Adult mental health community new cases appears to decrease during the COVID-19 period
The Victorian Agency for Health Information (VAHI) supplies some mental health service performance by consumer age groups (VAHI, 2020). However, there is limited information on measures regarding the mental health service usage in Victoria during COVID-19 despite some media outlets reporting on no spikes in suicide rates in Victoria during COVID-19 when compared to the last year (ABC News Corporation, 2020; The Age, 2020). We wanted to examine whether there was any publicly available health services data to examine how demand for mental health services (whether acute and/or community) have changed during the COVID-19 period in Victoria.
Data was scraped from the Microsoft Word documents published on the health.vic mental health performance reports website (Victoria State Government, 2020) and only community mental health data appeared to have relevant case volume related measures, i.e. new case rate. The inpatient data did not appear to have relevant measures to explore case volumes. There was generally a decrease in the new case rate across the health services between 2019 20 Q2 (Oct 2019 to Dec 2019) and 2019 20 Q3 (Jan to Mar 2020) with 13 out of the 17 (76.5%) adult mental health community services experiencing a decreasing number of cases opened in 2019 20 Q3. However, the overall new case rate at the state level (“Total Metro”) appears to remain relatively stable through the quarters.
The decrease in the new case rate could have represented the service planning decisions within the affected catchments to potentially reduce the opening of cases for new clients in the community. This coincides with specific COVID-19 restrictions on activities combined with physical distancing rules enacted around the end of Feb 2020 and early Mar 2020. The slight decline in the new case rate is likely influenced by, and not limited to, a combination of health services applying risk mitigation strategies and a potentially lower propensity of the population to seek mental health help due to the restrictions.
The relationship between the average length of case and the new case rate, perhaps unsurprisingly, is consistently negative and strongly linear across the quarters. Note the small sample of health services reported. This suggests that an increase in the new case rate represents potentially represents natural closure of case management processes to alleviate resourcing burden as new clients enter the community mental health services. The R squared value, for example, in 2019 20 Q3 was 0.593 only partially explaining the variation in the new case rate. Length of case is influenced by multiple factors from clinical case complexity to workforce availability and more data is required to explore further the possible added operational pressures of increased new cases.
Interestingly, the correlogram between the various community mental health measures reported indicates a moderate correlation (positive) between the percentage of open community cases where the consumer was concurrently on a Community Treatment Order (CTO) (Var9) and the percentage closed community cases where the consumer had a new community case opened within 6 months of case closure (Var1). This was ony statistically significant in quarters related to Jan-Jul 2020. It is possible that there a higher number of patients under involuntary treatment orders (and potentially re-referred to community mental health services) contributing to a higher new case rate. However, no conclusion is made about whether the COVID-19 situation in Victoria was a precipitating factor, among many, to the increased percentage of individuals on a CTO. Furthermore, there is likely to be catchment-level and individual-level factors that drive the number of patients placed on the CTO which are not captured by this analysis.
The source code for this analysis can be found in the below GitHub repository.
ABC News Corporation. (2020, August 27). No spike in suicide rates in victoria during covid-19 lockdowns, coroners court figures show. Retrieved from https://www.abc.net.au/news/2020-08-27/no-spike-in-suicide-rates-in-victoria-during-covid-19-lockdowns/12602060
The Age. (2020, August 27). No increase in victorian suicide rate as calls to helplines surge in pandemic. Retrieved from https://www.theage.com.au/national/victoria/no-increase-to-victorian-suicide-rate-during-covid-19-pandemic-20200827-p55pr9.html
VAHI. (2020). Victorian health services performance - mental health. Retrieved from https://vahi.vic.gov.au/reports/victorian-health-services-performance/mental-health
Victoria State Government. (2020). Mental health performance reports. Retrieved from https://www2.health.vic.gov.au/mental-health/research-and-reporting/mental-health-performance-reports