The Impact of Integrating Crisis Teams into Community Mental Health Services on Emergency Department and Inpatient Demand

Abstract

This investigation focused on the impact of integrating crisis team members into community mental health services on emergency department and adult mental health inpatient unit demand within an Australian public health service. Mixed methods were used including (a) the comparison of service use data with that of two other comparable services (both of which had community-based crisis teams), (b) surveys of (i) patients and carers and (ii) staff, and (c) focus groups with staff. The numbers of emergency department presentations with mental health conditions and adult mental health inpatient separations increased 13.9 and 5.7 %, respectively, from FY2006/07 to FY2012/13. Between the three services, there were minimal differences in the percentages of presentations with mental health conditions, the distribution of mental health presentations across a 24-h period, and the triage categories assigned to these patients. Survey participants reported that patients used the emergency department due to the urgency of situations, perceptions that gaining access to mental health services would take less time, and the unavailability of mental health services when help is needed. Staff identified several issues (e.g. inappropriate referrals) that may be unnecessary in increasing emergency department demand. The integration of crisis team members into community mental health services does not seem to have produced an increase in emergency department admissions or inpatient separations beyond what might be expected from population growth. The potential may exist, however, to reduce emergency department admissions through addressing the issue of inappropriate referrals.

Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study

“…As with use of the crisis center team in this study, a significant reduction in use of outpatient hospital services and in hospitalization after discharge have been reported [18,35]. These results corresponded to the profiles of patients with more serious MH using in the study more the crisis center, who usually are also treated in specialized services and experience frequent hospitalization [18,47]. Research on adequacy of help among patients confirms the difficulty of treating patients with more serious and complex MH profiles, as in the present group, and in meeting their needs [16].…”

“…Rather, the team described in this study served a clientele without family doctors, helping them to avoid inappropriate ED use. The crisis center and family-peer support teams, as community services that collaborated closely with ED staff, met the recommendations of the American Psychiatric Association for potentially reducing ED and hospitalization [ 27 ] by offering viable alternatives [ 16 , 47 ]. The major difference between the crisis center team intervention in this study and home treatments teams described in the literature was that treatment was provided in a small community organization, which offered a homelike, friendly environment [ 17 ].…”

Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators

“…Suggested remedies include implementing MH liaison nurses in general ERs (Wand et al 2016;Wand and White 2007), hiring ER case managers (Turner and Stanton 2015) and nurse addiction specialists (O'Brien et al 2012), as well as instituting "detox units" (Koivunen et al 2017), brief case management (Stergiopoulos et al 2017), brief intervention units (Johnstone and Zolese 1999), and discharge care planning (S. L. Zeller 2010). Alternative services have been developed, including regional psychiatric emergency services (S. Zeller et al 2014), crisis resolution and home treatment teams (Glover et al 2006;Hubbeling and Bertram 2012;Jespersen et al 2016), street triage and crisis intervention teams working with local police (Hoffman et al 2016;Horspool et al 2016;McKenna et al 2015;Winters et al 2015), and telepsychiatry (Narasimhan et al 2015;Saurman et al 2014;Seidel and Kilgus 2014). Most of these innovations have been only partially implemented, however, and evidence regarding their effectiveness is limited.…”

Reducing length of stay and return visits for emergency department pediatric mental health presentations

“…In response to the disproportionate increase in utilization of ED resources by youth with mental health concerns, a range of strategies has been implemented to mitigate impact on ED system measures. [13,[28][29][30] One pre-emptive effort utilizing community mental health crisis teams for youth, failed to demonstrate an impact on ED utilization for mental health concerns [31]. On the other end of the spectrum, EDs associated with pediatric inpatient psychiatric facilities had shorter mean lengths of stay for youth with mental health presentations than those without inpatient units, [32] and creation of an off-site child and adolescent rapid emergency stabilization unit decreased both mean ED length of stay and costs in one study [33].…”