Mental health presentations to a UK tertiary children's emergency department during the covid-19 pandemic in 2020 compared to 2019

ABSTRACT

Introduction: Observational study exploring the differences between the number and severity of mental health presentations to a Children's Emergency Department over a 2-month period during the Covid-19 Pandemic (2020) compared to the same months in 2019. Additionally, exploration of the possible impact of the introduction of a hotline giving clinicians access to 24/7 Children's and Adolescent Mental Health Services (CAMHS) advice. Methods: Identification of mental health presentations in children ≤ 16 years from coded admission data. Data collected included basic demographics, presenting complaint, final diagnosis, mental health Risk Assessment Matrix (RAM) outcome and timings of review, referral and discharge. Results: 141 cases were examined (2019-n=79, 2020-n=62). During the Covid-19 pandemic 18.9% (n=10) scored high on the RAM and 64.2% (n=34) scored moderate whilst in 2019, 17.2% (n=11) scored high on the RAM and 69.4% (n=38) scored moderate. 2019 data saw 25.3% (n=20) discharged directly compared to 37.1% (n=23) in 2020. In 2020, 26 (42.6%) of CAMHS reviews were via telephone compared to nine (12.3%) in 2019. Overnight (2000-0800), in 2019, there were 37 (46.8%) presentations, 86.5% (n=32) of which required admission and in 2020 there were 36 (58.1%) where 75.0% (n=27) required admission. Conclusion: A higher number of presentations was not seen in the CED despite the potentially adverse psychological effects caused by enforced isolation due to Covid-19. The provision of a 24/7 hotline may have contributed to clinician's decision to discharge, aiding a higher number of out of hours discharges.