scholarly journals A Multicenter Study of Short-Term Changes in Mental Health Emergency Services Use During Lockdown in Kitchener-Waterloo, Ontario During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Christopher Dainton ◽  
Simon Donato-Woodger ◽  
Charlene Chu
Keyword(s):  
Mental Health ◽  
Emergency Services ◽  
Suicide Attempts ◽  
Mental Health Crisis ◽  
Short Term ◽  
Health Crisis ◽  
Waterloo Region ◽  
Self Harm ◽  
Ed Visits ◽  
Services Use

Abstract Background The 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. Methods We 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. Poisson regressions were used to determine significant differences between numbers of each visit or call type during the lockdown period versus the previous year. Results Involuntary 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. Conclusions Contrary 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.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher Dainton ◽  
Simon Donato-Woodger ◽  
Charlene H. Chu
Keyword(s):  
Mental Health ◽  
Emergency Services ◽  
Suicide Attempts ◽  
Mental Health Crisis ◽  
Short Term ◽  
Health Crisis ◽  
Police Responses ◽  
Ed Visits ◽  
Mental Health Diagnoses ◽  
Services Use

Abstract Background The 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. Methods We 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. Results Involuntary 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. Conclusions Contrary 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.

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

2021 ◽  
Author(s):  
Christopher Dainton ◽  
Simon Donato-Woodger ◽  
Charlene H. Chu
Keyword(s):  
Mental Health ◽  
Emergency Services ◽  
Suicide Attempts ◽  
Mental Health Crisis ◽  
Short Term ◽  
Health Crisis ◽  
Police Responses ◽  
Ed Visits ◽  
Mental Health Diagnoses ◽  
Services Use

Abstract Background The 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. Methods We 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. Results Involuntary 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. Conclusions Contrary 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.

scholarly journals Care-pathways for patients presenting to emergency ambulance services with self-harm: national survey

2020 ◽  
pp. emermed-2019-208967
Author(s):  
Mohammed Gaber Zayed ◽  
Victoria Williams ◽  
Alexander Charles Glendenning ◽  
Jenna Katherine Bulger ◽  
Tom Hewes ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Admissions ◽  
Psychosocial Assessment ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Alternative Pathways ◽  
Mental Health Patients ◽  
Emergency Ambulance ◽  
Self Harm ◽  
The Uk

BackgroundSelf-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed.MethodsA structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically.ResultsAll 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported.ConclusionPractice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.

scholarly journals Abandonment: Experiences of accessing emergency services during mental health crisis

2018 ◽  
Vol 1 ◽  
Author(s):  
Amy Rene Lovelace ◽  
Liam Phelan ◽  
Rosanna Langer ◽  
Moira Ferguson ◽  
Lissa L Gagnon
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Health Care Providers ◽  
Emergency Services ◽  
Future Research ◽  
Major Theme ◽  
Care Providers ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Mental Health Challenges

Purpose: Emergency departments (ED’s) often serve as the access point to health services for individuals living with mental health challenges, with mental health crisis (MHC) accounting for 15% of all presentations to ED’s in Canada. Consumers’ experiences of emergency mental health services have widely been reported as negative. This research aims to explore the experiences of individuals accessing the ED for MHC. Method: A supra-analysis was conducted using data from four semi-structured interviews collected from a larger study exploring stigma, discrimination and resilience in people experiencing mental health challenges. Supra-analysis aims to explore an aspect of the data from a different theoretical perspective. Transcripts were selected based on a participant history of voluntarily accessing emergency services for MHC. Data analysis was completed using the process of thematic analysis which involved immersion in the data, the development and refinement of codes leading to themes. Findings: A major theme of abandonment was identified in participant interviews with subthemes of; geographic, socioemotional and therapeutic abandonment. Participants reported that the locations of care, lack of social/emotional engagement and lack of health care providers’ (HCP) knowledge led to negative experiences attending ED’s. Participants also reported a lack of desire to access emergency services in the future. Conclusion: Future research is vital to enhance the delivery of emergency services, to reduce the feelings of abandonment experienced by individuals accessing the ED for MHC. Training and education must be provided to HCP’s staffing ED’s that focuses on providing high quality, appropriate emergency services to this vulnerable population.

Taking a holistic approach to acute mental health crisis

2019 ◽  
Vol 11 (10) ◽  
pp. 426-432
Author(s):  
Amy Cook
Keyword(s):  
Mental Health ◽  
Emergency Services ◽  
Holistic Approach ◽  
Health Condition ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Emergency Department Overcrowding ◽  
The Uk ◽  
The Right

An innovative, collaborative model implemented by a UK ambulance service allows patients presenting with a mental health condition to be promptly assisted by a specialist team comprising a paramedic, mental health nurse and police officer. Initial evidence suggests that greater collaboration between emergency services and mental health trusts benefits patients and services: leading to timely assessments, reductions in patient distress levels, and decreasing emergency department overcrowding while providing substantial savings for the NHS. This article explores existing care pathways for patients experiencing acute mental health crisis. Current research from the UK is discussed, and compared with working practices of paramedics internationally. Through reflection of a case study, common difficulties faced in paramedic practice are identified. A multi-agency response to ensure the right care is provided in the right place at the right time is proposed.

An Expert Delphi study to derive a tool for mental health triage in emergency departments

2019 ◽  
pp. emermed-2018-208388 ◽  
Author(s):  
Anna J Mackway-Jones ◽  
Kevin C Mackway-Jones
Keyword(s):  
Mental Health ◽  
Delphi Study ◽  
Mental Health Problems ◽  
Delphi Panel ◽  
Mental Health Crisis ◽  
Physical And Mental Health ◽  
Health Crisis ◽  
Consensus Statements ◽  
Self Harm ◽  
Harm To Others

ObjectiveThis study aimed to investigate and collate the opinions of experts regarding the triage of patients in mental health crisis presenting to EDs.DesignA three-round e-Delphi study was conducted between November 2017 and April 2018. The panel of 28 representative experts were drawn from six stakeholder groups. 23 of the panel were clinicians working in England, while 5 were international triage experts.ResultsExperts generated 173 statements in six topic areas in the first round. 32 of these statements reached consensus in round 2. A further 20 statements reached consensus in round 3, leaving 121 statements that did not reach consensus. The consensus statements were used to develop a structured five-level triage tool where the highest level of priority was assigned to patients exhibiting extreme aggression or agitation, those requiring restraint, those at immediate risk of leaving before assessment and those who presented a high risk of self-harm or harm to others. At lower triage priorities, other factors, such as items of psychiatric history, collateral history, observations and judgements, have been identified.ConclusionsA broadly based, multispecialty, multiprofessional expert Delphi panel has reached consensus on 52 statements concerning the triage of patients presenting in mental health crisis to EDs. The triage tool derived from this work can be used to inform the design of triage instruments employed to prioritise patients with physical and mental health problems equitably.

scholarly journals Assessment tools of immediate risk of self-harm and suicide in children and young people: A scoping review

2018 ◽  
Vol 23 (2) ◽  
pp. 178-199
Author(s):  
Tim Carter ◽  
Gemma M Walker ◽  
Aimee Aubeeluck ◽  
Joseph C Manning
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Scoping Review ◽  
Emotional Health ◽  
Assessment Tools ◽  
Self Report ◽  
Initial Assessment ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Self Harm

There are increasing numbers of children presenting to paediatric hospital settings in mental health crisis. Typically, non-mental health professionals are responsible for the initial assessment of these children and are required to identify immediate physical and emotional health needs. To ensure the safety of these children, immediate risk of suicide and self-harm should be assessed. However, no standardized assessment tool is used in clinical practice, and for those tools that are used, their validity and reliability is unclear. A scoping review was conducted to identify the existing assessment tools of immediate self-harm and suicide risk. Searches of electronic databases and relevant reference lists were undertaken. Twenty-two tools were identified and most assessed acute risk of suicide with only four tools incorporating a self-harm assessment. The tools varied in number of items (4–146), subscales (0–11) and total scores (16–192). Half incorporated Likert-type scales, and most were completed via self-report. Many tools were subject to limited psychometric testing, and no single tool was valid or reliable for use with children presenting in mental health crisis to non-mental health settings. As such, a clinically appropriate, valid and reliable tool that assesses immediate risk of self-harm and suicide in paediatric settings should be developed.

scholarly journals Impact of the COVID-19 pandemic on suicide and self-harm among patients presenting to the emergency department of a teaching hospital in Nepal

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250706
Author(s):  
Roshana Shrestha ◽  
Shisir Siwakoti ◽  
Saumya Singh ◽  
Anmol Purna Shrestha
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Significant Degree ◽  
Organophosphate Poisoning ◽  
Mental Health Crisis ◽  
Record System ◽  
Cross Sectional ◽  
Health Crisis ◽  
Self Harm ◽  
The Impact

The COVID-19 pandemic is a global challenge that is not just limited to the physical consequences but also a significant degree of a mental health crisis. Self-harm and suicide are its extreme effects. We aim to explore the impact of this pandemic on suicide and self-harm in our Emergency Department. A cross-sectional study was conducted including all fatal and nonfatal self-harm patients presenting to the emergency department during the lockdown period (March 24-June 23, 2020; Period1), matching periods in the previous year (March 24-June 23,2019; Period 2) and 3 months period prior (December 24 2019-March 23, 2020; Period 3) were included through the electronic medical record system. The prevalence and the clinical profile were compared between these three periods. A total of 125 (periods 1 = 55, 2 = 38, and 3 = 32) suicide and self-harm cases were analyzed. Suicide and self-harm had increased by 44% and 71.9% during the lockdown in comparison to periods 2 and 3. Organophosphate poisoning was the most common mode. Females were predominant in all three periods with a mean age of 32 (95%CI: 29.3–34.7). There was a significant delay in arrival of the patients in period 1 (p = 0.045) with increased hospital admission (p = 0.003) and in-hospital mortality (18.2% vs 2.6% and 3.1%) (p<0.001). Our study showed an increase in suicide and self-harm cases in the emergency department during the initial phase of the COVID-19 pandemic which may reflect the increased mental health crisis in the community in low resource settings like Nepal. This study highlights the importance of priming all mental health care stakeholders to initiate mental health screening and intervention for the vulnerable population during this period of crisis.

Sign in / Sign up

Export Citation Format

Share Document