Reshaping mental health care delivery during the COVID-19 pandemic: service response and telepsychiatry in a catchment area of 10 million people

Background Detailed information on the effects of the COVID-19 pandemic on large public health systems is lacking. Here we describe the overall functioning of a regional network comprising 58 community mental health centres (CMHCs), which covers a catchment area of approximately 10 million people. Methods We employed a registry–based approach to summarize descriptive information on demographic and clinical data retrieved from all CMHCs over a two–year period, grouped according to the provinces of Lombardy in Italy. We then described the progression of all subtypes of remote vs. in-person consultations across provinces after the onset of the pandemic, and calculated remote/face–to–face service delivery ratios according to gender, age and main diagnosis. Results Compared to the previous year, the largest drop of outpatient contacts was recorded in provinces that were most affected by the early impact of the viral outbreak, peaking in March and May 2020 (-21.89% and -16.86% respectively). A progressive increase of telepsychiatry interventions was observed diffusely, reaching a peak of almost one every four consultations. Remote/face–to–face ratios were significantly higher in females across all age and diagnostic subgroups, in patients from lower age groups and with diagnoses of Eating and Obsessive–Compulsive disorders. Conclusions Our study is the first to describe the impact of the pandemic on a large public mental health system. Future research on service uptake and cost–effectiveness of blended remote delivery should be tailored to service users of different age groups and clinical diagnoses to optimize organization of services.