Reduced Activity in an Inpatient Liaison Psychiatry Service During the First Wave of the COVID-19 Pandemic: Comparison With 2019 Data and Characterization of the SARS-CoV-2 Positive Cohort

Background: The COVID-19 pandemic led to changes in the way that healthcare was accessed and delivered in the United Kingdom (UK), particularly during the peak of the first lockdown period (the “first wave”) beginning in March 2020. In some patients, COVID-19 is associated with acute neuropsychiatric manifestations, and there is suggestion that there may also be longer term neuropsychiatric complications. Despite this, at the time of writing there are only emerging data on the direct effects of the COVID-19 pandemic on psychiatric care.Methods: In this retrospective study we analyzed referrals to an inpatient liaison psychiatry department of a large acute teaching hospital during the first wave of covid-19 in the UK and compared this data to the same period in 2019.Results: We saw a 40% reduction in the number of referrals in 2020, with an increase in the proportion of referrals for both psychosis or mania and delirium. Almost one third (28%) of referred patients tested positive for COVID-19 at some point during their admission, with 40% of these presenting with delirium as a consequence of their COVID-19 illness. Save delirium, we did not find evidence for high prevalence of new-onset acute mental illness in COVID-19 positive patients.Conclusion: Our data indicate decreased clinical activity in our inpatient psychiatry liaison department during the first wave of the COVID-19 pandemic, although a relative increase in relative increase in referrals for psychosis or mania, suggesting less of a relative decrease in more severe cases of mental illness. The reasons for this are likely multifactorial, including structural changes in the NHS and patient reluctance to present to emergency departments (ED) due to infection fears and Government advice. Our data also supports the literature suggesting the high relative prevalence of delirium in COVID-19, and we support integration of psychiatry liaison teams in acute general hospital wards to optimize delirium management. Finally, consideration should be given to adequate staffing of community and crisis mental health teams to safely manage the mental health of people reluctant to visit EDs.

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Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65

BJPsych Open ◽

10.1192/bjo.2021.823 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S311-S312

Author(s):

Sarah Bradbury ◽

George Crowther ◽

Manimegalai Chinnasamy ◽

Laura Shaw ◽

Sara Ormerod ◽

...

Keyword(s):

Mental Health ◽

Older People ◽

Emergency Departments ◽

Community Mental Health Services ◽

Service Evaluation ◽

Liaison Psychiatry ◽

Convenience Sample ◽

National Priority ◽

Health Related ◽

The Uk

AimsThe number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.MethodWe performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.ResultReferral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.ConclusionTo plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.

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Bibliotherapy for Mental Health

International Research in Higher Education ◽

10.5430/irhe.v2n2p67 ◽

2017 ◽

Vol 2 (2) ◽

pp. 67

Author(s):

Jennifer Yontz-Orlando

Keyword(s):

Mental Health ◽

United States ◽

Mental Illness ◽

Medical Condition ◽

Action Plan ◽

The United States ◽

World Health ◽

Group Setting ◽

Health Crisis ◽

The Uk

The United States is facing an epidemic of mental illness, affecting nearly 60 million Americans annually (http://www.nami.org/ ). The World Health Organization describes mental health as “a long neglected problem” and has established an action plan for 2013-2020 (http://www.who.int/mental_health/action_plan_2013/en/). One way to combat mental illness is through bibliotherapy, which is the use of written materials including fiction, nonfiction, and poetry to support emotional and psychiatric healing.Bibliotherapy has been in existence since ancient times, but began in earnest in the United States in the 1850’s during the “Great Awakening.” At that time, mental illness began to be seen as a medical condition rather than a supernatural phenomenon. Since then, due to the changing nature of our institutions, interest in bibliotherapy waned until the 1950’s when there was a slight resurgence in its practice. However, in the last 20 years, bibliotherapy has gained a stronghold in the United Kingdom. To relieve the stress of an overcrowded mental health system, public policy in the UK has supported the use of bibliotherapy in a variety of its institutions. There are many ways to conduct bibliotherapy, but studies show that when the process is interactive, such as in a support group setting, the results are better. Also, bibliotherapy can be conducted by many sorts of professionals, including doctors, therapists, social workers, teachers, and librarians. Studies also show that when the bibliotherapists are trained in the best practices of bibliotherapy, results improve. Bibliotherapy is an effective, low-cost alternative for people in need of therapeutic assistance. The UK model should be studied and implemented in the United States and in other nations to help solve the mental health crisis.

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Civil and forensic patients in secure psychiatric settings: A comparison

BJPsych Bulletin ◽

10.1192/pb.bp.115.052910 ◽

2017 ◽

Vol 41 (3) ◽

pp. 156-159 ◽

Cited By ~ 3

Author(s):

Nuwan Galappathie ◽

Sobia Tamim Khan ◽

Amina Hussain

Keyword(s):

Mental Health ◽

Mental Illness ◽

Clinical Implications ◽

Treatment Needs ◽

Forensic Patients ◽

Adult Services ◽

Frequent Episodes ◽

Self Harm ◽

Male Patients ◽

The Uk

Aims and methodTo evaluate differences between male patients in secure psychiatric settings in the UK based on whether they are detained under civil or forensic sections of the Mental Health Act 1983. A cohort of patients discharged from a secure psychiatric hospital were evaluated for length of stay and frequency of risk-related incidents.ResultsOverall, 84 patients were included in the study: 52 in the forensic group and 32 in the civil group. Civil patients had more frequent incidents of aggression, sex offending, fire-setting and vulnerability, whereas forensic patients had more frequent episodes of self-harm.Clinical implicationsSecure hospitals should ensure treatment programmes are tailored to each patient's needs. Civil patients require greater emphasis on treatment of their mental illness, whereas forensic patients have additional offence-related treatment needs. Regular liaison between forensic and general adult services is essential to help ensure patients can return to appropriate settings at the earliest opportunity in their recovery.

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Health promotion and mental health

The Future for Health Promotion ◽

10.1332/policypress/9781447341239.003.0006 ◽

2018 ◽

pp. 141-172

Author(s):

Colin Palfrey

Keyword(s):

Mental Health ◽

Health Promotion ◽

Mental Illness ◽

Mental Health Promotion ◽

Post Traumatic Stress ◽

Obsessive Compulsive ◽

Scottish Health Survey ◽

Promotion Strategies ◽

Mental Health Foundation ◽

The Uk

This chapter examines health promotion campaigns and policies designed to raise the profile of mental health, and more specifically to help those suffering from mental illness. It begins with an overview of mental illnesses such as schizophrenia, depression, anxiety, obsessive compulsive disorder, post-traumatic stress disorder, eating disorders, and personality disorders. It then considers the NHS policy on mental health; the mental health promotion strategies in the UK, including the Scottish Health Survey of 2016, the All Wales Mental Health Promotion Network, and the Mental Health Foundation report in Northern Ireland; the implications of the coexistence of physical and mental illness for policy makers and practitioners; and mental health charities such as Anxiety UK, Centre for Mental Health, Rethink Mental Illness, SANE and Time to Change. The chapter also discusses various mental health promotion strategies throughout the UK, locations for mental health promotion, and economic evaluations of mental health promotion.

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Mental health services for single homeless people

BJPsych Advances ◽

10.1192/bja.2020.54 ◽

2020 ◽

pp. 1-11

Author(s):

Philip Timms ◽

Jenny Drife

Keyword(s):

Mental Health ◽

Mental Illness ◽

Personality Disorder ◽

Health Services ◽

Substance Misuse ◽

Homeless People ◽

Psychiatric Services ◽

Background Information ◽

The Past ◽

The Uk

SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance misuse, and personality disorder. However, psychiatric services in the UK have only recently engaged actively with homeless people. This article provides some background information about homelessness and mental illness and describes the elements of inclusion health and some of the models of service for homeless people that have been established over the past 30 years.

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Mental health services for adults with learning disabilities

The British Journal of Psychiatry ◽

10.1192/bjp.184.4.291 ◽

2004 ◽

Vol 184 (4) ◽

pp. 291-292 ◽

Cited By ~ 56

Author(s):

Nick Bouras ◽

Geraldine Holt

Keyword(s):

Mental Health ◽

Mental Illness ◽

Human Rights ◽

Learning Disabilities ◽

Mental Retardation ◽

Personality Disorders ◽

Community Care ◽

Mental Handicap ◽

Adults With Learning Disabilities ◽

The Uk

Services for people with learning disabilities have been transformed since the late 1960s by the move from institutional to community care. (Learning disabilities is the term currently used in the UK in preference to mental retardation, developmental disabilities and mental handicap.) Important changes include the progress towards integration, participation, inclusion and choice for people with learning disabilities, which have occurred in the context of the broader civil and human rights movements. It is time to examine the services delivered to people with learning disabilities and comorbid psychiatric disorders (mental illness, personality disorders, behavioural problems with aggression) and the evidence for their effectiveness.

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The Mental Capacity Act and mental healthcare in prison: opportunities and challenges

The Psychiatrist ◽

10.1192/pb.bp.111.036988 ◽

2012 ◽

Vol 36 (7) ◽

pp. 241-243 ◽

Cited By ~ 1

Author(s):

Sharon Davies ◽

Claire Dimond

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Healthcare ◽

Legal Framework ◽

Mental Capacity ◽

Best Interests ◽

People With Mental Illness ◽

Mental Capacity Act 2005 ◽

Mental Capacity Act ◽

The Uk

SummaryThe UK Mental Health Act 1983 does not apply in prison. The legal framework for the care and treatment of people with mental illness in prison is provided by the Mental Capacity Act 2005. We raise dilemmas about its use. We highlight how assessing best interests and defining harm involves making challenging judgements. How best interests and harm are interpreted has a potentially significant impact on clinical practice within a prison context.

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Investigating the relationship between COVID-19-related and distress and ICD-11 adjustment disorder: two cross-sectional studies

BJPsych Open ◽

10.1192/bjo.2020.158 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Menachem Ben-Ezra ◽

Wai Kai Hou ◽

Robin Goodwin

Keyword(s):

Mental Health ◽

Mental Illness ◽

Serious Mental Illness ◽

Odds Ratio ◽

Adjustment Disorder ◽

Elevated Risk ◽

Stressful Events ◽

Cross Sectional ◽

Cross Sectional Studies ◽

The Uk

Background To assess the prevalence of elevated risk of serious mental illness and probable ICD-11 adjustment disorder in the UK population at two time points during COVID-19, and their association with COVID-19-related stressful events. Aims To check the dose–response model for stress between the number of COVID-19-related stressful events and mental health indices. Method We conducted two cross-sectional studies, using internet survey samples across the UK (N = 1293 for study 1; N = 1073 for study 2). Samples used internet panel surveys during March–April 2020 and 3 months later (June 2020), and used random stratified samples. Studies assessed prevalence of serious risk of mental illness and probable ICD-11 adjustment disorder. Results Elevated risk of serious mental illness was found among those with COVID-19-related social life or occupationally stressful events (study 1). Elevated risk of serious mental illness and probable ICD-11 adjustment disorder was evident among those reporting COVID-19-related stressful events (personal health problems and caregiving; study 2). Cumulative COVID-19-related stressful events were associated with elevated risk of serious mental illness in study 1 (odds ratio 1.65; 95% CI 1.03–2.64; P = 0.037), and with both elevated risk of serious mental illness (odds ratio 2.19; 95% CI 1.15–4.15; P = 0.017) and probable ICD-11 adjustment disorder (odds ratio 2.45; 95% CI 1.27–4.72; P = 0.007) in study 2. Conclusions Psychiatrists should be aware that COVID-19-related stressful events can lead to serious psychological problems. Mental health professionals need to pay particular attention to patients who report cumulative COVID-19-related stressful events, and consider them for mental health assessment and treatment.

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“We need to slowly break down this barrier”: understanding the barriers and facilitators that Afro-Caribbean undergraduates perceive towards accessing mental health services in the UK

Journal of Public Mental Health ◽

10.1108/jpmh-12-2019-0099 ◽

2020 ◽

Vol 19 (1) ◽

pp. 63-81

Author(s):

Tamara Nadine Sancho ◽

Michael Larkin

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Critical Incident ◽

Structural Changes ◽

Barriers And Facilitators ◽

Future Research ◽

Sociocultural Factors ◽

Content Type ◽

The Uk

Purpose Undergraduates are highly susceptible to the development of mental health difficulties. Afro-Caribbean students are particularly vulnerable to the pressures of university yet are less likely than other ethnic groups to receive early intervention. This paper aims to understand the barriers and facilitators that Afro-Caribbean undergraduates perceive towards accessing mental health services in the UK. Design/methodology/approach Critical Incident Technique was used as the qualitative method because it explores the critical factors that contribute to or detract from a specific experience. Seventeen Afro-Caribbean undergraduates participated in five focus groups. This involved engaging in a novel psychosocial activity that incorporated vignettes to encourage the identification of barriers and facilitators to service access. The data were analysed thematically to generate categories of critical incidents and wish-list items. Findings Analysis revealed rich data from a sub-group rarely researched within UK literature. Fifteen barriers, eleven facilitators and five wish-list items were identified. The importance of mental health literacy, social networks, cultural sensitivity and concerns surrounding services underpinned many categories. Originality/value Findings provide a new perspective on barriers reported in previous literature. Novel facilitators were highlighted where, although psychological and sociocultural factors were deemed valuable, structural changes were most desired. Recommended changes illustrate innovative interventions that could make services accessible for young adult Afro-Caribbean populations. Future research should explore the barriers and facilitators identified by Afro-Caribbean undergraduates across various universities who have successfully accessed and engaged with services. This could provide a holistic perspective on viable facilitators enabling access despite the presence of barriers.

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Does mental health matter? Commentary on the provision of mental health services in Mozambique

International Psychiatry ◽

10.1192/s1749367600003064 ◽

2012 ◽

Vol 9 (2) ◽

pp. 36-38

Author(s):

Kupukai Mlambo

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Health Services ◽

Health Services ◽

Service Provision ◽

Literature Search ◽

Qualitative Interviews ◽

Diagnosis And Treatment ◽

The Uk ◽

Made In

Despite attempts made in recent years to address the diagnosis and treatment of mental illness in Mozambique, service provision remains deficient. The present paper focuses on the attitudes to mental illness and its diagnosis and treatment in Mozambique. This paper is based on both a thorough literature search and on the results of qualitative interviews carried out with six individuals of Mozambican origin now living in the UK.

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