The finding:
In this Irish study, authors describe how CL psychiatrists in Ireland collaborated with multiple stakeholders to change psychiatric care delivery models at four study sites. These sites represent different practice settings in Ireland. Authors describe four workflows starting when patients or referring providers first contact the mental health services leading to triage and finally the subsequent care in community, emergency department and or inpatient care. In summary, this study provides a country-wide administrative perspective of how stakeholders reorganized C-L psychiatry practice, a reorganization where urgency of the situation acted as a catalyst for the change.

Strength and weaknesses:
One key strength is that this study provides a national perspective of how c-l psychiatry reorganized when it was forced to adapt to COVID-19 pandemic. However, just as we have seen with rapid adoption of telehealth across practice settings, these re-engineered care models will be useful not only for dealing with future pandemics and related emergencies but also in rethinking of existing models to allow clinicians to provide efficient care. One limitation is that results may not be generalizable to all settings, especially to settings with limited resources. Regrettably lack of mental health resources is an issue even in developed countries. For example, in this study authors describe concerning disparities in staffing levels in Ireland. Nonetheless, several components of the care delivery described in the article are relevant to a broader audience and settings. Finally, this study did not provide information about pediatric C-L services.    

Relevance:
Several clinicians and administrators will find the workflow redesign and collaboration among multiple stakeholders relevant as they themselves redesign existing workflows at their own institutions or think about future mitigation plans for crisis management. Providers who may find this helpful includes C-L psychiatrists, clinicians participating in quality improvement and system/service line design and hospital and community administrators.  

Type of study (EBM guide):
Case series or report