Psychiatric Inpatient Admissions Research Articles

Experiences and impact of psychiatric inpatient admissions far away from home: a qualitative study with young people, parents/carers and healthcare professionals

BackgroundThere are significant clinical, policy and societal concerns about the impact on young people (YP), from admission to psychiatric wards far from home. However, research evidence is scarce.AimsTo investigate the...

Rates of venous thromboembolism associated with acute psychiatric admission: A retrospective cohort study.

The present study aimed to identify rates of venous thromboembolism (VTE) amongst patients treated in inpatient mental health units using linked primary care and mental health care records. Patients resident in the London Borough of Lambeth admitted to mental health units in Southeast London between January 2008 and March 2019 were included, as well as a control group of patients being treated in the community for mental illness. The primary outcome measure was a diagnosis of VTE being recorded in GP records during or within 3 months of an admission to a mental health unit. For 7,198 psychiatric inpatient admissions, 11 episodes of VTE (1.5/1,000 admissions) were identified, with no VTE cases identified in 4,561 patients being treated in the community for mental illness during an equivalent window. This finding indicates that VTE rates following psychiatric inpatient admission might be similar to those following unselected acute medical admission. Larger scale studies are required to confirm the estimated incidence of VTE in patients with mental health conditions and the contribution of acute psychiatry hospitalisation to VTE risk.

Attitude toward patients with mental disorders: what is going on amongst Iranian pharmacies?

IntroductionAs the incidence of mental disorders continues to rise, and pharmacy staff can significantly affect the willingness of patients with mental disorders to seek help; we aimed to evaluate the stigmatizing attitude of the pharmacy staff toward these patients in Iran.MethodsWe conducted this cross-sectional study between April 2020 and December 2021 in Tehran, Iran, and included pharmacists, pharmacy technicians and pharmacy students, with the experience of working in a pharmacy for at least three months. The social distance scale (SDS) and dangerousness scale (DS) were used to measure the stigmatizing attitude of the participants. Higher scores indicated more stigmatizing attitudes.ResultsWe included a total of 186 participants with a mean age of 32.97 ± 9.41 years, of which 101 (54.3%) were male, and 75 (40.3%) were pharmacists, 101 (54.3%) were pharmacy technicians, and 8 (4.3%) were pharmacy students. The mean SDS score was 14.2 ± 4.13, and the mean DS score was 33.85 ± 8.92. The greatest tendency for social distance was reported for a patient with a mental disorder, ‘being the caretaker of their children for an hour or two’ and ‘marrying their children.’ The most perceived dangerousness was reported for a patient with a mental disorder ‘owning a gun.’ Positive personal history of psychopharmacological treatment was statistically correlated with lower DS (P = 0.001) and SDS (P = 0.007) scores. Positive family history of psychiatric inpatient admission was significantly correlated with higher DS (P = 0.05) and SDS (P = 0.03) scores. Higher rates of ‘received psychiatric prescriptions per month’ was associated with lower DS scores (P = 0.04).ConclusionOur participants did not have an overall positive attitude toward patients with mental disorders. Although, compared to previous studies, they held a more positive attitude. Positive personal history of psychopharmacological treatment predicted a more positive attitude and positive family history of psychiatric inpatient admission predicted a more negative attitude.

Predictors of non-fatal suicide attempts among Veterans Health Administration (VHA) patients who experienced military sexual trauma.

Military sexual trauma (MST) has been identified as a risk factor for suicidal behavior. To inform suicide prevention efforts within the Veterans Health Administration (VHA), this study evaluates predictors of non-fatal suicide attempts (NFSAs) among VHA patients who experienced MST. For VHA patients in fiscal year (FY) 2019 who previously screened positive for a history of MST, documented NFSAs were assessed. Using multivariable logistic regression, demographic, clinical, and VHA care utilization predictors of NFSAs were assessed. Of the 212,215 VHA patients who screened positive for MST prior to FY 2019 and for whom complete race, service connection, and rurality information was available, 1742 (0.8%) had a documented NFSA in FY 2019. In multivariable logistic regression analyses, total physical and mental health morbidities were not associated with NFSA risk. Predictors of a documented NFSA included specific mental health diagnoses [adjusted odds ratio (aOR) range: 1.28-1.94], receipt of psychotropic medication prescriptions (aOR range: 1.23-2.69) and having a prior year emergency department visit (aOR = 1.32) or inpatient psychiatric admission (aOR = 2.15). Among VHA patients who experienced MST, specific mental health conditions may increase risk of NFSAs, even after adjustment for overall mental health morbidity. Additionally, indicators of severity of mental health difficulties such as receipt of psychotropic medication prescriptions and inpatient psychiatric admissions are also associated with increased risk above and beyond risk associated with diagnoses. Findings highlight targets for suicide prevention initiatives among this vulnerable group within VHA and may help identify patients who would benefit from additional support.

Racial disparities in law enforcement/court-ordered psychiatric inpatient admissions after the 2008 recession: a test of the frustration-aggression-displacement hypothesis.

Societies under duress may selectively increase the reporting of disordered persons from vulnerable communities to law enforcement. Mentally ill African American males reportedly are perceived as more threatening relative to females and other race/ethnicities. We examine whether law enforcement/court order-requested involuntary psychiatric hospitalizations increased among African American males shortly after ambient economic decline-a widely characterized population stressor. We identified psychiatric inpatient admissions requested by law enforcement/court orders from 2006 to 2011 across four US states (Arizona, California, New York, North Carolina). Our analytic sample comprises 13.1 million psychiatric inpatient admissions across 95 counties over 72months. We operationalized exposure to economic downturns as percent change in monthly employment in a metropolitan statistical area (MSA). We used zero inflated negative binomial and linear fixed effects regression analyses to examine psychiatric inpatient admissions requested by law enforcement/court orders following regional employment decline over a time period that includes the Great Recession of 2008. Declines in monthly employment precede by one month a 6% increase in psychiatric hospitalizations requested by law enforcement/court order among African American males (p < 0.05), but not among other race/sex groups. Estimates amount to an excess of 2554 involuntary admissions among African American males statistically attributable to aggregate-level employment decline. Economic downturns may increase involuntary psychiatric commitments among African American males. Our findings underscore the unique vulnerability of racial/ethnic minorities during economic contractions.

Ketamine for major depressive disorder during an inpatient psychiatric admission: Effectiveness, adverse events, and lessons learned

ObjectiveMost studies examining the efficacy of ketamine for Major Depressive Disorder (MDD) have been conducted in outpatient or mixed inpatient/outpatient settings. Less is known about effectiveness and tolerability of ketamine for psychiatrically hospitalized patients. Efficacy and tolerability data from a naturalistic sample of acute inpatients may help inform institutions considering ketamine therapy for inpatient services. MethodsWe performed a retrospective chart review of inpatients with non-psychotic MDD treated during the initial 3 years of a ketamine infusion program. Treatment effectiveness was defined using change in Montgomery Asberg Depression Rating Scale (MADRS) scores over five infusions. MDD treatment response was defined by a 50 % reduction of MADRS score, and remission was defined as MADRS score ≤ 10 at any point during the treatment. We also report the frequency of adverse events. Results41 patients with MDD were treated and had outcome data. 19 patients (46.5 %) met criteria for response and 15 patients (26.5 %) met criteria for remission during treatment. Four patients (10 %) had adverse psychological or behavioral outcomes. LimitationsMADRS scales were administered by psychiatrists, psychologists, and trainees in each discipline who did not undergo standardized training in scale administration. Consistent data regarding the race/ethnicity of the patients was not available. ConclusionTwice weekly racemic ketamine infusion is an effective treatment option for patients hospitalized with MDD. Unmonitored or at home ketamine therapy may pose substantial risks.

The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England.

High-quality evidence is lacking for the impact on healthcare utilisation of short-stay alternatives to psychiatric inpatient services for people experiencing acute and/or complex mental health crises (known in England as psychiatric decision units [PDUs]). We assessed the extent to which changes in psychiatric hospital and emergency department (ED) activity were explained by implementation of PDUs in England using a quasi-experimental approach. We conducted an interrupted time series (ITS) analysis of weekly aggregated data pre- and post-PDU implementation in one rural and two urban sites using segmented regression, adjusting for temporal and seasonal trends. Primary outcomes were changes in the number of voluntary inpatient admissions to (acute) adult psychiatric wards and number of ED adult mental health-related attendances in the 24months post-PDU implementation compared to that in the 24months pre-PDU implementation. The two PDUs (one urban and one rural) with longer (average) stays and high staff-to-patient ratios observed post-PDU decreases in the pattern of weekly voluntary psychiatric admissions relative to pre-PDU trend (Rural: -0.45%/week, 95% confidence interval [CI]=-0.78%, -0.12%; Urban: -0.49%/week, 95% CI=-0.73%, -0.25%); PDU implementation in each was associated with an estimated 35-38% reduction in total voluntary admissions in the post-PDU period. The (urban) PDU with the highest throughput, lowest staff-to-patient ratio and shortest average stay observed a 20% (-20.4%, CI=-29.7%, -10.0%) level reduction in mental health-related ED attendances post-PDU, although there was little impact on long-term trend. Pooled analyses across sites indicated a significant reduction in the number of voluntary admissions following PDU implementation (-16.6%, 95% CI=-23.9%, -8.5%) but no significant (long-term) trend change (-0.20%/week, 95% CI=-0.74%, 0.34%) and no short- (-2.8%, 95% CI=-19.3%, 17.0%) or long-term (0.08%/week, 95% CI=-0.13, 0.28%) effects on mental health-related ED attendances. Findings were largely unchanged in secondary (ITS) analyses that considered the introduction of other service initiatives in the study period. The introduction of PDUs was associated with an immediate reduction of voluntary psychiatric inpatient admissions. The extent to which PDUs change long-term trends of voluntary psychiatric admissions or impact on psychiatric presentations at ED may be linked to their configuration. PDUs with a large capacity, short length of stay and low staff-to-patient ratio can positively impact ED mental health presentations, while PDUs with longer length of stay and higher staff-to-patient ratios have potential to reduce voluntary psychiatric admissions over an extended period. Taken as a whole, our analyses suggest that when establishing a PDU, consideration of the primary crisis-care need that underlies the creation of the unit is key.

Clinical and sociodemographic predictors of inpatient admission after presentation in a psychiatric emergency room: an observational study

BackgroundThe admission decision after presentation in the psychiatric emergency room (PER) has potentially far-reaching consequences for the patient and the community. In a short amount of time, information must be collected and evaluated for a well-founded admission decision. The present study aimed to identify risk factors associated with inpatient psychiatric admission (IPA) after previous emergency presentation to the PER.MethodsElectronic patient records for all patients presenting in the PER of Hannover Medical School (MHH) in the year 2022 were retrospectively examined (n = 2580). Out of these, 2387 were included in this study. Two multivariate binary logistic regression analyses were performed to identify risk factors for IPA within sociodemographic, circumstantial and clinical variables.Results1300 (54.5%) consultations resulted in IPA. The most significant sociodemographic and circumstantial risk factors for IPA were found to be suicide attempt (depending on method: OR 9.1–17.4), aggressive behavior towards people prior to presentation (OR 2.9, 95% CI 1.7–4.8), previous psychiatric treatment (OR 1.8, 95% CI 1.4–2.3) and transfer from another hospital or medical discipline of MHH as means of presentation (OR 6.3, 95% CI 3.0–13.0). Among psychopathological aspects, suicidal ideation (OR 3.8, 95% CI 2.9–4.9), suicidal intent (OR 116.0, 95% CI 15.9–844.8), disturbance of orientation (OR 3.7, 95% CI 2.5–5.3), delusions (OR 2.3, 95% CI 1.6–3.1), visual hallucinations (OR 2.9, 95% CI 1.6–5.1), hopelessness/despair (OR 2.4, 95% CI 1.7–3.2) and inhibition of drive (OR 1.6, 95% CI 1.3–2.1) were significantly associated with IPA.ConclusionsThe admission decision is a complex process influenced by a multitude of sociodemographic, circumstantial and clinical factors. A deeper understanding of the decision-making process can be used to improve patient care and facilitate the evaluation process in the PER.

Psychiatric disorders in inpatient Ethiopian migrant workers in the United Arab Emirates.

Migrant workers have higher rates of mental health problems than non-migrant workers, with Ethiopian migrant workers in the United Arab Emirates appearing to be overrepresented in the psychiatric inpatient population compared with their numbers in the general population. We sought to investigate the pattern of psychiatric inpatient admissions in Ethiopian migrant workers over a 10-year period (2011-2020) in order to highlight demographic and clinical characteristics, and to investigate factors predicting the length of hospital stay. We reported the mean and frequency of demographic and clinical data of Ethiopian psychiatric inpatients at one of the largest governmental hospitals in eastern Abu Dhabi between 2011 and 2020, and investigated factors predicting length of stay in hospital using linear regression. Our results show that Ethiopian expatriates made up 7.9% of all admissions over a 10-year period, had a mean length of hospital stay of almost 20 days, with 98.1% of them being female, 92.8% being domestic workers, 90.1% having a language barrier, 57.4% being single and 55.5.% having one or more recent stressors prior to admission. The most common diagnoses were acute stress reaction (31.6%), psychosis (29.3%), bipolar disorder (14.8%) and adjustment disorder (11.0%). Work-related stress, termination of employment and several clinical factors significantly predicted length of stay in hospital.

Pruritus is associated with longer hospital stays and higher costs in psychiatric inpatients from the USA National Inpatient Sample (2012-2015): a cross-sectional study.

This national inpatient data analysis determined that, in addition to the increased costs and duration of hospital stay associated with pruritus, the prevalence of pruritus during inpatient psychiatric admissions in the USA is 18.6% (approximately 1 in 5 patients).

“A turn in the road, but still a rough journey” - Parent and child perspectives of outcomes after pre-adolescent inpatient psychiatric admission

BackgroundResearch regarding the outcomes of child and adolescent psychiatric inpatients appears insufficient and neglected. Where data are available, the majority of studies focus on adolescents. This study aimed (a) to describe child and parental perspectives of short-, medium- and long-term outcomes of children who have had a pre-adolescent inpatient psychiatric admission, and (b) to analyse these dyadic experiential data to identify outcome variables of importance to families and service users that could be used in future outcomes-based research.MethodsThe study employed a qualitative methodology, using semi-structured in-depth interviews of ten parent-child dyads to (a) collect the perspectives of children who have had an inpatient psychiatric admission at a pre-adolescent unit and their parents, and (b) to analyse the experiences of inpatient admission and perceived outcomes after discharge using thematic analysis.ResultsOverall, inpatient psychiatric admission was viewed as a positive and empowering experience by parents and children. Clear short-term benefits were reported as a result of new diagnoses, medications and new skills gained through the admission process. More than half of parent-child dyads reported long-term benefits, but many families commented on ongoing challenges. Thematic analysis identified diagnostic certainty, acquisition of cognitive and behavioural skills, appropriate educational environment, peer relationships, sustained follow-up and medication management, and parent-child relationships, as important contributors to outcomes. Importantly, the presence or lack of these elements influenced outcomes.ConclusionsThe study explored parent-child dyadic perspectives about their experiences of inpatient mental health admissions for pre-adolescents and perceived outcomes after admission. The majority of families found inpatient admission positive and helpful, and thematic analysis identified a number of functional variables that may predict outcome. However, positive outcomes were associated with ongoing difficulties over time, as indicated by the theme “a turn in the road, but still a rough journey”.

Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence.

Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding. To examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences. Forensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal. Most patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending. Many individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains.

Gender‐affirming care important to mental health of adolescents

It's ironic that the very places where young people whose gender identity is different from the sex that was assigned at birth seek help — psychiatric hospitals — may cause harm by not affirming the youth's gender identities. Such youth are twice as likely to access psychiatric inpatient care as cisgender peers, and research has shown that the stress these youth face from having to deal with transphobic systems — including, sometimes, unsupportive parents, school staff, and peers — may play a factor in their increased risk of depression, anxiety, suicidal ideation, suicide attempts, and nonsuicidal self‐harm. An editorial in the Journal of the American Academy of Child and Adolescent Psychiatry noted that higher rates of mental health challenges among these young people explain why they access inpatient services more frequently than cisgender peers. Research has found that these young people “often experience discrimination during psychiatric inpatient admissions (e.g., being misgendered during admission intake, facing stigmatization for an evolving gender identity, and receiving care from staff who have not been trained to provide gender‐affirming care), the editorial added. This is despite the fact that organizations such as the American Academy of Child and Adolescent Psychiatry underscore the importance of “psychiatric care that is inclusive and affirming,” for these youth. [McKenna, J. L., Anglemyer, E., McGregor, K. (2023, Jun 24). Gender‐affirming mental health care for transgender and gender diverse youth on pediatric inpatient psychiatry units. J Am Acad Child Adolesc Psychiatry, S0890‐8567(23)00330‐1. http://doi.org/10.1016/j.jaac.2023.05.021. Online ahead of print.]

Incidence of adverse mental health outcomes after sleeve gastrectomy compared with gastric bypass and restrictive bariatric procedures: a retrospective cohort study.

This study examined rates of suicide and hospitalization with psychiatric diagnoses after sleeve gastrectomy compared with gastric bypass and restrictive procedures (gastric banding/gastroplasty). This was a longitudinal retrospective cohort study comprising all patients who underwent primary bariatric surgery in New South Wales or Queensland, Australia, between July 2001 and December 2020. Hospital admission records, death registration, and cause of death records (if applicable) within these dates were extracted and linked. Primary outcome was death by suicide. Secondary outcomes were admissions with self-harm; substance-use disorder,schizophrenia,mood, anxiety, behavioral, and personality disorders; any of these; and psychiatric inpatient admission. A total of 121,203 patients were included, with median follow-up of 4.5 years per patient. There were 77 suicides, with no evidence of difference in rates by surgery type (rates [95% CI] per 100,000 person years: 9.6 [5.0-18.4] restrictive, 10.8 [8.4-13.9] sleeve gastrectomy, 20.4 [9.7-42.8] gastric bypass; p=0.18). Rates of admission with self-harm declined after restrictive and sleeve procedures. Admission with anxiety disorders, any psychiatric diagnosis, and as a psychiatric inpatient increased after sleeve gastrectomy and gastric bypass, but not restrictive procedures. Admissions with substance-use disorder increased after all surgery types. Variable associations between bariatric surgeries and hospitalization with psychiatric diagnoses might indicate distinct vulnerabilities among patient cohorts or that differing anatomical and/or functional changes may contribute to effects on mental health.

Suicide Characteristics ofVeterans Hospitalized forSuicide Ideation or Attempt.

Veteran suicide rates continue to be unacceptably high, with the most common risk factor being a past suicide attempt (SA). However, some characteristics of suicidal ideation (SI) and behavior among Veterans hospitalized for suicide risk remain under-reported. One hundred and eighty-three Veterans hospitalized for either an SA or SI with intent were screened for enrollment in a treatment study to prevent suicide. Veterans completed a demographic form, the Columbia-Suicide Severity Rating Scale, and the McLean borderline personality disorder screening measure shortly after inpatient psychiatric admission. Chi-squared and t-tests were used to compare suicide characteristics (e.g., intensity, duration, deterrents, and controllability) between Veterans with and without a lifetime history of SA. Thematic analyses of the reported method of SI were conducted. Sixty-seven percent of participants were hospitalized for SI and 33% were hospitalized for SA. Twenty-one percent of Veterans hospitalized for SI also endorsed a recent SA in the weeks preceding hospitalization. Most participants reported at least one lifetime SA (71%). Veterans with a lifetime history of SA reported greater frequency and duration of ideation in the week before hospitalization (t[169] =  -2.56, P = .01; t[168] =  -2.04, P = .04) while also reporting that deterrents were less likely to prevent an SA (t[107.09] =  -3.58, P = .001) compared to those with no lifetime SA. Overall, Veterans hospitalized for SI/SA demonstrated markers of chronic suicide risk, as most participants endorsed a past attempt in their lifetime. Some Veterans admitted for SI also reported a past month's attempt, suggesting that in certain cases, hospitalization does not immediately follow an acute suicidal crisis. A past SA differentiated Veterans on average frequency and duration of SI as well as the perception of deterrents preventing suicidal behavior. Therefore, a thorough evaluation of suicide methods and intensity may be informative in treatment planning for Veterans at greatest risk of suicide.

Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic.

This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic. Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test. In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777). Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.

(339) Urologic and Psychiatric Considerations in Male Genital Self-Mutilation

Abstract Introduction Male genital self-mutilation (GSM) can be categorized into four subtypes – amputation, castration, mutilation, and combined amputation/castration. The most common psychiatric diagnosis associated with GSM is schizophrenia, followed by substance use disorders, personality disorders and gender dysphoria. Objective We discuss a case of amputation/castration GSM in a patient presenting without his severed organ. Treatment considerations in patients with active psychosis due to schizophrenia presenting with GSM are discussed. Methods A 30-year-old single male with a history of schizophrenia requiring multiple prior inpatient psychiatric admissions, obsessive compulsive disorder, and autism spectrum disorder presented to the Emergency Department with penile and bilateral testicular self-amputation. Upon inquiry regarding the method of injury, the patient stated “someone” instructed him to “cut off” his penis and testes with a pair of scissors. He subsequently disposed of his severed organs by flushing them down the toilet. Consent was obtained from the patient’s mother, who served as his healthcare proxy. He underwent operative intervention including penile “stump-plasty”, suture ligation of the bilateral spermatic cords, and scrotal Penrose drain placement with loose re-approximation of scrotal skin. He was admitted for inpatient psychiatric care for management of schizophrenia with active psychosis. Post-operatively he was observed repeatedly touching and contaminating his surgical site and developed a wound infection. The patient underwent operative wound exploration and washout on post-operative day 10. He convalesced well after completing a course of antibiotics for MRSA wound infection. Results Operative intervention options in patients presenting with GSM differ based on the presence or absence of the severed penis. In this patient who presented without the severed penis, possible operative intervention includes primary closure with urethral advancement (stump-plasty), debridement and delayed repair with skin grafting, and perineal urethrostomy. Our patient underwent stump-plasty, and was able to void while standing in the post-operative period. Penile replantation can be considered when the organ has not been discarded. Considerations in psychiatric patients presenting with self-inflicted injuries secondary to a psychotic episode include the patient’s ability to provide informed consent, insight into the patient’s condition, history and severity of mental illness, and increased likelihood of future attempts at self-harm. Severe schizophrenia is associated with increased perioperative complications, including sepsis, acute kidney injury, increased length of stay, and operative wound infections, as well as increased odds of having an adverse operative outcome. Risk factors for GSM include psychotic experiences, personality disorders, prior history of GSM, alcohol and drug use, guilt toward sexual feelings, and early father loss. Patients presenting with an acute episode of psychosis and GSM have increased risk of future GSM, with up to one-third of these patients making a repeated attempt at GSM. Conclusions In a patient with GSM who presents without the severed organ, the physician should consider the patient’s psychiatric history. In patients with an acute psychotic episode and severe schizophrenia, physicians should consider primary closure with urethral advancement versus perineal urethrostomy rather than delayed repair with skin grafting to avoid the risk of wound infection. Disclosure No

The Impact of COVID-19 on Mental Healthcare Utilization in Switzerland Was Strongest Among Young Females-Retrospective Study in 2018-2020.

Objectives: To provide a thorough assessment of the impact of the COVID-19 pandemic on the utilization of inpatient and outpatient mental healthcare in Switzerland. Methods: Retrospective cohort study using nationwide hospital data (n > 8 million) and claims data from a large Swiss health insurer (n > 1 million) in 2018-2020. Incidence proportions of different types of psychiatric inpatient admissions, psychiatric consultations, and psychotropic medication claims were analyzed using interrupted time series models for the general population and for the vulnerable subgroup of young people. Results: Inpatient psychiatric admissions in the general population decreased by 16.2% (95% confidence interval: -19.2% to -13.2%) during the first and by 3.9% (-6.7% to -0.2%) during the second pandemic shutdown, whereas outpatient mental healthcare utilization was not substantially affected. We observed distinct patterns for young people, most strikingly, an increase in mental healthcare utilization among females aged <20years. Conclusion: Mental healthcare provision for the majority of the population was largely maintained, but special attention should be paid to young people. Our findings highlight the importance of monitoring mental healthcare utilization among different populations.

Risk of hospital admission after discharge from postpartum psychiatric emergency department visits: A focus on the social determinants of health

ObjectiveOf those with postpartum psychiatric emergency department (ED) visits, a minority of receive hospital admission at their initial visit. Among those discharged, we aimed to determine subsequent risk of psychiatric admission, and understand how social determinants of health (SDOH) – individually and collectively – impact this risk. MethodFrom all postpartum individuals discharged from psychiatric ED visits in Ontario, Canada (2008–2020)(n = 13,130), we generated adjusted relative risks (aRR) for psychiatric inpatient admission within 365 days post-ED visit by four SDOH (age, neighbourhood income, community size, immigration) and other clinical factors. Using latent class analysis (LCA) to identify subgroups based on clustering of SDOH, we then compared adjusted risk across subgroups. ResultsPsychiatric admission occurred for 9.5% (n = 1242) within 365 days. Across SDOH, risk was lower among adolescents (vs. ≥35 years aRR 0.80, 95%CI 0.65–0.97) and immigrants (<5 years in Canada vs. Canadian-born/long-term residents 0.70, 0.51–0.96; ≥5 years in Canada 0.79, 0.65–0.95). Among four identified subgroups, compared to the “older/urban/high-income” subgroup (11.1% admission), the “urban/immigrant/low-income” (7.6%; 0.68, 0.55–0.82) and “young/rural/low-income” subgroups (9.7%; 0.78, 0.63–0.96), but not the “semi-urban/middle-income” subgroup (9.5%; 0.86, 0.73–1.01), were at lower admission risk. ConclusionsFuture research is needed to explore reasons for SDOH-based differences in admission risk, and inform equitable postpartum services.

Impact of COVID‐19 on rate of admissions in the Humber Teaching NHS Foundation Trust in Yorkshire

After the onset of COVID-19 many countries’ populations exhibited a significant deterioration in mental health, including high rates of anxiety, depression and psychological distress.1 During the first month of lockdown in the UK, the population showed an 18.9% increase of clinically significant mental distress compared with the incidence in pre-lockdown conditions.2 A consequent study found that people who had self-reported a previous mental health illness had also been more likely to have worse mental health during and following the lockdown period.3 Studies have shown that from the beginning of the lockdown period in the UK until early 2021, there had been a considerable increase in the rate of antidepressant prescribing in primary care, but referrals to and contact with mental health services did not reflect this and instead decreased from the corresponding period in the previous year.4 As such this raises the question of how effectively mental health was being managed during the pandemic and whether this is reflected in the number of admissions in the COVID-19 period. In this context, we wanted to analyse the rate of admissions in old age psychiatry, general adult psychiatry and learning disability units within the Humber Teaching NHS Foundation Trust during pre- and post-COVID-19 periods to see if there was a significant change in admissions because of the COVID-19 pandemic, alongside the out-of-area admissions during the same period, and the cost implications. This service evaluation was prompted by conflicting discussions that were taking place around whether there was an increase or decrease in the number of admissions over the pandemic period. It has been observed that services have been stretched during the pandemic. This service evaluation looked at the impact of COVID-19 on admissions to psychiatric inpatient units, as well as its effect on out-of-area bed stays. We specifically looked at seven different types of units across the Humber region: Avondale (acute assessment); New Bridges (acute and treatment, adult male); Maister Lodge and Mill View Lodge (old age); Westlands (acute and treatment, adult female); psychiatric intensive care unit (PICU); Mill View Court (psychiatric assessment), and Lilac and Willow units (learning disability). Data were collected retrospectively using admission records for each respective unit and out-of-area admissions were specifically highlighted. Quarters 1–4 of 2019–20 were used for the pre-COVID-19 figures, while quarters 1–4 of 2020–21 and quarters 1–3 of 2021–22 were used for the post-COVID-19 figures. Graphical representations of these data sets were produced to demonstrate how COVID-19 and all the subsequent policy changes impacted psychiatric inpatient admissions. The data were analysed using an unpaired t-test, to see whether there was any significant difference between the admissions prior to COVID-19 and post-COVID-19. Out of the five units that had general adult psychiatric patients, only one, Avondale Unit, showed a statistically significant decrease in admissions per quarter during the COVID-19 lockdown – compared with prior to the pandemic, Mill View Court, New Bridges, Westlands and PICU all noticed slight variations in the number of adult admissions. However, none of these variations were found to be statistically significant. The magnitude of admissions to Avondale in comparison with the other units, meant that overall, the data showed a significant decrease in admissions per quarter. Neither of the two units that admitted old age psychiatric patients or psychiatric patients with learning disability pre-COVID and post-COVID pandemic showed a statistically significant change in quarterly admission during this time. When comparing the number of out-of-area admissions prior to and during the COVID-19 pandemic, there was a significant increase in out-of-area admissions per quarter in both adult and older people submissions in the post-COVID-19 data. The comparison was made in looking at averages per quarter pre- and post-COVID-19. When examining the economic implications of the increase in out-of-area bed stays, the current minimum cost per day per bed is £515 with the maximum cost being £849. The average of this would be £682 per day for an out-of-area bed stay. It is almost double the cost compared with inpatient admissions within the Humber Teaching Trust. Therefore, it appears that an increase in number of out-of-area bed stays has had cost implications for the trust(Figure). The cost implications to the Humber NHS Trust are shared by the Hull CCG who fund the patient placement. Prior to COVID-19 the cost of out-of-area placement was picked up by the patient's CCG: Humber NHS Trust had agreed to put operating procedures in place to ensure that local CCGs were aware and approved of any out-of-area placements as and when the need arose. During COVID-19 with the increase in out-of-area placements Humber agreed to contract some beds from both Cygnet and The Priory for a limited time, which was funded from a specific COVID-19 allocation from commissioners. This was part of the national funding allocation response to COVID-19. This study found that psychiatric hospital admissions in the post-COVID-19 period were significantly lower compared with pre-COVID-19 periods only for general adult psychiatry admissions across the Humber Teaching NHS Foundation Trust region, but not in learning disability or old age psychiatry where hospital admission numbers remained constant. However, there was a temporary increase in out-of-area bed stays due to the COVID-19 situation. The UK was placed in the first of many lockdowns during this period.5 Most care homes and respite services were locked down due to the pandemic and they were not able to accept patients from family homes. This resulted in an increased admission rate in hospitals. Additionally, due to COVID-19 outbreaks, some mental health units were closed for admissions, which also resulted in an admission to an out-of-area unit. As a general trend, it was found that over the course of the pandemic women's mental health admissions had been on the increase possibly due to factors such as domestic violence during lockdowns, dealing traumatic events such as miscarriages alone and the loss of the closer support network during pregnancy and childbirth.6 None declared. Thanks to Debby Shaw (Performance Management Advisor) in the Humber Teaching NHS Foundation Trust for her helpful input and support in analysing the data.