Mental health service activity during COVID-19 lockdown among individuals with potential neurodevelopmental disorders: South London and Maudsley data on services and mortality from January to July 2020

  1. Evangelia Martin
  2. Eleanor Nuzum
  3. Matthew Broadbent
  4. Robert Stewart

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Abstract

The lockdown and social distancing policy imposed due to the COVID-19 pandemic is likely to have had a widespread impact on mental healthcare service provision and use. Previous reports from the South London and Maudsley NHS Trust (SLaM; a large mental health service provider for 1.2m residents in South London) highlighted a shift to virtual contacts among those accessing community mental health and home treatment teams and an increase in deaths over the pandemic’s first wave. However, there is a need to quantify this for individuals with particular vulnerabilities, including those with learning disabilities and other neurodevelopmental disorders. Taking advantage of the Clinical Record Interactive Search (CRIS) data resource with 24-hourly updates of electronic mental health records data, this paper describes daily caseloads and contact numbers (face-to-face and virtual) for individuals with potential neurodevelopmental disorders across community, specialist, crisis and inpatient services. The report focussed on the period 1 st January to 31 st July 2020. We also report on daily accepted and discharged trust referrals, total trust caseloads and daily inpatient admissions and discharges for individuals with potential neurodevelopmental disorders. In addition, daily deaths are described for all current and previous SLaM service users with potential neurodevelopmental disorders over this period. In summary, comparing periods before and after 16 th March 2020 there was a shift from face-to-face contacts to virtual contacts across all teams. The largest declines in caseloads and total contacts were seen in Home Treatment Team, Liaison/A&E and Older Adult teams. Reduced accepted referrals and inpatient admissions were observed and there was an 103% increase in average daily deaths in the period after 16 th March, compared to the period 1 st January to 15 th March (or a 282% increase if the 2-month period from 16 th March to 15 th May was considered alone).

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  1. ScreenIT

    SciScore for 10.1101/2020.10.11.20210625: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: CRIS has received approval as a data source for secondary analyses (Oxford Research Ethics Committee C, reference 18/SC/0372) and has supported over 200 peer reviewed publications to date Activity and caseload data were extracted via CRIS and enumerated for every day from 1st January 2020 to 31st July 2020.
    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. Profiles of services used by individuals with potential neurodevelopmental disorders and catchment morbidity are also likely to vary. It is also likely that we did not capture all of the services individuals with neurodevelopmental disorders are currently accessing for mental healthcare, as well as undiagnosed individuals; in addition, inclusion criteria defined a relatively broad group including learning disability and ADHD diagnoses. Classification of service types is inevitably approximate and likely to vary between mental health service providers. Finally, no attempt was made to adjust for temporal changes (e.g. seasonal effects) that might be observed in previous years’ data.

    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 10.1101/2020.10.11.20210625 on medRxiv