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The Early Impact of COVID-19 on Mental Health and Community Physical Health Services and Their Patients’ Mortality in Cambridgeshire and Peterborough, UK

22 Pages Posted: 1 Sep 2020

See all articles by Shanquan Chen

Shanquan Chen

University of Cambridge

Peter B. Jones

University of Cambridge - Department of Psychiatry; NIHR Collaboration for Leadership in Applied Health Research; NIHR Cambridge Biomedical Research Centre; Cambridgeshire and Peterborough NHS Foundation Trust

Benjamin R. Underwood

Cambridgeshire and Peterborough NHS Foundation Trust

Anna Moore

Department of Psychiatry, University of Cambridge; Cambridgeshire and Peterborough NHS Foundation Trust

Edward T. Bullmore

University of Cambridge; NIHR Collaboration for Leadership in Applied Health Research; Cambridgeshire and Peterborough NHS Foundation Trust

Soumya Banerjee

University of Cambridge - Department of Psychiatry

Emanuele F. Osimo

Department of Psychiatry, University of Cambridge; Cambridgeshire and Peterborough NHS Foundation Trust

Julia B. Deakin

Cambridgeshire and Peterborough NHS Foundation Trust

Catherine F. Hatfield

Cambridgeshire and Peterborough NHS Foundation Trust

Fiona J. Thompson

Cambridgeshire and Peterborough NHS Foundation Trust

Jonathon D. Artingstall

Cambridgeshire and Peterborough NHS Foundation Trust

Matthew P. Slann

Cambridgeshire and Peterborough NHS Foundation Trust

Jonathan R. Lewis

Cambridgeshire and Peterborough NHS Foundation Trust

Rudolf N. Cardinal

University of Cambridge - Department of Psychiatry; Cambridgeshire and Peterborough NHS Foundation Trust

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Abstract

BACKGROUND: COVID-19 has affected social interaction and healthcare worldwide.

METHODS: We examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK, plus service activity and deaths. We conducted interrupted time series analyses with respect to the UK “lockdown”. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI).

OUTCOMES: Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for psychosis/mania and eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality, primarily in the over-70s, lagged slightly behind confirmed numbers of COVID-19 cases. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity.

INTERPRETATION: COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. This may reflect a genuine reduction of need or a lack of help-seeking and pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.

FUNDING: UK Medical Research Council and National Institute of Health Research.

DECLARATION OF INTERESTS:  Several authors (PBJ, BRU, AM, ETB, ESO, JBD, CFH, FJT, RNC) are CPFT clinicians involved in delivering some of the services discussed here and two (BRU, FJT) are clinical directors and therefore involved in managing them.  PBJ is a scientific advisory board member for Johnson & Johnson and Recordati.  BRU is clinical director of the Windsor Unit at Fulbourn Hospital (CPFT), which delivers clinical trials in dementia/mild cognitive impairment for academic and commercial organisations without personal benefit, and is the clinical lead for dementia for the NIHR Clinical Research Network (CRN) in the East of England. His salary is part-funded by the NIHR CRN. He has been principal investigator on trials for Axovant, Lilly, and EIP Pharma; his institution has benefited from payment for research carried out but he has not personally received any money. His wife is the lead for mental health for Suffolk Clinical Commissioning Group.  AM’s salary is part-funded by the Anna Freud National Centre for Children and Families, a mental health charity.  ETB is a scientific advisory board member for Sosei Hepares, and was a half-time employee of GlaxoSmithKline until May 2019.  RNC consults for Campden Instruments Ltd and receives royalties from Cambridge University Press, Cambridge Enterprise, and Routledge.  SC, SB, EFO, JBD, CFH, FJT, JDA, MPS, and JRL have nothing else to disclose.

ETHICS APPROVAL STATEMENT: De-identified data was extracted from CPFT clinical records by CPFT’s Information & Performance team and via the CPFT Research Database (NHS research ethics 17/EE/0442). The study was conducted under UK National Health Service Research Ethics approval (ref. 17/EE/0442).

Keywords: COVID-19/SARS-CoV-2 coronavirus pandemic, depression, anxiety, self-harm, alcohol and substance misuse, suicidality, mortality, severe mental illness (SMI)

Suggested Citation

Chen, Shanquan and Jones, Peter B. and Underwood, Benjamin R. and Moore, Anna and Bullmore, Edward T. and Banerjee, Soumya and Osimo, Emanuele F. and Deakin, Julia B. and Hatfield, Catherine F. and Thompson, Fiona J. and Artingstall, Jonathon D. and Slann, Matthew P. and Lewis, Jonathan R. and Cardinal, Rudolf N., The Early Impact of COVID-19 on Mental Health and Community Physical Health Services and Their Patients’ Mortality in Cambridgeshire and Peterborough, UK. THELANCETPSYCH-D-20-01652, Available at SSRN: https://ssrn.com/abstract=3648247 or http://dx.doi.org/10.2139/ssrn.3648247

Shanquan Chen

University of Cambridge

Peter B. Jones

University of Cambridge - Department of Psychiatry ( email )

NIHR Collaboration for Leadership in Applied Health Research

United Kingdom

NIHR Cambridge Biomedical Research Centre

United Kingdom

Cambridgeshire and Peterborough NHS Foundation Trust ( email )

London, SW1A 2NS
United Kingdom

Benjamin R. Underwood

Cambridgeshire and Peterborough NHS Foundation Trust

Anna Moore

Department of Psychiatry, University of Cambridge ( email )

Cambridgeshire and Peterborough NHS Foundation Trust ( email )

Edward T. Bullmore

University of Cambridge ( email )

Trinity Ln
Cambridge, CB2 1TN
United Kingdom

NIHR Collaboration for Leadership in Applied Health Research ( email )

United Kingdom

Cambridgeshire and Peterborough NHS Foundation Trust ( email )

Soumya Banerjee

University of Cambridge - Department of Psychiatry ( email )

Herchel Smith Bldg
Robinson Way
Cambridge, CB2 0SZ
United Kingdom

Emanuele F. Osimo

Department of Psychiatry, University of Cambridge ( email )

Cambridgeshire and Peterborough NHS Foundation Trust ( email )

Julia B. Deakin

Cambridgeshire and Peterborough NHS Foundation Trust

Catherine F. Hatfield

Cambridgeshire and Peterborough NHS Foundation Trust

Fiona J. Thompson

Cambridgeshire and Peterborough NHS Foundation Trust

Jonathon D. Artingstall

Cambridgeshire and Peterborough NHS Foundation Trust

Matthew P. Slann

Cambridgeshire and Peterborough NHS Foundation Trust

Jonathan R. Lewis

Cambridgeshire and Peterborough NHS Foundation Trust

Rudolf N. Cardinal (Contact Author)

University of Cambridge - Department of Psychiatry ( email )

United Kingdom

Cambridgeshire and Peterborough NHS Foundation Trust ( email )

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