Using past and current data to estimate potential crisis service use in mental healthcare after the COVID-19 lockdown: South London and Maudsley data

  1. Robert Stewart
  2. Matthew Broadbent

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Abstract

The lockdown policy response to the COVID-19 pandemic in the UK has a potentially important impact on provision of mental healthcare with uncertain consequences over the 12 months ahead. Past activity may provide a means to predict future demand. Taking advantage of the Clinical Record Interactive Search (CRIS) data resource at the South London and Maudsley NHS Trust (SLaM; a large mental health service provider for 1.2m residents in south London), we carried out a range of descriptive analyses to inform the Trust on patient groups who might be most likely to require inpatient and home treatment team (HTT) crisis care. We considered the 12 months following UK COVID-19 lockdown policy on 16 th March, drawing on comparable findings from previous years, and quantified levels of change in service delivery to those most likely to receive crisis care. For 12-month crisis days from 16 th March in 2015-19, we found that most (over 80%) were accounted for by inpatient care (rather than HTT), most (around 75%) were used by patients who were current or recent Trust patients at the commencement of follow-up, and highest numbers were used by patients with a previously recorded schizophreniform disorder diagnosis. For current/recent patients on 16 th March there had been substantial reductions in use of inpatient care in the following 31 days in 2020, more than previous years; changes in total non-inpatient contact numbers did not differ in 2020 compared to previous years, although there had been a marked switch from face-to-face to virtual contacts.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.29.20142448: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: CRIS has supported over 200 peer reviewed publications to date, and has received approval as a data source for secondary analyses (Oxford Research Ethics Committee C, reference 18/SC/0372).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Considering limitations, it is important to bear in mind that the data are derived from a single site. Because complete data are being provided for that site with no hypothetical source population intended, calculation of confidence intervals was not felt to be appropriate for the descriptive data provided in this report; applicability to other mental healthcare providers cannot therefore be inferred and would need specific investigation, although we recommend the broad approach as a methodology worth considering. Profiles of services and catchment morbidity are also likely to vary between sites; for example, the very high predominance of people with psychotic disorders in those requiring inpatient and/or HTT input may well be related to SLaM’s particular inner urban catchment. Finally, the core task of predicting levels of future service activity, and the characteristics of those requiring highest-cost services, is clearly complex. On the one hand, there has been a marked consistency in the users of crisis services in past years; on the other hand, the COVID-19 pandemic has placed unique challenges on mental health services, those using them and those not yet using them but in need of them. Therefore it will be important to set up an adequate monitoring system to assess service use as close to real-time as possible and to identify any unexpected divergences from previous norms.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.06.29.20142448 on medRxiv