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COVID-19 publications


CRIS has been an integral part of our research into the COVID-19 pandemic. 

The COVID-19 pandemic is likely to have wide and unforeseen consequences across health sectors. These include potentially profound effects on mental health and mental health services. CRIS has an important role to play in helping us understand these effects and improve care, but we need to act fast. 

Since the lockdown began the CRIS team have worked to turn around research activity and focus this on the pandemic and its consequences for people using mental health services.

As well as setting up a number of studies now underway, they have prioritised a series of initiatives to improve the usefulness of CRIS data. These include seeking permission for regular updates from the Acute Trust partners on emergency or hospital care by SLaM service users over the pandemic period, as well as making good use of the CRIS data linkage already set up with local GP records.

Read Professor Robert Stewart's blog on CRIS in the time of coronavirus to see more about how CRIS is being used. 

Pre-print publications

Preprints publications are research papers that have not been peer-reviewed or accepted by traditional academic journals. The benefits of pre-prints are that study information and data can be made publically available in a shorter timeframe however findings and conclusions have not been reviewed by other independent scientists as they would in a post-print published journal paper. 


Pre-print publications

Mental health service activity and mortality during COVID-19 lockdown among individuals with: neurodevelopmental disorders and personality disorders

October 13 and September 14 2020

Authors: Evangelia Martin, Eleanor Nuzum, Matthew Broadbent and Robert Stewart

Lockdown and social distancing due to COVID-19 are likely to have had widespread impacts on mental healthcare service provision and use. In these two studies, our researchers quantify activity for individuals with neurodevelopmental disorders and personality disorders.

Comparing periods before and after the 16th March 2020:

  • For neurodevelopmental disorders (January to July 2020): Mean number of accepted referrals decreased by 32% and caseloads were reduced in all specific services. Overall, total caseload numbers remained relatively unchanged with a 6% decrease, although inpatient numbers were reduced more substantially by 22% because of discharges made in the early period of lockdown.
  • For personality disorders (January to May 2020): Daily caseloads showed reductions across services while mean daily deaths increased by 28%. There was a large 36% decrease in the number of accepted referrals and a small 4% decrease in the number of discharged patients and in total caseload. A marked decrease in inpatient admissions of 43% was seen while a smaller decrease in inpatient discharges (by 14%) accompanied a decrease by 23% in the total number of inpatients for diagnostic group.
  • Daily numbers of deaths had increased in both groups during the March to May period: by 28% in people with personality disorders, and by over 280% in people with neurodevelopmental disorders. In common with reports for other service user groups, contacts with many services had moved substantially from face-to-face to virtual arrangements.

Professor Robert Stewart says: "We wanted to describe the experiences of both of these groups because they are often a little lost in general mental healthcare statistics.

Both groups clearly experienced substantial changes in their contacts with mental healthcare over what was a challenging period.

The higher mortality rates are clearly very concerning and need further attention, particularly as we enter a second wave of the pandemic."


Comparison of mental health service activity before and shortly after UK social distancing responses to the COVID-19 pandemic: February-March 2020

September 28 2020

AuthorsRobert Stewart, Evangelia Martin, Ioannis Bakolis, Matthew Broadbent, Nicola Byrne, Sabine Landau

This study describes early changes in mental health service activity before and after social distancing for COVID-19 was implemented, by comparing activity before and after 16 March 2020 up to the end of March for:

  1. inpatient admissions, discharges and numbers
  2. contact numbers and daily caseloads (Liaison, Home Treatment Teams, Community Mental Health Teams
  3. Numbers of deaths for past and present patients.

Daily caseloads fell for all services, apart from working age and child/adolescent community teams. All grouped liaison, home treatment and community mental health services had substantially reduced face-to-face patient contacts, with variable and only partial compensatory increases in non-face-to-face contacts.

Inpatient numbers fell 13.6% after 16th March, and daily numbers of deaths increased by 61.8% during that period.

Professor Robert Stewart says:

"We are putting this information in the public domain, as it describes a very early point in the first wave of the pandemic which presented substantial challenges to mental healthcare. We were pleased to be able to turn around the manuscript very rapidly at the time, although had less satisfactory experiences with conventional publication routes which have been influential in the alternative means of dissemination being trialled on this site."


Excess mortality in mental health service users during the COVID-19 pandemic described by ethnic group: South London and Maudsley data.

14 July 2020

AuthorsProfessor Robert StewartMatthew Broadbent and Jayati Das-Munshi

The COVID-19 pandemic has been accompanied by excess all-cause mortality at a national level. CRIS researchers previously described a 2.4-fold excess mortality in past and present SLaM service users during the period of the pandemic from 16 March to 15 May 2020 to that for the same period in 2019. In this pre-print our researchers compared mortality within specific ethnic groups.

When examined by recorded ethnicity, the ratio of total deaths between the two years was highest at 3.33 in Black African/Caribbean patients and those from other ethnic groups at 2.63, compared to 2.47 in White British patients.

Considering premature deaths (age at death below 70), 2020:2019 ratios were 3.07 for other ethnic groups and 2.74 for Black African/Caribbean patients compared to 1.96 for White British patients.

Professor Robert Stewart says

"Unfortunately these figures speak for themselves and show the sizeable inequalities in mortality that have been described at a national level. I could say that the results are unsurprising, but then perhaps the problem is that we’ve stopped feeling surprised. Clearly this is as much a challenge for SLaM as for everywhere else."


Using past and current data to estimate potential crisis service use in mental healthcare after the COVID-19 lockdown: South London and Maudsley NHS Trust data

30 June 2020

Authors: Professor Robert Stewart and Matthew Broadbent

The CRIS team have estimated service use by those most likely to receive crisis care in the 12 months following UK COVID-19 policy on 16 March 2020.

Comparing data from 16 March 2015-19 the CRIS team found that over 80% of crisis days at SLaM were accounted for by inpatient care, 75% were used by patients who were current or recent Trust patients at the start of follow-up, and highest numbers were used by patients with a previously recorded schizophreniform disorder diagnosis.

For current/recent patients on 16 March there had been substantial reductions in use of inpatient care in the following 31 days in 2020 but no significant change in total non-inpatient contact numbers.

Professor Robert Stewart says:

"The wealth of information in the health record is allowing us to learn from previous years what we might expect in the year ahead. Taking advantage on the 24-hour updates from CRIS, we are putting in place monitoring processes to warn us early if demand on particular services moves beyond that previous experienced."


Mental health service activity during COVID-19 lockdown: South London and Maudsley NHS Trust data on working age community and home treatment team services and mortality from February to mid-May 2020

16 June 2020

Authors: Professor Robert Stewart, Evangelia Martin and Matthew Broadbent

This paper describes daily caseloads and contact numbers (face-to-face and virtual) for home treatment teams (HTTs) and working age adult community mental health teams (CMHTs) from 1 February to 15 May 2020 at SLaM.

The CMHTs sector showed relatively stable caseloads and total contact numbers, but a substantial shift from face-to-face to virtual contacts, while HTTs showed the same changeover but reductions in caseloads and total contacts (although potentially an activity rise again during May).

The number of deaths for the two months between 16 March and 15 May were 2.4-fold higher in 2020 than 2019, with 958 excess deaths.

Professor Robert Stewart says:

“While it is reassuring to see that the mortality in SLaM service users has fallen back to 2019 levels, the number of deaths from March to May are still clearly concerning.

We believe that the excess mortality is higher than would be expected in the general population, reflecting the vulnerability of mental healthcare service users to this and potential future outbreaks."