One-fifth of patients attending hospital from hotel quarantine suffered mental health emergencies

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One-fifth of patients who attended an emergency department from hotel quarantine were suffering from mental health emergencies rather than Covid-19, research led by the Royal Prince Alfred hospital in Sydney has found.

Researchers conducted a retrospective study of emergency department presentations by patients referred from special health accommodation quarantine hotels in Sydney during 1 June to 30 September 2020.

They found that of 2,774 people registered for accommodation in the hotels, 461 presented at least once to the Royal Prince Alfred emergency department, with 542 emergency presentations in total.

Of those, 13 patients (2.8%) were diagnosed with Covid‐19, none of whom required intensive care.

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But the most frequent emergency department diagnosis category was mental health, with 102 presentations, or 19% of health hotel quarantine patients who presented to emergency. This is five times the proportion for all emergency department presentations in Australia (3.6%).

The most frequent reasons for mental health presentations were anxiety, suicidal ideation and acute psychosis. A significant proportion – 15% – presented to emergency for cardiovascular conditions.

The findings, published in the Medical Journal of Australia, are the first to assess the impact of mental health during hotel quarantine in Australia. The authors wrote that “it highlights the need for increased psychological support and other services for people in quarantine”.

Prof Alexandra Martiniuk, an epidemiologist with the University of Sydney school of public health, said many of those in the study did have pre-existing mental health needs.

“Also we need to consider why people were travelling and in quarantine in June through to September 2020. Was it due to death or severe illness in the family, or returning from a country with high burden of Covid? Those are all possible contributing factors to high rates of anxiety and suicidal ideation.

“That said, quarantine may certainly exacerbate poor mental health and of course we can do more to improve it.”

The final report into Victoria’s hotel quarantine system, tabled in December, included evidence from Pam Williams of the Department of Health and Human Services. She “noted that those returned travellers who initially arrived were mainly business travellers or people returning from an overseas holiday,” the report said.

“As time went on, and the commonwealth repatriated Australian citizens who may have been living overseas, the cohort changed to include ‘more families with young children, people with diverse languages and cultures, and [those with] complex medical and mental health issues.”

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There has been at least one confirmed case of a person dying by suicide in the hotel quarantine system.

In April last year, a person in one of the first hotel quarantine intakes in Melbourne died in a South Wharf hotel room.

But more than a year later, the Victorian state coroner has confirmed that the death is still under investigation and no court hearing dates have been set.

The death is being investigated as a death in custody or care, as the man was being detained under public health measures, meaning it is subject to a mandatory inquest.

It is not subject to a directions hearing within a statutory timeframe, as are deaths in custody which involve police contact.

No hearing dates have been scheduled at this stage.

“As the investigation is ongoing, no further comment can be made,” a coroner’s court spokesperson said.

• In Australia, the crisis support service Lifeline is 13 11 14. In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is at 800-273-8255 or chat for support. You can also text HOME to 741741 to connect with a crisis text line counselor. Other international helplines can be found at www.befrienders.org

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