Association between COVID-19 and inpatient self-harm

To the Editor

There have been mixed reports of the impact of COVID-19 on mental health. Predicted surges in Australian suicide rates have not been observed (Pirkis et al., 2021), but there has been increased demand for mental health services. At a Western Australian 100-bed private psychiatric hospital in West Perth (Perth Clinic), staff anecdotally noted increases in patient severity and the demands on staff due to increased complexity. Since, as part of the ongoing evaluation of the Clinic’s operation, staff routinely collate and report data on all adverse events, it was possible to examine the impact of the period since COVID-19 on adverse events in the Clinic. To do this, we created a mean occurrence of both self-harm incidents (that are reported by staff and recorded in the risk register) and total adverse events (i.e. falls, self-harm, medication errors) for the 4 years (2014–2018). Against this mean, we compared the percentage change in total adverse events and self-harm for the 12-month period before and after the onset of COVID-19 in Western Australia (defined as when the first lockdown occurred). As expected, the rate of total incidents fluctuated around the mean, such that it was −7% below the 5-year average before COVID-19 and 2% after the onset of COVID-19. In contrast, while self-harm incidents were 8% above the 5-year average in the year before the arrival of COVID-19, the rate of self-harm increased to 107% in the year after the arrival of COVID-19. This increase resonates with the staff perceptions of the increase in the severity of patients presenting since COVID-19 and to the degree that self-harm is a risk factor for subsequent suicide, and the data suggest that psychiatrists would be prudent to continue to monitor for long-term mental health impacts of COVID-19.