@article{Bakolis_I-2021_36312,
title = {Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in ten UK sites: a regression discontinuity in time design},
author = {Bakolis, I. and Stewart, R. and Baldwin, D. and Beenstock, J. and Bibby, P. and Broadbent, M. and Cardinal, R. and Chen, S. and Chinnasamy, K. and Cipriani, A. and Douglas, S. and Horner, P. and Jackson, C. and John, A. and Joyce, D. and Lee, S. and Lewis, J. and McIntosh, A. and Nixon, N. and Osborn, D. and Phiri, P. and Rathod, S. and Smith, T. and Sokal, R. and Waller, R. and Landau, S.},
month = {may},
year = {2021},
abstract = {Objectives: To investigate changes in daily mental health service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020. Design: A regression discontinuity in time analysis of daily service-level activity. Setting and participants: Mental healthcare data were extracted from ten UK providers. Outcome measures: Daily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads), and community services (face-to-face/non-face-to-face contacts, caseloads): Adult, Older Adult, and Child/Adolescent Mental Health; Early Intervention in Psychosis; Home Treatment Teams; Liaison/A&amp;E. Data were extracted for 2019 and 2020 to 31st May for all sites, supplemented to 31st July for four sites. Changes around the commencement and lifting of COVID-19 ‘lockdown’ policy (March 23rd and May 10th respectively) were estimated using a regression discontinuity in time design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites. Results: Pooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86-2.87), reduced referrals (0.62, 0.55-0.70), and reduced inpatient admissions (0.75, 0.67-0.83) and caseloads (0.85, 0.79-0.91) compared to the pre-lockdown period. All community services saw shifts from face-to-face to non-face-to-face contacts, but varied in caseload changes. Lift-of-lockdown was associated with reduced deaths (0.42, 0.27-0.66), increased referrals (1.36, 1.15-1.60), and increased inpatient admissions (1.21, 1.04-1.42) and caseloads (1.06, 1.00-1.12) compared to the lockdown period. Site-wide activity, inpatient care and community services did not return to pre-lockdown levels after lift-of-lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect. Conclusions: Mental health service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.},
volume = {11},
issue = {5},
journal = {BMJ Open},
publisher = {},
url = { https://doi.org/10.1136/bmjopen-2021-049721},
}
