Frequent visitors to psychiatric emergency services: Staff attitudes and temporal patterns

Arfken, Cynthia L.; Zeman, Lori Lackman; Yeager, Lindsay; Mischel, Edward; Amirsadri, Alireza

doi:10.1007/bf02287355

Cited by 24 publications

(13 citation statements)

References 26 publications

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“…Most were retired and 87% had at best a high school (or lower) level of education. Although they were by no means the picture of social and financially stability, those < 65 appeared more typical of the "downward drift" type patient often associated with the PES [10,22,34,38,39]. The latter were 75% single/divorced/separated, 49% either receiving welfare, unemployment insurance or some other type of supplementary income and 70% were either renters (rooms or apartments) or living with a family member.…”

Section: Discussionmentioning

confidence: 99%

The elderly in the psychiatric emergency service (PES); a descriptive study

Chaput¹,

Beaulieu

Paradis

et al. 2011

BMC Psychiatry

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BackgroundThe impact of an aging population on the psychiatric emergency service (PES) has not been fully ascertained. Cognitive dysfunctions aside, many DSM-IV disorders may have a lower prevalence in the elderly, who appear to be underrepresented in the PES. We therefore attempted to more precisely assess their patterns of PES use and their clinical and demographic characteristics.MethodsClose to 30,000 visits to a general hospital PES (Montreal, Quebec, Canada) were acquired between 1990 and 2004 and pooled with over 17,000 visits acquired using the same methodology at three other services in Quebec between 2002 and 2004.ResultsThe median age of PES patients increased over time. However, the proportion of yearly visits attributable to the elderly (compared to those under 65) showed no consistent increase during the observation period. The pattern of return visits (two to three, four to ten, eleven or more) did not differ from that of patients under 65, although the latter made a greater number of total return visits per patient. The elderly were more often women (62%), widowed (28%), came to the PES accompanied (42%) and reported « illness » as an important stressor (29%). About 39% were referred for depression or anxiety. They were less violent (10%) upon their arrival. Affective disorders predominated in the diagnostic profile, they were less co-morbid and more likely admitted than patients under 65.ConclusionAlthough no proportional increase in PES use over time was found the elderly do possess distinct characteristics potentially useful in PES resource planning so as to better serve this increasingly important segment of the general population.

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Section: Discussionmentioning

confidence: 99%

The elderly in the psychiatric emergency service (PES); a descriptive study

Chaput¹,

Beaulieu

Paradis

et al. 2011

BMC Psychiatry

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“…One observer (AW) spent over 50 hours in the PER across each of the three shifts per day, each day of the week, and each week of the month in order to account for variation in PER utilisation patterns (Arfken et al 2002, Sobel et al 1998). This observer is best described as having been a ‘ peripheral‐member‐researcher ’ as described in Adler and Adler’s (1994) typology of researcher membership roles.…”

Section: Methodsmentioning

confidence: 99%

Observing the work of an urban safety‐net psychiatric emergency room: managing the unmanageable

Lincoln

White²,

Aldsworth

et al. 2010

Sociology Health & Illness

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Staff in the psychiatric emergency room (PER) have demanding jobs requiring a complex balance between the needs and safety of the individual and the community, systemic resources, and job responsibilities while providing timely, effective care. Little research exists concerning day-to-day work activities of PER staff, their interaction, and their perceptions of their work. This study explored the work of PER staff and the organisational context of the PER work setting.Observations of staff were conducted in the public spaces of a public urban PER using two observational techniques. The first was designed to measure the types of work activities staff engaged in and the time spent in these work activities (work task data). The second technique was the gathering of observational data by a peripheral-member-researcher (participant observation data). Analyses were conducted of both the work task and participant observation data. Results indicate that most PER staff time is spent in administrative and phone tasks, while less than a third is spent on direct clinical work. Four important issues for PER work were identified: a workload that is unmanageable, managing the unmanageable, bogus referrals and dumping and insurance problems. The PER remains the front-line of the medical and social service systems. Work done in these settings is of critical importance; however little attention is paid to the content and nature of the work. Our study demonstrates that staff of the PER face challenges on many levels as they struggle with the task of working with people presenting in psychiatric and social crisis.

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“…However, opinions held by service providers may influence care. Research has shown that certain types of psychiatric manifestations, especially substance use, deliberate self-harm, and suicidal ideation, may meet with a suboptimal response from service providers (Arfken et al, 2002;Betz et al, 2013;Moss et al, 2015;Saunders et al, 2012;Sun, Long, & Boore, 2007; "Survey: ED physicians report burnout, desire help for dealing with frequent users," 2011; Van Boekel et al, 2013). This is problematic as it may lead to negative interactions, marginalization, and low service satisfaction (McCann et al, 2006;Saunders et al, 2012;Sun et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Which skills boost service provider confidence when managing people presenting with psychiatric emergencies?

Poremski

Lim

Kunjithapatham

et al. 2016

Int J Mental Health Nurs

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ABSTRACT:The way service seekers interact with the staff at emergency services has been shown to influence the standard of care, especially in the case of certain psychiatric manifestations. Staff reactions to psychiatric complaints have been linked to their comfort dealing with these types of service users as well as their competencies understanding the illness. It is therefore vital to understand which skills increase confidence in treating psychiatric emergencies.Twenty-six open-ended convergent interviews were conducted with staff working in a psychiatric emergency department. Thematic analysis was used to analyze the data. Participants reported several non-technical skills which developed from exclusively serving people with psychiatric emergencies: 1) Vigilance allowed staff to be sensitive to minor changes in behavior which precede psychiatric emergencies. 2) The ability to negotiate and find tangible solutions was particularly important when dealing with psychiatric complaints which may not have tangible resolutions.3) The ability to appraise social support networks allowed staff to plan follow-up actions and ensure continuity of care when support was available. 4) The ability to self-reflect allowed participants to learn from their experience and avoid burnout, frustration, and fatigue. Participants also reported several other clinical skills which they gained during training, including teamwork, de-escalating techniques and risk assessment. Tentatively speaking, these skills improve staff's confidence when treating psychiatric emergencies. Certain skills may be generalized to staff working in medical emergency departments who frequently encounter psychiatric complaints.

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Frequent visitors to psychiatric emergency services: Staff attitudes and temporal patterns

Cited by 24 publications

References 26 publications

The elderly in the psychiatric emergency service (PES); a descriptive study

The elderly in the psychiatric emergency service (PES); a descriptive study

Observing the work of an urban safety‐net psychiatric emergency room: managing the unmanageable

Which skills boost service provider confidence when managing people presenting with psychiatric emergencies?

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