The experiences of individuals with mental illness and addictions who frequently present to hospital emergency departments (EDs) have rarely been explored. This study reports findings from self-reported, quantitative surveys (n = 166) and in-depth, qualitative interviews (n = 20) with frequent ED users with mental health and/or substance use challenges in a large urban centre. Participants presented to hospital for mental health (35 %), alcohol/drug use (21 %), and physical health (39 %) concerns and described their ED visits as unavoidable and appropriate, despite feeling stigmatized by hospital personnel and being discharged without expected treatment. Supporting this population may require alternative service models and attention to staff training in both acute and community settings.

PurposeLong-term childhood cancer survivors may be at increased risk for poor social outcomes as a result of their cancer treatment, as well as physical and psychological health problems. Yet, important challenges, namely social isolation, are not well understood. Moreover, survivors' perspectives of social isolation as well as the ways in which this might evolve through young adulthood have yet to be investigated. The purpose of this research was to describe the trajectories of social isolation experienced by adult survivors of a childhood cancer.MethodsData from 30 in-depth interviews with survivors (9 to 38 years after diagnosis, currently 22 to 43 years of age, 60 % women) were analyzed using qualitative, constant comparative methods.ResultsExperiences of social isolation evolved over time as survivors grew through childhood, adolescence and young adulthood. Eleven survivors never experienced social isolation after their cancer treatment, nor to the present day. Social isolation among 19 survivors followed one of three trajectories; (1) diminishing social isolation: it got somewhat better, (2) persistent social isolation: it never got better or (3) delayed social isolation: it hit me later on.ConclusionsKnowledge of when social isolation begins and how it evolves over time for different survivors is an important consideration for the development of interventions that prevent or mitigate this challenge.Implications for Cancer SurvivorsAssessing and addressing social outcomes, including isolation, might promote comprehensive long-term follow-up care for childhood cancer survivors.

Urgent psychiatric services may be an important part of the continuum of mental health services. Further work is needed to clarify the role of urgent psychiatric services, develop standards or best practices, and evaluate outcomes using rigorous methodologies.

Substance use can be a barrier to stable housing for homeless persons with mental disorders. We examined DSM-IV symptoms among homeless adults (N0497), comparing those who reported daily substance use (DSU) with non-daily substance users. Multivariable linear regression modeling was used to test the independent association between DSU and symptoms using the Colorado Symptom Index total score. DSU was independently associated with higher symptoms (beta03.67, 95 % CI 1.55-5.77) adjusting for homelessness history, age, gender, ethnicity, education, marital status, and mental disorder sub-type (adjusted R 2 00.24). We observed a higher prevalence of DSU in our sample than has been previously reported in a Housing First intervention. DSU was also independently associated with more DSM-IV symptomatology. We have an opportunity to observe this cohort longitudinally and examine if there are changes in substance use based on treatment assignment and commensurate changes in housing stability, community integration, health status, and quality of life.