A quarter of century after: The changing ecology of psychiatric emergency services

Chen, Wen‐Hao; Hsieh, Ming H.; Liao, Shih‐Cheng; Liu, Chen-Chung; Liu, Chih-Min; Wu, Chi‐Shin; Lin, Yuanqing; Hwang, Tzung‐Jeng; Chien, Yi‐Ling

doi:10.1111/appy.12487

Cited by 3 publications

(5 citation statements)

References 29 publications

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“…Increases between 1988 and 2014 in Taiwan were driven by visits related to trauma and stressor-related disorders, depressive disorders, and suicide attempts. 5 In contrast, in Denmark, the number of MSUD ED visits decreased from 1985 to 2012. 6 Where data are available, research in Canada appears to coincide with patterns observed in the USA, with upward trends primarily reflecting increases in anxiety disorders and substance use disorders.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

“…Internationally, literature points to increasing ED visits across varied populations and contexts 3–8. In the USA, ED visits by adults with MSUD increased by over 30% between 2006 and 2015, primarily due to alcohol use disorder, followed by mood and anxiety disorders 7.…”

Section: Introductionmentioning

confidence: 99%

“…In other settings, findings differ in terms of what is driving ED use and/or the direction of changes in rates of ED use. Increases between 1988 and 2014 in Taiwan were driven by visits related to trauma and stressor-related disorders, depressive disorders, and suicide attempts 5. In contrast, in Denmark, the number of MSUD ED visits decreased from 1985 to 2012 6…”

Section: Introductionmentioning

confidence: 99%

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Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

et al. 2022

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ObjectivesInformation on emergency department (ED) visits for mental and substance use disorders (MSUDs) is important for planning services but has not been explored in British Columbia (BC), Canada. We describe all MSUD ED visits for people ages 15 and older in the province of BC in 2017/2018 and document trends in MSUD ED visits between 2007/2008 and 2017/2018 by disorder group.DesignPopulation-based linked administrative data comprised of ED records and physician billings capturing all MSUD ED visits in BC.SettingBC is Canada’s westernmost province with a population of approximately 5 million. Permanent residents receive first-dollar coverage for all medically necessary services provided by licensed physicians or in hospitals, including ED services.PopulationAll people age >15 with MSUD ED visits during the study period.MeasuresAll claims with a service location in the ED or corresponding to fee items billed only in the ED were examined alongside ED visits reported through a national reporting system. Patient characteristics (sex/gender, age, location of residence, income, treated disorders and comorbidities) and previous outpatient service use for all ED visits by visit diagnosis are also described.ResultsA total of 72 363 people made 134 063 visits to the ED in 2017/2018 for needs related to MSUD. MSUD ED visits have increased since 2010, particularly visits for substance use and anxiety disorders. People with more frequent visits were more likely to be male, on public prescription drug plans for income assistance, prescribed psychiatric medications, and living in lower-income neighbourhoods. They used more community-based primary care and psychiatry services and had lower continuity of primary care.ConclusionsMSUD ED visits are substantial and growing in BC. Findings underscore a need to strengthen and target community healthcare services and adequately resource and support EDs to manage growing patient populations.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

et al. 2022

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“…In Australia, the number of ED visits concerning mental health issues increased between 2004/2005 and 2016/2017, largely due to psychoactive substance abuse which involves drugs or other substances that affect mood, awareness, thoughts, feelings, or behavior such as alcohol, caffeine, nicotine, and certain pain medicines, etc., followed by anxiety and mood disorders [ 8 ]. Between 1988 and 2014, Taiwan saw a rise in visits to ED associated with depression disorders, suicide attempts, as well as trauma and stressor-related disorders, which are emotional and behavioral problems that may be caused by childhood traumatic and stressful experiences [ 9 ]. On the basis of available data, research in Canada is consistent with trends in the USA, with anxiety disorders and substance abuse disorders showing the most upward trends [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

2023

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Background: The number of readmissions to the emergency department (ED) for mental health services each year is significant, which increases healthcare costs and negatively affects the morale and quality of life of patients and their families. Object: This scoping review aimed to establish a better understanding of interventions that have been implemented to reduce psychiatric patient readmission and ED use within the ED, to identify areas for improvement, and therefore to assist in the development of more effective actions in the future. Method: The scoping review was conducted on several bibliographic databases to identify relevant studies. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria. Using Covidence software, 26 out of 6951 studies were eligible for inclusion in this scoping review based on the PRISMA checklist. Data were extracted, collated, summarized, presented, and discussed. Result: This review identified 26 studies which examined interventions aimed to reduce ED visits, such as the High Alert Program (HAP), the Patient-Centered Medical Home (PCMH), the Primary Behavioral Health Care Integration (PBHCI), and the Collaborative Care (CC) Program, etc. Twenty-three of the studies were conducted in North America, while the rest were conducted in Europe and Australia. A total of 16 studies examined interventions directed to any mental health conditions, while the rest addressed specific health conditions, such as substance use disorders, schizophrenia, anxiety, depression. Interventions involved comprehensive and multidisciplinary services, incorporation of evidence-based behavioral and pharmacological strategies, and emphasized the case management that was found to be effective. Additionally, there was a marked consideration for diverse mental health groups, such as those with substance use disorder and of young age. Most interventions showed a positive effect on reducing psychiatric ED visits. Conclusion: Various initiatives have been implemented worldwide to reduce the number of emergency department visits and the associated burden on healthcare systems. This review highlights the greater need for developing more accessible interventions, as well as setting up a comprehensive community health care system aiming to reduce frequent ED presentations.

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Assessing emergency physicians' competency gaps in caring for acute psychiatric emergencies: a comparative analysis of self-perceived confidence and performance against training program expectations

Chen,

Chaou,

et al. 2024

BMC Med Educ

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Background The increasing trend of patients with mental health conditions seeking emergency care is a global phenomenon. Numerous studies have emphasized the importance of emergency physicians' ability to recognize and manage psychiatric emergencies, both for patient well-being and societal safety nets. With the growing demand for emergency care related to mental health conditions, it is crucial to assess whether emergency physicians possess sufficient confidence and capabilities to adapt to these changes. Against this backdrop, our study aimed to explore the factors influencing emergency physicians' management of acute psychiatric emergencies and to critically evaluate whether current training programs adequately align with societal expectations for psychiatric emergency care. Methods A cross-sectional survey, disseminated online by the Taiwan Society of Emergency Medicine, targeted 936 attending physicians and 449 residents in 43 Resident Review Committee approved training hospitals in winter 2021. The questionnaire covered participant demographics, skill requirements, and confidence in managing acute psychiatric patients independently. Statistical analyses included descriptive statistics, chi-square tests, medians (IQRs), and Wilcoxon rank-sum tests. Results Out of 229 participants, 63.8% were attending physicians, and 81.7% were affiliated with medical centers. Psychiatrists led 69.9% of emergency psychiatric training curricula, and 66.8% reported that their clinical psychiatric training outcomes were assessed by psychiatrists. Clinical seniority, training hospital level, and the average number of patients with an acute psychiatric presentation seen in a daily shift influenced physicians' self-reported confidence in managing acute psychiatric patients independently. Medical center training improved capability in managing psychiatric emergencies in the elderly, while encountering a higher average number of patients with an acute psychiatric presentation seen in a daily EM shift was associated with better performance, especially in managing specific populations. Conclusions Our nationwide study highlights how clinical seniority, training hospital level, and patient volume per shift influence emergency physicians' confidence in managing acute psychiatric patients. However, there remains room for improvement, particularly in addressing the needs of specific patient populations. These findings underscore the importance of refining training curricula to bridge these gaps and enhance the quality of psychiatric emergency patient care.

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A quarter of century after: The changing ecology of psychiatric emergency services

Cited by 3 publications

References 29 publications

Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

Assessing emergency physicians' competency gaps in caring for acute psychiatric emergencies: a comparative analysis of self-perceived confidence and performance against training program expectations

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