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Reshaping mental health care delivery during COVID-19: a register-based study on service response and telepsychiatry

Nature Mental Health volume 1, pages 514–523 (2023)Cite this article

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Abstract

Detailed information on the effects of the coronavirus disease 2019 pandemic on large public health systems is lacking. Here we describe the overall functioning of a regional network comprising 58 community mental health centres, which covers a catchment area of approximately 10 million people. We employed a registry-based approach to summarize descriptive information on demographic and clinical data retrieved from all community mental health centres over a 2-year period, grouped according to the provinces of Lombardy in Italy. We then described the progression of all subtypes of remote versus in-person consultations across provinces after the onset of the pandemic and calculated remote/face-to-face service delivery ratios according to gender, age and main diagnosis. Compared with the previous year, the largest drop in outpatient contacts was recorded in provinces that were most affected by the early impact of the viral outbreak, peaking in March and May 2020 (−21.89% and −16.86%, respectively). A progressive increase in telepsychiatry interventions was observed diffusely, reaching a peak of almost one every four consultations. Remote/face-to-face ratios were significantly higher in females across all age and diagnostic subgroups, in patients from lower age groups and with diagnoses of eating and obsessive–compulsive disorders. Our study is the first to describe the impact of the pandemic on a large public mental health system. Future research on the service uptake and cost-effectiveness of blended remote delivery should be tailored to service users of different age groups and clinical diagnoses to optimize the organization of services.

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Fig. 1: Modification of all consultations delivered in CMHCs of Lombardy grouped by province and expressed as percentage variation between 2020 and 2019.
Fig. 2: Progression from January to December 2020 of the use of telepsychiatry in CMHCs of Lombardy grouped by province and expressed as percentage of total consultations (remotely + face-to-face).
Fig. 3: Heat map of Lombardy with each province coloured according to the percentage of consultations performed remotely during 2020.

Data availability

Raw de-identified mental health care data from the central regional system are available upon reasonable request by writing to the corresponding author, after approval of Struttura Salute Mentale, Dipendenze, Disabilità e Sanità Penitenziaria, Regione Lombardia, Italy. Raw geographical packages (including shape files) can be retrieved from https://www.geoportale.regione.lombardia.it/download-dati. Population density data can be retrieved from https://www.asr-lombardia.it/asrlomb/it/14017comuni-superficie-territoriale-popolazione-residente-media-e-densit%C3%A0-media-al-3112-italia. Regional COVID-19 epidemic data can be retrieved from https://www.epicentro.iss.it/coronavirus/bollettino/Bolletino-sorveglianza-integrata-COVID-19_21-luglio-2020_appendix.pdf. Crude mortality rate variations can be retrieved from the following National Institute of Statistics (ISTAT) web portals: https://public.tableau.com/app/profile/istat.istituto.nazionale.di.statistica/viz/Andamentodeidecessi2015-2022_mar/Andamentodeidecessi?publish=yes and https://www.istat.it/it/files/2020/05/Istat-ISS_-eng.pdf. Environmental air quality data can be retrieved from https://www.eea.europa.eu/themes/air/urban-air-quality/european-city-air-quality-viewer.

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Acknowledgements

We thank all members of the Società Italiana di Psichiatria–Sezione Regionale Lombarda (SIP.Lo) and V. Cuman of the Azienda Regionale per l’Innovazione e gli Acquisti (ARIA SpA). We thank Sasha D’Ambrosio for his precious contribution to the revision of the main study figures.

Author information

Authors and Affiliations

  1. Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy

    Barbara Giordano, Orsola Gambini & Armando D’Agostino

  2. Department of Mental Health and Addiction, ASST, Lodi, Italy

    Giancarlo Cerveri & Chiara Cibra

  3. Psychiatric Unit 1, Azienda ULSS 9 Scaligera, Verona, Italy

    Simona Tomassi

  4. Struttura Salute Mentale, Dipendenze, Disabilità e Sanità Penitenziaria, Regione Lombardia, Italy

    Vanna Poli & Paola Sacchi

  5. Department of Psychiatry, University of Oxford, Oxford, UK

    Andrea Cipriani

  6. Department of Biomedical and Clinical Sciences Luigi Sacco, Università degli Studi di Milano, Milan, Italy

    Bernardo Dell’Osso

  7. Department of Mental Health and Addiction, ASST Fatebenefratelli Sacco, Milan, Italy

    Bernardo Dell’Osso

  8. CRC ‘Aldo Ravelli’ for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy

    Bernardo Dell’Osso & Orsola Gambini

  9. Department of Neurosciences and Mental Health, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Paolo Brambilla

  10. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy

    Paolo Brambilla

  11. Department of Health Sciences, Università degli Studi di Milano, Milan, Italy

    Orsola Gambini & Armando D’Agostino

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Contributions

A.C., A.D’A., G.C., S.T. and V.P. contributed to the development of the study concept and design. A.D’A. and B.G. collaborated to analyse the data. A.D’A. and B.G. developed the conceptual framework of the paper. B.G. wrote the first draft of the paper and prepared the figures. A.C., B.D’O., G.C., O.G. and P.B. contributed to critical revision of the paper. V.P. and P.S. provided administrative, technical and material support. O.G. and P.B. provided supervision and mentorship. All authors contributed to the interpretation of results and approved the final version of the report. The corresponding author (A.D’A.) attests that all the listed authors meet the authorship criteria and that no others meeting the criteria have been omitted.

Corresponding author

Correspondence to Armando D’Agostino.

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Nature Mental Health thanks Stefano Barlati, Marta Bosia and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Supplementary Tables 1a,b and 2 and Figs. 1a,b, 2, 3, 4, 5 and 6.

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Giordano, B., Cerveri, G., Tomassi, S. et al. Reshaping mental health care delivery during COVID-19: a register-based study on service response and telepsychiatry. Nat. Mental Health 1, 514–523 (2023). https://doi.org/10.1038/s44220-023-00089-x

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