Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation

Fleury, Marie-Josée; Imboua, Armelle; Grenier, Guy

doi:10.1007/s10597-024-01239-w

Community Ment Health J

2024

DOI: 10.1007/s10597-024-01239-w

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Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation

Marie-Josée Fleury,

Armelle Imboua,

Guy Grenier

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2024

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Cited by 3 publications

References 72 publications

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Reasons Explaining High Emergency Department Use in Patients With Mental Illnesses: Different Staff Perspectives

Fleury,

Ferland,

Farand

et al. 2024

Int J Mental Health Nurs

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For patients with mental illnesses (MIs), emergency departments (EDs) are often the entry point into the healthcare system, or their only resort for quickly accessing mental health treatment. A better understanding of the various barriers justifying high ED use among patients with MIs may help recommend targeted interventions that better meet their needs. This explorative qualitative study aimed to identify such barriers and the solutions brought forth to reduce ED use based on the perspectives of clinicians and managers working in EDs, other hospital departments or the community sector. Interviews were conducted between April 2021 and February 2022; 86 mental health professionals (22% were nurses) from four large urban ED sites in Quebec (Canada) were interviewed. Barriers were identified in relation to patient profiles, healthcare system and organisational features and professional characteristics. The key barriers that were found to explain high ED use were patients having serious MIs (e.g., psychotic disorders) or social issues (e.g., poverty), lack of coordination and patient referrals between EDs and other health services, insufficient access to mental health and addiction services and inadequacy of care. Very few solutions were implemented to improve care for high ED users. Better deployment of ED interventions in collaboration with outpatient care may be prioritised to reduce high ED use for patients with MIs. Improvements to the referral and transfer processes to outpatient care, particularly through care plans and case management programs, may be implemented to reduce high ED use and improve outpatient care among patients with multiple health and social needs.

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Reasons Explaining High Emergency Department Use in Patients With Mental Illnesses: Different Staff Perspectives

Fleury,

Ferland,

Farand

et al. 2024

Int J Mental Health Nurs

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Emergency Department Use among Patients with Mental Health Problems: Profiles, Correlates, and Outcomes

Fleury,

Cao,

Grenier

2024

IJERPH

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Patients with mental health (MH) problems are known to use emergency departments (EDs) frequently. This study identified profiles of ED users and associated these profiles with patient characteristics and outpatient service use, and with subsequent adverse outcomes. A 5-year cohort of 11,682 ED users was investigated (2012–2017), using Quebec (Canada) administrative databases. ED user profiles were identified through latent class analysis, and multinomial logistic regression used to associate patients’ characteristics and their outpatient service use. Cox regressions were conducted to assess adverse outcomes 12 months after the last ED use. Four ED user profiles were identified: “Patients mostly using EDs for accessing MH services” (Profile 1, incident MDs); “Repeat ED users” (Profile 2); “High ED users” (Profile 3); “Very high and recurrent high ED users” (Profile 4). Profile 4 and 3 patients exhibited the highest ED use along with severe conditions yet received the most outpatient care. The risk of hospitalization and death was higher in these profiles. Their frequent ED use and adverse outcomes might stem from unmet needs and suboptimal care. Assertive community treatments and intensive case management could be recommended for Profiles 4 and 3, and more extensive team-based GP care for Profiles 2 and 1.

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Enhancing Emergency Room Mental Health Crisis Response: A Systematic Review of Integrated Models

Katiki,

Ponnapalli,

Desai

et al. 2024

Cureus

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scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

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Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation

Cited by 3 publications

References 72 publications

Reasons Explaining High Emergency Department Use in Patients With Mental Illnesses: Different Staff Perspectives

Reasons Explaining High Emergency Department Use in Patients With Mental Illnesses: Different Staff Perspectives

Emergency Department Use among Patients with Mental Health Problems: Profiles, Correlates, and Outcomes

Enhancing Emergency Room Mental Health Crisis Response: A Systematic Review of Integrated Models

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