As COVID-19 restrictions start to ease, psychiatrists have warned that a surge in mental illness presentations to health services is now looking "increasingly likely".

According to the College of Psychiatrists of Ireland (CPI), an initial lull in referrals back in March when the pandemic first began has now been replaced by a "worrying increase in referrals, urgent and acute presentations to specialist mental health services and relapses".

In order to get a better picture of the impact of COVID-19 on mental health services, the CPI carried out a survey of its members. Almost 200 consultant psychiatrists responded, including general adult psychiatrists, child and adolescent psychiatrists, and psychiatrists of later life.

The survey revealed that, as expected, the majority of psychiatrists (68%) saw an initial lull in referrals to mental health services following the ‘lockdown' announced on March 27.

This was attributed to patients not attending their GPs, as well as the impact of cocooning.

However, it also found that the reduction in community referrals "was balanced by a steady rate of referrals to the Emergency Department". Some child and adolescent psychiatrists also noted an increase in referrals prior to the cancellation of the State exams and in children with co-morbid autism.

Meanwhile, when the past month of the lockdown was compared to the first, the survey found that the number of new referrals to secondary mental health services had increased significantly.

"While this could naturally be expected to occur given the fall off in referrals during the initial month of the lockdown, 35% of consultants reported the number of new referrals had increased or significantly increased compared to even from before the lockdown.

"In addition to new referrals to services, consultants also identified that the number of referrals of patients already attending their services experiencing a relapse of mental illness had also increased or significantly increased compared to the first month of the lockdown," the CPI noted.

While again, this may have been expected, "50% of consultants believed referrals of patients experiencing a relapse in mental illness had increased or significantly increased compared to before the lockdown".

The survey also revealed that compared to the first month of the lockdown, many psychiatrists reported a big increase in the number of emergency referrals. For example, 64% dealt with emergency referrals that required action that day or within hours.

"Compared to the first month of the lockdown, consultants identified that the number of referrals had increased or significantly increased across a range of presentations including self harm/suicidal ideation, new onset depression, relapse of depression, generalised anxiety, panic attacks/panic disorder, eating disorders and new onset or relapse of psychotic disorders," the CPI said.

When it came to suicidal ideation/self-harm, the majority of consultants said that the number of cases they were seeing in the past month had increased or significantly increased compared to before the lockdown.

Furthermore, 14% of psychiatrists said that more lethal methods were being used in acts of self-harm.

Overall, around 80% of psychiatrists felt that social isolation and reduced access to face-to-face secondary mental health supports was contributing to emergency presentations.

Additional factors such as reduced access to local counselling supports and GPs, abuse/neglect in the home environment and increased reliance on drugs/alcohol were also believed to be contributing to emergency presentations.

The impact of school closures was also highlighted as a major source of stress.

"Although a longer period to gather more data is needed, as predicted, an increase in presentations and incoming pressure on the mental health services is clearly arising, and concerns about the impact of this on an already overburdened, underdeveloped mental health service in Ireland are chief among consultant psychiatrists and their teams," commented CPI president, Dr William Flannery.

The CPI added that this mental health curve that is now emerging needs to be "urgently addressed and flattened by the incoming government with a national multi-sectorial taskforce, clear leadership and doubling of the funding to mental health services required".