, healthcare utilisation remained below pre-COVID-19 levels however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028).ConclusionsPublic health implications of delayed and lost care will become fully apparent over time. In the short-term, backlogs in care need to managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses, including the adoption of a pandemic recovery plan. In the long-term, COVID-19 has highlighted weaknesses in the health system and is an opportunity to progress reform towards a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.Key messages The COVID-19 pandemic impacted non-COVID-19 healthcare utilisation in Ireland with evidence of delayed and lost acute hospital care and increased need for emergency mental health and alcohol services.Population health and health system recovery from COVID-19 is a public health priority.

Mental health policy response to COVID-19: lessons learned

BackgroundGood mental health is critical to the functioning of society and recovery from COVID-19 pandemics. Corona pandemics is considered as crisis, causing uncertainty and unpredictability resulting in fear and high levels of psychological distress in populations. Mental health impacts occur as an impact of the virus or as the consequences of physical isolation. Mental health of other specific (vulnerable) populations affected by the COVID-19. Mitigating the hazardous effects of COVID-19 on mental health is an international public health priority. The aim of the study is to review mental health policy responses to COVID-19 crisis internationally and present successful examples as well as learned lessons.MethodsA rapid clustered review of evidences reflecting mental health policy responses in the face of COVID-19 pandemics has been conducted.ResultsCOVID-19 pandemics is an indisputable emergency for health systems and challenge for mental health care. Major mental health policy response measures should be based on whole of society approach and include access to remote mental health service provision as well as emergency mental health and psychosocial services especially to vulnerable populations in order to strengthen social cohesion and social support. COVID-19 crisis, on the other hand, might also be considered as an opportunity to improve the scale and effectiveness of mental health services and increase funding to mental health care and psychosocial services. It raised concerns and stimulated discussion about the re-shifting institutional long term care more into community based service approach.ConclusionsEnsuring preparedness and planning of mental health service is an important for staying ahead of mental health impacts that will be long term, complex, and may take time to fully emerge. Further transdisciplinary research on mental health system, policy and COVID-19 epidemics prevention, preparedness, responses and impacts is needed.

A multicenter study of short-term changes in mental health emergency services use during lockdown in Kitchener-Waterloo, Ontario during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic and subsequent lockdown measures have led to increasing mental health concerns in the general population. We aimed to assess the short-term impact of the pandemic lockdown on mental health emergency services use in the Kitchener-Waterloo region of Ontario, Canada.MethodsWe conducted an observational study during the 6-month period between March 5 and September 5, 2020 using National Ambulatory Care Reporting System metadata from mental health visits to three regional Emergency Departments (ED); mental health and substance related police calls; and calls to a regional mental health crisis telephone line, comparing volumes during the pandemic lockdown with the same period in 2019. Quasi-Poisson regressions were used to determine significant differences between numbers of each visit or call type during the lockdown period versus the previous year. Significant changes in ED visits, mental health diagnoses, police responses, and calls to the crisis line from March 5 to September 5, 2020 were examined using changepoint analyses.ResultsInvoluntary admissions, substance related visits, mood related visits, situational crisis visits, and self-harm related mental health visits to the EDs were significantly reduced during the lockdown period compared to the year before. Psychosis-related and alcohol-related visits were not significantly reduced. Among police calls, suicide attempts were significantly decreased during the period of lockdown, but intoxication, assault, and domestic disputes were not significantly different. Mental health crisis telephone calls were significantly decreased during the lockdown period. There was a significant increase in weekly mental health diagnoses starting in the week of July 12 – July 18. There was a significant increase in crisis calls starting in the week of May 31 – June 6, the same week that many guidelines, such as gathering restrictions, were eased. There was a significant increase in weekly police responses starting in the week of June 14 – June 20.ConclusionsContrary to our hypothesis, the decrease in most types of mental health ED visits, mental health and substance-related police calls, and mental health crisis calls largely mirrored the overall decline in emergency services usage during the lockdown period. This finding is unexpected in the context of increased attention to acutely deteriorating mental health during the COVID-19 pandemic.

Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders

We explored emergency department clinical leaders' views on providing emergency mental health services to pediatric and geriatric patients with suicidal ideation and suicide attempts. We conducted semistructured interviews with a total of 34 nursing directors, medical directors, and behavioral health managers at 17 general hospital EDs across the United States, using purposive sampling to ensure variation among hospitals. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed using Atlas.ti and a directed content analysis approach. Respondents from across a range of ED types expressed concerns regarding the capacity of their EDs to meet mental health needs of children and older adults. They experienced emotional distress over the increasing number of pediatric patients presenting to EDs with suicidal ideation/suicide attempt and described EDs as inappropriate environments for young patients with suicidal ideation/suicide attempt. Similarly, leaders expressed feeling ill-equipped to diagnose and treat geriatric patients with suicidal ideation/suicide attempt, who often had medical comorbidities that complicated treatment planning. Respondents noted that pediatric and geriatric patients frequently boarded in the ED. Some felt compelled to use creative solutions to provide safe spaces for pediatric and geriatric patients. Respondents voiced frustration over the lack of outpatient and inpatient mental health services for these patients. Clinical leaders in EDs across the nation expressed distress at feeling they were not adequately equipped to meet the needs of pediatric and geriatric patients with suicidal ideation/suicide attempt. Future innovations to provide ED care for children and older adults with suicidal ideation/suicide attempt might include training for ED teams, access to specialist mental health clinicians through telehealth, and adaptations of physical spaces.