Self-harm presentations to Emergency Departments and Place of Safety during the ‘first wave’ of the UK COVID-19 pandemic: South London and Maudsley data on service use from February to June 2020

  1. Eleanor Nuzum
  2. Evangelia Martin
  3. Gemma Morgan
  4. Rina Dutta
  5. Christoph Mueller
  6. Catherine Polling
  7. Megan Pritchard
  8. Sumithra Velupillai
  9. Robert Stewart

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Abstract

The lockdown and social distancing policy imposed due to the COVID-19 pandemic has had a substantial impact on both mental health service delivery, and the ways in which people are accessing these services. Previous reports from the South London and Maudsley NHS Trust (SLaM; a large mental health service provider for around 1.2m residents in South London) have highlighted increased use of virtual contacts by mental health teams, with dropping numbers of face-to-face contacts over the first wave of the pandemic. There has been concern that the impact of the COVID-19 pandemic would lead to higher mental health emergencies, particularly instances of self-harm. However, with people advised to stay at home during the ‘first wave’ lockdown, it is as yet unclear whether this impacted mental health service presentations. Taking advantage of SLaM’s Clinical Records Interactive Search (CRIS) data resource with daily updates of information from its electronic mental health records, this paper describes overall presentations to Emergency Department (ED) mental health liaison teams, and those with self-harm. The paper focussed on three periods: i) a pre-lockdown period 1 st February to 15 th March, ii) a lockdown period 16 th March to 10 th May and iii) a post-lockdown period 11 th May to 28 th June. In summary, all attendances to EDs for mental health support decreased during the lockdown period, including those with self-harm. All types of self-harm decreased during lockdown, with self-poisoning remaining the most common. Attendances to EDs for mental health support increased post-lockdown, although were only just approaching pre-lockdown levels by the end of June 2020.

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  1. ScreenIT

    SciScore for 10.1101/2020.12.10.20247155: (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).
    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 note that these data are derived from only four, neighbouring general hospitals. 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 similar trends have been reported from at least one other UK site (9). It is important to remember that even outside of lockdown, the majority of self-harm in the community does not present to medical services so this data cannot be assumed to represent trends in all self-harm, only episodes resulting in emergency care (10). The services used by people for self-harm may be broader than ED and POS, which this study would not have captured and may also differ from other sites. This study also did not capture self-harm attendances to ED that did not involve ED mental health liaison team. While all four hospitals included had 24-hour liaison teams and a policy of referring and recording all attendances for self-harm throughout the period, some attendance may have been missed, either because they were not referred to mental health liaison teams at all or because they were too unwell for any mental health input throughout their time in the ED and were referred for liaison follow-up during an inpatient admission inste...

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.12.10.20247155 on medRxiv