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Routine patient data shows that the first COVID-19 lockdown had an adverse effect on a wide range of wellbeing measures for those with severe mental illness.

There is much evidence that the COVID-19 pandemic had a significant detrimental impact on general population mental health, however to date there has been limited information on how people with severe mental illness were affected. In a new study published today in European Psychiatry, a research team led by HERC assessed how the early stages of the pandemic impacted the wellbeing of patients with severe mental illness, and their use of mental health services.

The research team examined the records of over 34,400 patients with severe mental illness registered at Oxford Health NHS Foundation Trust between March 2016 and July 2020. Most (92%) of these had been referred to mental health services before the pandemic began. The most commonly-recorded conditions included depression, anxiety, dementia, psychosis, schizophrenia, and personality disorder.

The analysis included use of community and outpatient mental health services, psychiatric hospital admissions, and Health of the Nation Outcome Scales (HoNOS) assessments. HoNOS measure twelve factors of health and social functioning, with values ranging between 0 (no problem) and 4 (severe to very severe problem). These factors include depressed mood, aggressive or agitated behaviour, self-harm, problem drinking or drug taking, relationship issues, and problems with living conditions.

Key findings

  • Average total HoNOS scores for all patients became immediately worse in the weeks following the introduction of lockdown on 23 March 2020. Scores subsequently increased steadily by 0.06 per week, leading to an overall increase of 0.69 by the end of the study.
  • In particular, this was driven by increases in agitated behaviour, problems with occupation and activities, problems with activities of daily living, hallucinations and delusions, cognitive problems, and physical illness.
  • Patients with a history of psychosis were particularly affected. For this group, average total HoNOS scores showed an immediate deterioration, and were around 0.76 higher by the end of the study period (3 July 2020).
  • Weekly outpatient and community referrals fell immediately after lockdown was imposed by -196 (49%). Referrals then recovered over the lockdown period at a rate of 17 per week, so that by 3 July 2020 there was no significant difference. 
  • The number of weekly face-to-face appointments fell dramatically within the first week of lockdown, but this was compensated by an instantaneous switch to remote consulting. In fact, the total number of weekly contacts grew gradually over the weeks following lockdown by 95 per week, leading to a combined increase of 1400 contacts per week by the start of July 2020.
  • There was no significant change in the number of weekly inpatient admissions, or the average length of inpatient stay.

Lead author Ed Penington said: ‘Our study found a significant harmful effect of the COVID-19 pandemic on patients with severe mental illness, and this was not restricted to any particular measure of wellbeing, symptoms, or social functioning. In particular, we found evidence of distinct, acute impacts on patients with a history of psychosis.’

Co-author Associate Professor Apostolos Tsiachristas  added: ‘Our results suggest that there may have been some level of unmet need for mental health care during the COVID-19 pandemic, and that opportunities for early interventions could have been missed. Ultimately, this may increase demand for more intensive care in the future. In preparing for future pandemics, policy makers and service providers should take into account the distinct experiences of patients with severe mental illness and plan to ensure continuity of access to key services.’