CRIS provides authorised researchers with regulated, secure access to anonymised information extracted from South London and Maudsley NHS Foundation Trust electronic clinical records system. It helps researchers look at real-life situations on a large scale. This means it's easier to see patterns and trends, like what treatments work for some and don't work for others.
In this blog, originally published on the NIHR Maudsley BRC site on 7 April 2020,Professor Robert Stewart, academic lead for the CRIS data resource since its development in 2007-8, discusses the consequences of COVID-19 on mental health services.
The COVID-19 pandemic is likely to have wide and unforeseen consequences across health sectors. These include potentially profound effects on mental health and mental health services. CRIS has an important role to play in helping us understand these effects and improve care, but we need to act fast.
To begin with, there are the direct effects of the virus itself which seems to cause more severe illness in people with other health conditions, particularly cardiovascular and respiratory diseases. These conditions are more common in many people with mental health disorders who may therefore be more vulnerable to viral pneumonia and its consequences.
This situation is accompanied by the dramatic changes in our mental health services that have occurred over only a few weeks – due to staff sickness or self-isolation, cases of COVID-19 on inpatient units, the growing pressures on our neighbouring hospitals, and the need to minimise face-to-face contact while infection risk is still high.
Finally, there is the impact of the national lockdown. Many people receiving mental health services are already lonely, already in a precarious financial position, and/or already at risk from others around them. All of these may make self-isolation hard or intolerable.
We know very little of how these situations will affect people using South London and Maudsley NHS Foundation Trust (SLaM) services, and the pandemic has happened so quickly that there is little relevant information from anywhere else in the world. Also, most national information on health and healthcare is made available many months after it was collected, and so can’t help us evaluate the last few weeks.
A key advantage of CRIS is that its information is updated from source healthcare records every 24 hours. This provides a near-unique opportunity to understand events and their impact as they happen.
Since the lockdown began only 3-4 weeks ago, we have worked to turn around our research activity and focus this on the pandemic and its consequences for people using mental health services. As well as setting up a number of studies now underway, we have prioritised a series of initiatives to improve the usefulness of CRIS data. These include seeking permission for regular updates from our Acute Trust partners on emergency or hospital care by SLaM service users over the pandemic period, as well as making good use of the CRIS data linkage already set up with local GP records.
Initiatives also include natural language processing (‘text mining’) work to capture information on COVID-19 symptoms, on the health conditions that may place people at risk, on levels of social isolation being experienced, and on the effects that this may have on health and wellbeing.
Achieving this turn-around in capability has been helped substantially by an award from the recent King’s Together call for COVID-19 relevant initiatives, a call which is also funding CRIS work to support research into COVID-19 infection and maternity outcomes through the MRC eLIXIR platform.
However, most important of all has been the dedication and flexibility of the CRIS team who have not only kept pre-existing CRIS projects up and running during this period of lockdown and virtual meetings, but have also worked tirelessly to ensure that CRIS is maximally able to answer the many urgent questions facing UK mental healthcare now and in the weeks ahead.