Ulster University

Academic Institute

Economic and Social Research Council

Yes

259

From March 2020 individuals, wider society and health care systems have all been seriously affected by the COVID-19 pandemic (WHO, 2020). It is likely that the pandemic has more severely impacted on people with prior mental health problems: generally research suggests that, pre-pandemic, people with Severe Mental Illness (SMI) (here we include schizophrenia, bi-polar disorder and major depressive disorder) could expect to experience considerable social exclusion, poor physical health and die up to 20 years earlier than the general population (Walker, 2015, NICE, 2018). They are also vulnerable to conditions such as diabetes (T2), cardiovascular disease (CVD), stroke and cancers, often due to lifestyle factors - poor diet, smoking, and lack of exercise. More generally the pandemic and subsequent lockdown may have exacerbated their physical and mental health. Many people with SMI either live alone or in shared community residential settings, and the closure of community-based rehabilitation centres during the pandemic, and absence of community activities, can exacerbate this sense of isolation and loneliness, leading potentially to mental health deterioration. Moreover, a reduction in services may limit access to routine health care including community and hospital psychiatric services. This study will assess the impact of the COVID-19 pandemic and subsequent quarantine on people with SMI, when compared with the general population. We will also assess mortality in this population over the same period. We will examine (1) changes in psychotropic medication use, prescribed to people with SMI over the pandemic period (for example, we cite as indicative dates Mar 2020–September 2021) compared to a pre-COVID-19 period (Mar 2018-June 2019); (2) mortality outcomes for this population over the same periods (Mar 2020-September 2021) compared to a pre-COVID-19 period (Mar 2011-June 2019). Aim: to investigate the health impact of the pandemic and lockdown on those living with Severe Mental Illness. This includes examination of:  prescribing patterns for psychotropic medication across the whole period of interest (2011-2021), with specific focus on comparisons between the pandemic quarantine period and selected pre-COVID-19 periods;  changes in all-cause/cause-specific mortality over the whole study population (2011-2021), focussing on risks associated with (a) multi-morbidity, (b) the range of contextual data provided with the 2011 Census – this will allow us a preliminary examination (determined by the available mortality downloads) of putative changes that may be accounted for by the pandemic/lockdown; and finally,  changes in mortality over the noted periods (2011-2021) - in relation to multimorbidity; medication use and socio-demographic context (note - assumes we can include later downloads of the mortality data).

This study - on the impact of the pandemic and quarantine - is of considerable importance to Health and Social Care research. People with SMI (were and) are socially excluded (Richter & Hoffmann, 2019) and many experience clinical deterioration for reasons not directly related to their diagnosis – for example, the pandemic may exacerbate their symptoms, such as a lack of social contact and long periods of time spent alone with no outside contact may lead to depression increasing their need for treatment and care. While most people with SMI are cared for in the community through primary care and community mental health services, these have since been severely restricted e.g. cancelled appointments, moving appointments to phone calls rather than face-to-face and no home visits meaning the person may have no social contact with anyone. There is, as yet, little evidence on how the pandemic has altered mental health outcomes for this population and how their symptoms have been managed. Moreover, we know that (pre-COVID-19) people with SMI have reduced life expectancy compared to the average population (NICE, 2018). Of note, NICE states that the major causes of death in people with SMI are preventable cardiovascular disease, endocrine disease and respiratory failure (NICE, 2018). Thus, there is a need to examine age and sex-specific outcomes (medication use, treatment and mortality) for people with SMI. This may provide better evidence on disparities, opportunities for early diagnosis, and gaps in screening and treatment. Our study intends to assist policy makers, service providers and health practitioners in addressing this major health gap.

22/10/2021

TRE