(562) Untoward Effects of COVID on Mental Health in a Tertiary Burn Unit: Four Self-immolation Burns

Introduction: Burn Intensive Care Units (BICU)s are resource-heavy and labor-intensive units with very sick patients. COVID revolutionized telehealth resources in primary care facilities to enable physicians to provide care while limiting the exposure of personnel and the public to COVID-19. However, already strained mental health resources continued to lag. Patients in need of mental health care often turn to unorthodox means of seeking help, including self-immolation in times of acute suicidality without access to resources for support. Emergency departments and primary care facilities become safe havens for patients in need of psychiatric treatment. We aimed to describe four patients seen in one month in our burn center with self-immolation burns.

Methods: Patients were identified using the Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted to the BICU between May 8th, 2022 to June 7, 2022, were included. Demographics, length of stay (LOS), co-morbid conditions, and mortality were evaluated.

Results: There were 4 patients seen within one month with self-immolation burns. Three of the four were male. The median age was 49 (27-62). All patients were Black. Seventy-five percent survived. The average percentage of total body surface area involved was 23% (+/- 26%). One patient required amputation due to extent of his burn injury. One patient absconded from the hospital without completing care for her burn or her mental crisis. Despite having inpatient psychiatry consultations and involuntary commitment paperwork for all four patients, only one patient met the criteria for inpatient psychiatric admission after completing his burn treatment. This patient then remained in the burn center for 8 additional days awaiting inpatient psych placement due to the lack of available psychiatric beds in the region.

Conclusions: A lack of access to mental health providers and resources does not indicate a lack of need. Burn centers may become the new safe haven for patients with profound mental health needs. If injuries are survivable, patients may still not have an appropriate disposition, taking up valuable burn center beds while delaying more intensive psychiatric care.