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BACKGROUND:Italy retains a distinctive organization of mental health services according to a community-based model of care with a multidisciplinary team serving a well-defined catchment area under the coordination of the local department of mental health. The coronavirus disease 2019 (COVID-19) pandemic is forcing Italian mental health services to develop new organizational strategies at all levels of care in order to face the associated challenges.AIM:To explore factors associated with changes in psychiatric admissions to an inpatient psychiatric unit located in Lombardia Region, Italy.METHODS:All hospital admissions (n = 44) were recorded to an inpatient psychiatric unit during a three month national lockdown in Italy in 2020 and compared with those occurring over the same time period in 2019 (n = 71). For each admission, a 20-item checklist was completed to identify factors leading to admission. Statistical analyses were performed using Statistical Package for Social Sciences for Windows, release 11.0. Chi-square test (or Fisher's exact test) and Mann-Whitney U-test were applied, where appropriate.RESULTS:Hospital admissions dropped by 38% during the COVID-19 pandemic. No significant differences were found in demographics, clinical variables associated with hospital admissions and length of stay between 2019 and 2020. Compared with 2019, a significantly greater proportion of hospital admissions in 2020 were related to difficulties in organizing care programs outside the hospital (chi-square = 4.91, df 1, one-way P = 0.035) and in patients' family contexts (chi-square = 3.71, df 1, one-way P = 0.049). On the other hand, logistic and communication difficulties pertaining to residential facilities and programs were significantly more common in 2019 than in 2020 (chi-square = 4.38, df 1, one-way P = 0.032).CONCLUSION:Admissions to the inpatient psychiatric unit dropped significantly during the COVID-19 pandemic in 2020, with difficulties in organizing care programs outside the hospital and in patients' family contexts occurring more frequently compared with 2019.

readmission to hospital. In a recent King’s Fund report, Collins sets out the challenges of conceptualising mental health outcomes, writing that many physical health traumas have a clear path to recovery and a reasonably clear shared sense of priorities. ‘In the care of people with mental health conditions, and perhaps people with other chronic conditions, there is a much broader range of sometimes contested objectives.’ We need to ensure that these different perspectives are accommodated within the process of evaluating productivity and efficiency. Inevitably this means that our optimising problem becomes multidimensional in nature. It is therefore quite possible that allocating resources in particular ways may improve outcomes in one domain while degrading those in other areas. However, there may also be situations characterised by ‘pareto-dominance’, whereby outcomes can be improved in one area without a negative impact elsewhere.

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