The COVID-19 pandemic has had an enormous impact on both physical and mental health of people around the world.

The aim of the study was to evaluate the number and characteristics of people seeking emergency psychiatric help during combined psychosocial stressful events in March 2020.

Data for 3927 patients seeking emergency psychiatric help were collected and analyzed for the months preceding, during and after lockdown due to COVID-19 pandemic and concomitant earthquake that took place on 22nd March 2020 in Zagreb, and compared with the same months of 2019.

A significant decrease in both the number of visits and admissions to the hospital was found for the month of lockdown. There was a significant decrease in the number of out-patients visits and day hospital admissions. Compared with other months, more women and younger patients sought help. There was a significant rise in the number of patients presenting with suicidal thoughts, as well as a larger percentage of involuntary admissions.

Overall less people sought psychiatric help in the face of an unpredictable acute threat, which was interpreted in the light of prioritizing fear of infection over mental health issues. Alternatively, it is possible that people threatened with immediate danger mobilize short- term compensatory psychological resources which help deal with or put off mental illness. This research was conducted as part of the project of the Croatian Science Foundation CORONA-04-2086 Life in the time of COVID-19-social implications on the security and well-being of vulnerable groups in the European context.

No significant relationships.

Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units.

This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units.

We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies – of Interventions and Risk of Bias in Randomized Trials.

Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI −261.24 to −67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43–0.68; P < 0.001).

Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.