Psychiatric Emergencies in the Community: Characteristics and Outcome in Switzerland

Abstract

Psychiatric emergencies occur frequently in the community setting, e.g. the patient’s home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical records of consultations classified as psychiatric emergencies of a 24/7 service of community-based emergency physicians. Information on sociodemographic, clinical and situational factors was extracted. The observation period was 6 months in 2017. Binary logistic regression was used to examine predictors for involuntary admissions. Most emergency consultations (64.5%) took place at the patient’s home, followed by police stations (31.0%), public places (3.2%), and somatic hospitals (1.3%). Patient characteristics and reasons for consultation varied considerably between the locations. The first involved person was commonly a relative. Of all consultations, 38.4% resulted in involuntary admissions, mainly in patients with psychosis, suicidality, aggression, refusal of necessary treatment and previous involuntary admissions. Situation-related factors and the involvement of relatives were no significant predictors of the outcome. Psychiatric emergencies occur in different places and in patients with a variety of psychiatric symptoms. Although half of the emergency situations were resolved in the community, the rate of involuntary admissions was still high. For additional reduction, the further development of quickly available alternatives to psychiatric inpatient treatment is required. These should be specifically geared towards acute situations in patients with the described risk factors. Additionally, the role of relatives during psychiatric emergencies should be further studied.

The ability of Psychosocial Care Centers specialized in Alcohol and Drugs to handle crises

“…Among the users admitted in different crises, 13.4% required external referral, which evidenced the ability of the services to handle these situations in their own territory. This result is corroborated by international studies, which evidenced that most of the crisis demands in mental health are solved by community services or specialized teams in the community ( 4 , 20 ) . As an example, a study in Switzerland identified 12.7% of referrals for hospitalization ( 20 ) .…”

“…This result is corroborated by international studies, which evidenced that most of the crisis demands in mental health are solved by community services or specialized teams in the community ( 4 , 20 ) . As an example, a study in Switzerland identified 12.7% of referrals for hospitalization ( 20 ) . We did not find studies that evaluated the CAPS AD III’s ability to handle crises.…”

“…Intoxication due to the use of AOD is one of the demands that most justifies clinical or psychiatric referral of users assisted in crisis in the community services, accounted for between 28.4% and 40% of the cases ( 14 , 20 ) . In addition to that, referrals often occur directly to hospitals without the patients receiving any other type of care ( 21 ) .…”

“…Intoxication due to the use of AOD is one of the demands that most justifies clinical or psychiatric referral of users assisted in crisis in the community services, accounted for between 28.4% and 40% of the cases (14,20) .…”

Knowledge and attitude towards home treatment among referring healthcare professionals and self-referring patients to a psychiatric hospital: Better information is needed

“…Hospital physicians might further benefit from services of consultation- liaison psychiatry in their hospital who have a valid overview on the mental healthcare structures in the region (Evans et al, 2019). Related to emergency physicians, knowledge of HT might be helpful as well to prevent IA in circumstances were outpatient treatment seems to be not sufficient and inpatient treatment is refused by the patient (Mötteli et al, 2021). In addition, patients should also be informed about the HT option (for instance at the beginning of their inpatient treatment through the clinics’ triage team) as most of them do not know the existence of HT services, but have a positive attitude towards this approach.…”