Comments on a comparative study of access to inpatient psychiatric treatment in a public mental health service in Melbourne during COVID-19

Sir,

We are delighted to know that our paper on the study of inpatient access and treatment during the first COVID-19 lockdown in Melbourne[1] has drawn some interest.

Our study was an observational study aimed at describing the characteristics of patients who used inpatient beds in our service and exploring any changes to certain inpatient-related service provision parameters (length of stay, readmission, type of admission, and seclusion). We have explained that we did not explore reasons behind certain changes (e.g., reduced access of patients with severe mental illnesses) as it was beyond the scope of this work. In addition, we have stated clearly that our study has limitations and there is a need for a prospective study with larger data.

In relation to the question about the reference year, it is not uncommon to use 2019 as a reference year and a select period[2,3] while exploring the effect of COVID-19 pandemic. We selected the period of 6 weeks in 2019 as the control period so that two time periods in 2019 and 2020 would be comparable. We note the suggestion to use a 5-year aggregate data for the control period as ideal. While we agree that more data in the control period could help minimise any time-related variation in epidemiological patterns, it is less useful for data which is for only specified period during the year. A 5-year aggregate is more useful when comparing the data for the entire year. A time series analysis of characteristics of patients in epochs (e.g., 6 weeks or even shorter every 2 weeks), like in another study,[4] rather would be more helpful although this sort of approach will be more challenging when we focus on multiple diagnostic groups.

We would like to state that the interim period between the control and study periods was not marked by any significant changes in service provision or faced with service access issues in our service (e.g., there was no public health event or incident). Furthermore, there was no change in the policy or processes associated with access to and functioning of Broadmeadows Inpatient Psychiatric Unit (BIPU) during the interim period. We attempted to explain this in our discussion that BIPU has two discharges per day as a key performance indicator which meant there was availability of beds on every day basis. There was also no change in the operation of the emergency department or community teams which are the referral sources of BIPU. We would like to bring attention to the readers about the Royal Commission for the Mental Health System in Victoria, a major government initiative to review the functioning of Victorian public mental health services. The Royal Commission is yet to release their final recommendations and hence it has not had any impact on mental health service delivery.

In summary, we would like to highlight that our study has shown certain interesting findings that need further research to understand how lockdowns can impact access to hospital beds. Our current research is focused on comparing the effect of the first 6 months of lockdown and we hope this work will shed more lights on this topic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.