gms | German Medical Science

Background: The COVID-19 pandemic was (and is) a challenge for the mental health care system: Shifts in offer and utilization occurred, the system had to deal with SARS-CoV-2 infections of patients and hospital staff and vaccination of at-risk groups with mental illness is highly important to prevent the mortality gap to further widen.

Research question and objective: In the egePan project within the German Network of University Medicine (NUM) the COVID ᴪ studies aimed for evidence on changes in offer and utilization as well as challenges, problems and good-practice solutions in the mental health care system during the pandemic. What lessons can we learn from the results for post-pandemic mental health care?

Method: The COVID ᴪ ambulant study surveyed outpatient psychiatrists covering the first 3 high incidence phases (HIP) in spring 2020, winter 2020/2021 and spring 2021.The COVID ᴪ Psychiatry study surveyed head of departments of psychiatric inpatient providers and the COVID ᴪ psychosomatics study head of departments of psychosomatic providers in Germany covering the first 2 HIPs. The COVID Psy Vac study examined vaccination rates in a representative sample of hospitalized mentally ill people in 10 psychiatric inpatient facilities in August 2021. The COVID-ᴪ -routine data studies examined routine data on changes in utilization in the German outpatient and inpatient statutory health insurance system and guideline-conformity of care sequences during the first two HIPs.

Results: The first HIP saw large drops in utilization, the second HIP went along with to a lesser degree reduced utilization. Reduced utilization was mainly conceived as related to general protection and to creating capacities for patients with severe mental illness and co-morbid SARS-CoV-2 infection. Perceived problems were losses of contact, deteriorations, exacerbations and suicide attempts that were seen as related to reduced capacities and insufficient outpatient alternatives because of the rigidly sectorized mental health care system in Germany. Outpatient psychiatrists saw an increase in demand over the course of pandemic and already in summer 2021 50% had consultations for long-COVID-cases. In summer 2021 vaccination rates among hospitalized people with mental illness were lower than in the general population but vaccination offerings by mental health care institutions could close this gap.

Discussion: In the first HIP mental health inpatient institutions probably over-reduced capacities, whereas in later HIPs infected patients became a growing problem. Capacity reductions had in some cases problematic consequences because of insufficient outpatient alternatives due to the sectorized system. Outpatient providers reports of increasing demand underline the impact of social and society politics on mental health. All mental health care providers should offer vaccination for at-risk populations.

Practical implications: The pandemic highlights the need for more integrated mental health care system and better data-driven governance.

Appeal for practice: For the management of challenges like the current COVID-19 pandemic as well as in post-pandemic care a more integrated system and a better data-driven monitoring of routine care is needed.

Funding Sonstige Förderung; BMBF: NUM egePan Unimed Grant-No.: 01KX2021