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&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.


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Bakolis, I., Stewart, R., Baldwin, D., Beenstock, J., Bibby, P., Broadbent, M., Cardinal, R., Chen, S., Chinnasamy, K., Cipriani, A., Douglas, S., Horner, P., Jackson, C., John, A., Joyce, D., Lee, S., Lewis, J., McIntosh, A., Nixon, N., Osborn, D., Phiri, P., Rathod, S., Smith, T., Sokal, R., Waller, R. & Landau, S. 2021, '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', BMJ Open, 11(5), article no: 049721. https://doi.org/10.1136/bmjopen-2021-049721

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