Although frequently underestimated, psychiatric emergency consultations account for a significant share of all emergency department visits. It has also been established that these consultations have increased over the last years, and more particularly since the COVID-19 pandemic in 2020.
This thesis focuses on five original publications. The first four studies investigate different dimensions of visits to our local psychiatric emergency department (ED) at the Geneva University Hospitals (HUG). These dimensions are: characteristics and sociodemographic factors of patients consulting before the COVID-19 pandemic, changes to these characteristics during the pandemic, effects of lockdown measures on clinical manifestations, and fears reported by patients during and after the lockdown periods. The fifth study examines the effects of the pandemic on admissions to the psychiatric department of the HUG.
The findings of these articles show a decrease of consultations in our psychiatric ED during the pandemic, associated with more severe psychopathologies and involuntary hospitalisations. Loneliness was a contributing factor to ED admissions. When the lockdown measures were lifted, we observed an increase in total consultations, as well as in suicidal behaviour and psychomotor agitation as reasons for admission. A notable increase in involuntary hospitalisations was also observed. During the pandemic, especially vulnerable populations, such as the young and the elderly, expressed fears including “fears of getting sick” and feelings of hopelessness. Regarding psychiatric department admissions, a decrease in hospitalisations during the pandemic was also noted and was associated with a higher proportion of involuntary hospitalisations and a greater use of coercive measures.
The repercussions of the pandemic and its long-term consequences on mental health have had a considerable impact on our daily work at the psychiatric ED and at the psychiatric department of the HUG. In light of these findings, it is evident that different clinical training and teaching programmes are needed, not only for psychiatrists, but also for somatic and prehospital healthcare workers in the ED. Moreover, future research should continue to focus on the socioeconomic characteristics of patients who visit the psychiatric ED to develop adequate mental healthcare and outpatient services designed to meet the specific needs in the Canton of Geneva.
