Skip to main content Accessibility help
×
Home
Hostname: page-component-99c86f546-n7x5d Total loading time: 0.33 Render date: 2021-11-28T02:26:28.940Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Mental health service demand during the Summer Olympics: literature review

Published online by Cambridge University Press:  02 January 2018

Dominic Dougall*
Affiliation:
Gordon Hospital, London, UK
Cornelius Kelly
Affiliation:
St Charles Hospital, London, UK
Masum Khwaja
Affiliation:
Gordon Hospital, London, UK
*
Dominic Dougall (dominic.dougall@nhs.net)
Rights & Permissions[Opens in a new window]

Abstract

Aims and method

Estimates of the impact of the London 2012 Olympic Games on general health service demand have been made. However, there are no formal estimates for mental health demand. Our aim was to conduct a review to identify data on mental health service demand during the previous ten Summer Olympics.

Results

Eight relevant papers were identified. Little has been published on mental health demand; however, available data suggest demand will not substantially increase.

Clinical implications

NHS London has no pan-London strategy for mental health services during the Olympics. This may not be unreasonable given the lack of evidence for increased demand during previous Olympics. However, high bed occupancy rates in mental health units in London and other strains on resources may amplify the impact of even small increases in demand on services.

Type
Review Article
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2012

The XXX Summer Olympiad and XIV Summer Paralympic Games will run for a 9-week period from 27 July to 9 September 2012. Several million visitors, 15 000 athletes and 14 000 officials will attend from over 200 countries. 1,2 Increased demand on health services in the six host boroughs in north east London has been projected to be 5.07% during the Olympics and 3% during the Paralympic Games. 3 Across London each National Health Service (NHS) trust has been requested to provide assurances to NHS London and the Department of Health regarding preparation for the Games. A comprehensive review of public health systems employed in previous games describes the surveillance systems that were implemented. Reference Enock and Jacobs4 These systems became more robust from the 1990s onwards. However, this review did not describe data collected from surveillance and no reference was made to mental health. Although no specific projections for mental health service usage have been made, the potential for London 2012 to attract people with a mental illness has been acknowledged. 5 Similarly, the potential for fixated persons to travel has also been noted. In light of the uncertainty over potential mental health demand, we aimed to review data from previous Summer Olympics on general health service and mental health service demand specifically.

Method

We limited our search to the previous ten Summer Olympic and Paralympic Games. Papers relating to other mass gatherings were not sought as there is no comparable event matching the size, duration and concentration of visitors attending the Summer Olympics. Differences in the demographics of those attending other mass gatherings are likely, which could decrease the validity of any comparison.

An electronic search of MEDLINE, EMBASE, CINAHL, PsycINFO and Health Business Elite databases was conducted. The following terms were linked by the Boolean operator ‘OR’: olympic games, paralympics games, olympi*, Beijing Olympic games, Beijing Olympic games 2008, Beijing olympi* (with key words repeated for each host city Athens, Sydney, Atlanta, Barcelona, Seoul, Los Angeles, Moscow, Montreal and Munich as described for Beijing) and combined with the following terms by ‘AND’: public health, mental health, disease distribution, psychiatric disorder, psychiatry, psych*, which were linked by ‘OR’. The search was limited to humans and years 1970-2012.

Titles and abstracts were screened by one author (D.D.) to identify English-language papers reporting disease surveillance or health service usage during Summer Olympic and Paralympic Games from the Munich 1972 Olympics onwards. Articles that did not report data or illness trends were not included. Papers retrieved from the initial screen were reviewed by two authors (D.D. and M.K.). Agreement was reached over the inclusion of the papers without the need to refer to a third author. A bibliographic search of all retrieved articles and NHS London policy documents was also conducted.

Results

Our initial search returned 614 papers, with 8 papers identified as relevant. The summary of the selection of papers is described in Fig. 1. The eight retrieved papers related to five of the previous ten Olympics (Table 1). Reference Liang, Lan, Chen, Zhang, Lü and Lü6-Reference Indig, Thackway, Jorm, Salmon and Owen13 No relevant papers for the Barcelona, Seoul, Moscow, Montreal and the Munich Olympics were identified.

FIG. 1 Summary of the selection of papers.

TABLE 1 Summary of evidence

Games, author and year Recorded cases of all health
conditions, total n
Change in general health
service demand
Mental health demand, n
Beijing 2008
    Liang et al (2011)Reference Liang, Lan, Chen, Zhang, Lü and Lü 6 Olympic period: 22 029
Paralympic period: 8046
Change in demand not
stated
Neuropsychiatric presentations
Olympics: 878
Paralympics: 85
    Dapeng et al (2010)Reference Dapeng, Ljungqvist and Troedsson 7 Olympic hospitals: 3567
Other hospitals: 314
Admissions: 128
Polyclinic: 22 137
Comparable with the
equivalent 2007 period
Presentations at the polyclinic: 33
No presentations at Olympic
designated hospitals
Athens 2004
    Tsouros & Efstathiou
    (2007)Reference Tsouros and Efstathiou 8
Olympic period: 10 564
Paralympic period: 3546
No change
(communicable disease)
Olympics: 16
Paralympics: <10
Sydney 2000
    Jorm et al (2003)Reference Jorm, Thackway, Churches and Hills 9 Emergency department presentations
over 38 days (Olympic period and 3
weeks prior): 55 339
Overseas visitors: 1431
5% increase No reference to mental health
    Indig et al (2003)Reference Indig, Thackway, Jorm, Salmon and Owen 13 Illicit drug use presentations over 38
days (Olympic period and 3 weeks
prior): 424
Illicit drug use increased by
over 50% compared with
the corresponding period
No reference to mental health
comorbidity
Atlanta 1996
    Wetterhall et al (1998)Reference Wetterhall, Coulombier, Herndon, Stephanie and Cantwell 10 Encounters over the 30-day monitoring
period: 44 142
Comparable with previous
years
No recorded mental health
admissions
Los Angeles 1984
    Weiss et al (1988)Reference Weiss, Mascola and Fannin 11 Not stated Decreased No reference to mental health
    Baker et al (1986)Reference Baker, Simone, Niemann and Daly 12 Cases at 9 event sites: 5516
Cases of drug or alcohol ingestion: 8
Not stated No recorded mental health
admissions

Data reported by all papers originated from centralised health surveillance systems in place during the Olympics period. Health service provision was coordinated by the respective games organising committees with a similar model of health service provision adopted; this included Olympic village polyclinics, medical or first aid stations and Olympic designated sentinel hospitals. The system of data collection was broadly the same, with healthcare professionals required to complete a medical encounter form detailing the nature of the presentation, either in paper or electronic form, which was then collated centrally.

General health service utilisation was reported in detail for the Beijing, Athens, Sydney, Atlanta and Los Angeles Olympics. Reference Liang, Lan, Chen, Zhang, Lü and Lü6-Reference Baker, Simone, Niemann and Daly12 Specific reference to mental health demand was only made in relation to the Beijing and Athens Olympics. Reference Dapeng, Ljungqvist and Troedsson7,Reference Tsouros and Efstathiou8 A single paper detailing drug and alcohol demand was also retrieved. Reference Indig, Thackway, Jorm, Salmon and Owen13

A large number of neuropsychiatric presentations were recorded during Beijing 2008, however the nature or severity of these presentations was not specified. Reference Liang, Lan, Chen, Zhang, Lü and Lü6 An earlier World Health Organization paper did not report any mental health presentations to Olympic designated hospitals, but did report 33 psychiatric encounters at the Olympic village polyclinic, comprising 0.1% of presentations. Reference Dapeng, Ljungqvist and Troedsson7 This suggests the neuropsychiatric presentations were either primarily neurological, less severe psychiatric disorders or both. Athens reported a similarly small number of mental health consultations, consisting of 0.2% of all presentations. Reference Tsouros and Efstathiou8

Sydney was the only host city to experience an increased demand for general health services, which itself was a modest 5% higher compared with the preceding year. Reference Jorm, Thackway, Churches and Hills9 An increase in presentations due to illicit drug use was also reported. Reference Indig, Thackway, Jorm, Salmon and Owen13 Surprisingly, psychiatric comorbidity, which can be associated with such presentations, was not reported.

A particularly extensive hospital monitoring system was employed during the Los Angeles Games, including 46 hospitals, 24 Olympic first aid stations and the three Olympic polyclinics. Reference Weiss, Mascola and Fannin11 Remarkably, a decreased demand for general health services was experienced. No data on psychiatric presentations were reported, although it was not clear whether psychiatric presentations were recorded as part of the monitoring system. A more limited report focusing on nine Olympic sites recorded the reasons for hospital admission, of which there were none for psychiatric disorders. Reference Baker, Simone, Niemann and Daly12

Discussion

The NHS 2012 Programme does not have a pan-London strategy for mental health planning for the Games. Modelling specific to mental health service demand has not been conducted. Prima facie this may not be imprudent, as data from previous Olympics do not suggest there will be a substantial rise in demand for mental health services. There may even be a decrease. However, the lack of data may be more reflective of monitoring practices, priorities in health surveillance systems or variations in service models resulting in people with mental illness being less likely to access or be referred to services.

Difficulty in estimating visitor numbers to the Games adds further uncertainty. Modelling by the Office for National Statistics suggests there will be an additional 510 000 visitors in London each day during the Games period. 3 This projection needs to be cautioned, as predictions for visitor numbers for previous games have been unreliable. Post hoc estimates of visitor numbers show large variations in attendance between games. This variation is likely to be multifactorial, with sociopolitical, cultural and geographical determinants. Both Sydney and Athens received fewer visitors than expected, with Beijing experiencing a 30% reduction of overseas visitors in contrast with the predicted increase. 14 Indeed, there is increasing evidence for displacement of visitors to London, with data published by the European Tour Operators Association in November 2011 indicating that bookings for the 16-day Olympic period were down 95%. 15

London may be considered unique when compared with recent host cities, as it is already well established as one of the most visited cities in the world, accommodating large numbers of visitors. Foreign visitor numbers to Beijing in 2008 were in the region of 4-5 million over the year. 16 In London during the third quarter of 2010 alone (corresponding with the Olympic months of July to September) there were a total of 4.24 million overseas visitors. 17 Greater accessibility through the proximity to the large population density of Europe, with cheap, visa-free travel also contrasts with other recent host cities.

Other factors may also mean mental health demand does not substantially rise during the Games period. The Olympics will run for a relatively short period in relation to the time course of mental illness and visitors are unlikely to stay for long periods and may only hold a ticket for a single event, resulting in a visit lasting only a few days. The incidence of new episodes of mental illness or recurrence of pre-existing illness may therefore be expected to be low. The demography and levels of affluence of visitors attending the Olympics may be different to the profile of regular visitors, due to the need to fund higher travel and accommodation costs. A corollary may also be that private mental health services are accessed in preference to public services. The combination of increased security and cost may also reduce the rate of unplanned travel that can be associated with mental illness, such as impulsive travel in the context of acute mania or other psychoses, which has been the authors’ experience working in central London.

Evidence from the football World Cup indicates that the UK's team performance may positively or negatively have an impact on morbidity. However, we are cautious in extrapolating this evidence to the Olympics as it is open to debate whether the Olympics will garner a level of passion comparable with the World Cup. A study of German football fans found that when they watched their own team they had higher pulse rates and blood pressures than when they watched other teams. Reference Reppel, Franzen, Bode, Weil, Kurowski and Schneider18 Acute cardiovascular events were found to be doubled during a stressful match. Reference Wilbert-Lampen, Leistner, Greven, Pohl, Sper and Völker19 More positively, when a team did well the rate of myocardial deaths fell. Reference Berthier and Boulay20 Notably the suicide rate fell in France during the football World Cup in 1998, which the French team won, with the greatest fall in men aged between 30 and 44. Reference Encrenaz, Contrand, Leffondré, Queinec, Aouba and Jougla21

Implications

The possibility that demand may not dramatically rise does not mean mental health trusts in London can be complacent. High rates of bed occupancy in mental health units may magnify the impact of even small increases in demand for in-patient treatment. 22 Decreased availability of transport, access to embassy support and interpreting services, may increase the length of in-patient stays and the overall burden on units. Antisocial behaviour or behaviour secondary to drug and alcohol misuse may also be misattributed to mental health disorders and lead to greater demand on assessment and liaison services in particular.

The NHS London guidance recommends ‘business as usual’ during London 2012. 23 Although this seems appropriate given the evidence, the degree of uncertainty may make the maxim ‘business as unusual’ more astute.

Footnotes

Declaration of interest

None.

References

1 Olympic Delivery Authority. Transport Plan for the London 2012 Olympic and Paralympic Games: Summary. First Edition. ODA, 2007.Google Scholar
2 London Organising Committee of the Olympic Games and Paralympic Games (LOCOG). Everyone's Games: A Guide to the London 2012 Olympic Games and Paralympic Games. LOCOG, 2010 (www.london2012.com/about-us/publications/publication=everyone-s-games/).Google Scholar
4 Enock, KE, Jacobs, J. The Olympic and Paralympic Games 2012: literature review of the logistical planning and operational challenges for public health. Public Health 2008; 122: 1229–38.CrossRefGoogle Scholar
6 Liang, X-y, Lan, L, Chen, W-n, Zhang, A-p, , C-y, , Y-w, et al. Disease distribution and medical resources during the Beijing 2008 Olympic and Paralympic Games. Chin Med J 2011; 124: 1031–6.Google ScholarPubMed
7 Dapeng, J, Ljungqvist, A, Troedsson, H. The Health Legacy of the 2008 Beijing Olympic Games: Successes and Recommendations. World Health Organization, 2010 (http://www.wpro.who.int/publications/PUB_9789290614593/en/index.html).Google Scholar
8 Tsouros, AD, Efstathiou, PA. Mass Gathering Preparedness: The Experience of the Athens 2004 Olympic and Para-Olympic Games. World Health Organization, 2007 (http://www.euro.who.int/__data/assets/pdf_file/0009/98415/E90712.pdf).Google Scholar
9 Jorm, LR, Thackway, SV, Churches, TR, Hills, MW. Watching the Games: public health surveillance for the Sydney 2000 Olympic Games. J Epidemiol Community Health 2003; 57: 102–8.CrossRefGoogle ScholarPubMed
10 Wetterhall, SF, Coulombier, DM, Herndon, JM, Stephanie, S, Cantwell, JD. Medical care delivery at the 1996 Olympic Games. JAMA 1988; 279: 1463–8.Google Scholar
11 Weiss, BP, Mascola, L, Fannin, SL. Public health at the 1984 Summer Olympics: the Los Angeles County experience. Am J Public Health 1988; 78: 686–8.CrossRefGoogle ScholarPubMed
12 Baker, WM, Simone, BM, Niemann, JT, Daly, A. Special event medical care: the 1984 Los Angeles Summer Olympics experience. Ann Emerg Med 1986; 15: 185–90.CrossRefGoogle ScholarPubMed
13 Indig, D, Thackway, S, Jorm, L, Salmon, A, Owen, T. Illicit drug-related harm during the Sydney 2000 Olympic Games: implications for public health surveillance and action. Addiction 2003; 98: 97102.CrossRefGoogle ScholarPubMed
14 European Tour Operators Association (ETOA). Olympic Hotel Demand. ETOA Report 2010. ETOA, 2010 (http://www.etoa.org/docs/olympics-reports/2010_etoa-olympic-report_update.pdf).Google Scholar
15 European Tour Operators Association (ETOA). London Set to Suffer 95% Leisure Tourism Slump during Olympic Games. ETOA, 2011 (http://www.etoa.org/news/2011/11/07/london-set-to-suffer-95-leisure-tourism-slump-during-olympic-games).Google Scholar
16 European Tour Operators Association (ETOA). Beijing Olympic Update. ETOA, 2009 (http://members.etoa.org/Pdf/Report_BeijingOlympicsUpdate_amended.pdf).Google Scholar
17 London & Partners. Overseas Visits, Q3 2010. London & Partners, 2010 (http://vlstatic.com/l-and-p/assets/media/london_overseas_visits_q3_2010.pdf).Google Scholar
18 Reppel, M, Franzen, K, Bode, F, Weil, J, Kurowski, V, Schneider, SA, et al. Central hemodynamics and arterial stiffness during the finals of the world cup soccer championship 2010. Int J Cardiol 2011; Dec 21 (Epub ahead of print).Google Scholar
19 Wilbert-Lampen, U, Leistner, D, Greven, S, Pohl, T, Sper, S, Völker, C, et al. Cardiovascular events during World Cup soccer. New Engl J Med 2008; 358: 475–83.CrossRefGoogle ScholarPubMed
20 Berthier, F, Boulay, F. Lower myocardial infarction mortality in French men the day France won the 1998 World Cup of football. Heart 2003; 89: 555–6.CrossRefGoogle ScholarPubMed
21 Encrenaz, G, Contrand, B, Leffondré, K, Queinec, R, Aouba, A, Jougla, E, et al. Impact of the 1998 football World Cup on suicide rates in France: results from the national death registry. Suicide Life Threat Behav 2012; 42: 129–35.CrossRefGoogle ScholarPubMed
22 Mental Health Act Commission. Coercion and Consent, Monitoring the Mental Health Act 2007-2009. The Mental Health Act Commission Thirteenth Biennial Report 2007–2009. TSO (The Stationery Office), 2009.Google Scholar
Figure 0

FIG. 1 Summary of the selection of papers.

Figure 1

TABLE 1 Summary of evidence

Submit a response

eLetters

No eLetters have been published for this article.
You have Access
Open access
1
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Mental health service demand during the Summer Olympics: literature review
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Mental health service demand during the Summer Olympics: literature review
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Mental health service demand during the Summer Olympics: literature review
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *