Patients Who Attend the Emergency Department Following Medication Overdose: Self-reported Mental Health History and Intended Outcomes of Overdose

Experiences of individuals presenting to the emergency department for mental health reasons: A systematic mixed studies review

OBJECTIVE

Emergency departments the world over have seen substantial increases in the number of individuals presenting for mental health reasons. However, we have a limited understanding of their experiences of care. The aim of this review was to systematically examine and synthesise literature relating to the experiences of individuals presenting to emergency department for mental health reasons.

METHODS

We followed Pluye and Hong's seven-step approach to conducting a systematic mixed studies review. Studies were included if they investigated adult mental health experiences in emergency department from the users' perspective. Studies describing proxy, carer/family or care provider experiences were excluded.

RESULTS

Sixteen studies were included. Thematic synthesis identified three themes and associated subthemes. Theme 1 - ED staff can make-or-break and ED experience - comprised: Feeling understood and heard; Engaging in judgement-free interactions; Receiving therapeutic support; Being actively and passively invalidated for presenting to the ED; and Once a psych patient, always a psych patient. Theme 2 - Being in the ED environment is counter-therapeutic - comprised: Waiting for an 'extremely' long time; and Lacking privacy. Theme 3 was Having nowhere else to go.

CONCLUSIONS

The experiences described by individuals presenting to emergency department for mental health reasons were mostly poor. The results illustrate a need for increased mental health education and training for all emergency department staff. Employment of specialist and lived experience workers should also be prioritised to support more therapeutic relationships and emergency department environments. In addition, greater investment in mental health systems is required to manage the current crisis and ensure future sustainability.

Experiences of acute care by persons with mental health problems: An integrative literature review

WHAT IS KNOWN ON THE SUBJECT?: Understanding experiences of acute care by persons with mental health problems is vital for improving these experiences through the development of different parts of the care delivery and its facilities. Literature has extensively addressed experiences of persons with mental health problems in acute care settings. Yet, there is a paucity of studies that aggregate and organize these findings in presenting development-oriented solutions for the improvements of these experiences. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Acute care can be understood through patients' experiences of structure (such as setting, staff and resources); process (such as communication and interpersonal relations); and outcome (such as satisfaction and post-discharge well-being and health) and suggests improvements in these domains. The paper illuminates that previous literature has mainly captured negative experiences of acute care by persons with mental health problems, and suggests diverting the focus to the best practices and to seek inspiration from other fields of research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Attending to the improvement and development of different parts of the acute care might be an important step in improving experiences of persons with mental health problems. For example, improving resource allocation systems and facilities, emphasizing professionalism in encounters with these patients and systematically assessing patient satisfaction during and after visits are important areas that require attention. ABSTRACT: Aim The provision of acute care to persons with mental health problems is challenging due to difficulties in encountering this group and the vulnerability of these persons. Understanding this group's experiences with acute care is thus an important endeavour. The purpose of this review was to critically and systematically identify and assess previous research on experiences of acute care by persons with mental health problems, guided by Donabedian's structure-process-outcome framework (Prospero ID: CRD42019116652). Method and results An integrative literature review was performed, resulting in the identification of 43 studies. The search was conducted using five electronic databases: Web of Science Core, PubMed, MEDLINE, CINAHL and PsycINFO. Discussion The review revealed that patients experienced structure components such as setting, staff and resources in a predominantly negative way. A predominately negative picture also emerged of the process components, where, for example, communication and interpersonal relations were represented by negative experiences, with limited positive experiences reported. The outcome components, related to patients' satisfaction and their well-being after discharge, were also predominantly experienced negatively. Implications for practice Using Donabedian's framework of structure, process and outcome allowed us to systematize the literature reviewed, to identify the research gaps and to suggest ways forward for the field's development.

Prescribers aware: a cross-sectional study from New Zealand emergency departments on the substances used in intentional self-poisoning and their sources

INTRODUCTION Intentional self-poisoning or self-harm through poisoning, is a common cause of presentations to emergency departments (EDs). National datasets do not allow identification of the substances most commonly used in hospital-treated intentional self-poisoning in New Zealand, nor do they capture sources of these substances. AIM To investigate the specific substances used in intentional self-poisoning and the sources from which they are obtained. METHODS In this cross-sectional study, information about the demographics and presentation particulars of intentional self-poisoning patients aged ≥16 years, presenting to three public EDs, as well as the substances they used in the self-poisoning event and the sources of these agents, were collected prospectively. RESULTS A total of 102 patients were recruited from the potentially eligible 1137 intentional self-poisoning patients presenting to the three EDs during the study period. Seventy per cent used their own prescription medications and 24% used medicines they purchased themselves. Paracetamol and ethanol were most commonly encountered substances. Patients presented a median of 1.9h after exposure (interquartile range 1.0-3.3h), 62% self-referred, 60% presented to the ED in the evening or at night and 66% were triaged into Australasian Triage Scale 3 (to be seen within 30min). Two-thirds were referred to emergency psychiatric services. DISCUSSION Collecting specific substance information, such as from this study, can assist in planning specific activities to prevent intentional self-poisoning. As most people used their prescribed medicines, the findings can inform and assist doctors in their prescribing practices when they manage patients at risk of self-poisoning.

Narratives of people who inject drugs on factors contributing to opioid overdose

BACKGROUND

In recent years, there has been increasing national and global attention to opioid overdoses. In San Francisco, it is estimated that the population of people who inject drugs (PWID) has more than doubled in the past ten years. The risk factors for opioid overdose have been examined closely, but firsthand accounts of PWID who have experienced overdoses are less documented. In this paper, we use two theories - lay expertise and structural vulnerabilities - as frameworks to frame and qualitatively examine the narratives of PWID surrounding their recent overdose experiences.

METHODS

Audio-recorded semi-structured open-ended motivational interviewing counseling sessions were conducted with PWID in San Francisco who have experienced at least one non-fatal overdose event (N = 40). Participants discussed the context of recent opioid overdoses, either witnessed or personally experienced, focusing on their perceptions of unique contributing factors. Interview data were coded and analysed using ATLAS.ti. We used a thematic content analysis approach to qualitatively analyze data queries and generate themes. We used theories of structural vulnerability and lay expertise to frame the analysis.

RESULTS

Using quotes from the participants, we report four central themes that contributed to participants' overdose experiences: 1) Social Dynamics and Opioid Expertise; 2) Uncertain Supply, Composition, Source; 3) Balancing Polysubstance Use, and 4) Emotional Pain.

CONCLUSION

As PWID described their overdose experiences, many factors that contributed to their overdoses were situated at the structural level. The everyday, lived experiences of PWID often competed or conflicted with public health messages and approaches. The accumulated expertise of PWID about everyday risk factors can be leveraged by public health practitioners to inform and improve overdose prevention interventions and messages.

Psychiatric service users' experiences of emergency departments: a CERQual review of qualitative studies

BACKGROUND

There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users' experiences regarding general EDs is limited.

AIM

To identify and summarize current, qualitative evidence regarding service users' experiences attending EDs. A secondary aim is to apply and test the newly developed CERQual approach to summarizing qualitative review findings.

METHODS

A systematic literature review of five databases based on PRISMA guidelines yielded 3334 unique entries. Screening by title/abstract identified 57 studies and, after full text assessment, nine studies were included. The included studies were critically appraised using CASP. Thematic synthesis was applied for data extraction and identification of findings. The CERQual approach was utilized to assess the confidence of the findings.

RESULTS

The results of the review showed moderate confidence in the findings that service users experience meeting caring and judgmental ED staff, and that waiting times and a stressful environment are integral to their ED experiences. In contrast, low-to-very low confidence was seen in the findings that service users experience having their symptoms ignored and that EDs are used due to a lack of alternatives. A companion may improve service users experience and outcome of ED visits.

CONCLUSION

Service users experience stress and discomfort in the ED. Service users highly appreciate knowing staff who can ease the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users' needs are more likely to be recognized and accommodated.