The impact of the COVID-19 pandemic and quarantine on people with Severe Mental Illness (SMI) in Northern Ireland: an examination of prescribed psychotropic medication and mortality between Census 2011 and 2021

From March 2020 individuals, wider society and health care systems have all been seriously affected by the COVID-19 pandemic (WHO, 2020). It is likely that the pandemic has more severely impacted on people with prior mental health problems: generally research suggests that, pre-pandemic, people with Severe Mental Illness (SMI) (here we include schizophrenia, bi-polar disorder and major depressive disorder) could expect to experience considerable social exclusion, poor physical health and die up to 20 years earlier than the general population (Walker et al, 2015, NICE, 2018). They are also vulnerable to conditions such as diabetes (T2), cardiovascular disease (CVD), stroke and cancers, often due to lifestyle factors – poor diet, smoking, and lack of exercise (Lawrence et al, 2013). More generally the pandemic and subsequent lockdown may have exacerbated their physical and mental health. Many people with SMI either live alone or in shared community residential settings, and the closure of community-based rehabilitation centres during the pandemic, and absence of community activities, can exacerbate this sense of isolation and loneliness, leading potentially to mental health deterioration. Moreover, a reduction in services may limit access to routine health care including community and hospital psychiatric services.

This study will assess the impact of the COVID-19 pandemic and subsequent quarantine on people with SMI, when compared with the general population. We will also assess mortality in this population over the same period.

We will examine (1) changes in psychotropic medication use, prescribed to people with SMI over the pandemic period (for example, we cite as indicative dates Mar 2020–September 2021) compared to a pre-COVID-19 period (Mar 2018-June 2019); (2) mortality outcomes for this population over the same periods (Mar 2020-September 2021) compared to a pre-COVID-19 period (Mar 2018-June 2019).

Note: COVID-19 mortality itself is not of specific interest here. What is at issue is the impact of the pandemic on those with SMI, part of which includes mortality outcomes, and changes to prescribing patterns over the pandemic period (for a more schematic view see the BSO data description below).

Aim: to investigate the health impact of the pandemic and lockdown on those living with Severe Mental Illness. This includes examination of:

• prescribing patterns for psychotropic medication across the whole period of interest (2011-2021), with specific focus on comparisons between the pandemic quarantine period and selected pre-COVID-19 periods;
• changes in all-cause/cause-specific mortality over the whole study population (2011-2021), focussing on risks associated with (a) multi-morbidity, (b) the range of contextual data provided with the 2011 Census – this will allow us a preliminary examination (determined by the available mortality downloads) of putative changes that may be accounted for by the pandemic/lockdown; and finally,
• changes in mortality over the noted periods (2011-2021) – in relation to multimorbidity; medication use and socio-demographic context (note – assumes we can include later downloads of the mortality data).