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Goyal N, Proper E, Lin P, Ahmad U, John-White M, O'Reilly GM, Craig SS. Using emergency department data to define a 'mental health presentation' - implications of different definitions on estimates of emergency department mental health workload. AUST HEALTH REV 2024; 48:342-350. [PMID: 38866423 DOI: 10.1071/ah24067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024]
Abstract
Objective This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58-0.59) and between the AIHW definition and review by EPS of 0.58 (0.57-0.58). Conclusions The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs.
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Affiliation(s)
- Nikita Goyal
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Edmund Proper
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Phyllis Lin
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Usman Ahmad
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Marietta John-White
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia
| | - Gerard M O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; and Emergency and Trauma Centre, Alfred Health, Melbourne, Vic, Australia; and National Trauma Research Institute, Alfred Health, Melbourne, Vic, Australia
| | - Simon S Craig
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia; and Paediatric Emergency Department, Monash Medical Centre, Clayton, Vic, Australia; and Clinical Sciences, Murdoch Children's Research Institute, Parkville, Vic, Australia
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Wittenhagen L, Hielscher E, Meurk CS, Scott JG, Steele ML, Bosley E, Watson S, Heffernan E. A cohort profile of children and adolescents who had a suicide-related contact with police or paramedics in Queensland (Australia). Emerg Med Australas 2024; 36:520-526. [PMID: 38495001 DOI: 10.1111/1742-6723.14392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/31/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Suicide is a leading cause of death in children and adolescents worldwide and a major public health concern. While suicidal behaviours place a significant demand on mental health and emergency services, data regarding suicide-related contacts with police and paramedics are an underutilised resource. The aim of the present study was to identify the demographic profile of young individuals (aged 5-17) and had a suicide-related contact with police or paramedics in Queensland (Australia). METHODS The present study utilised a population-wide linked dataset, including data from police and paramedics and health administrative data, between 1 February 2013 and 31 January 2018. RESULTS The identified cohort of 7929 children had a median age of 15 years and mainly comprised females (63.2%). Over the study period, 64 children died, most by suicide (76.6%). Less than a third of the cohort were responsible for almost two-thirds of the total number of contacts with police or paramedics. CONCLUSION Findings provide a comprehensive profile of children and adolescents in suicidal crisis and highlight the substantial number of interactions that occur with police and paramedics. Due to the way the linked dataset was constructed, it must be assumed that the number of young persons in suicidal crisis is higher. Findings highlight the value of considering pre-hospital alternatives to presenting to emergency departments (EDs) for this cohort, to reduce impost on EDs and improve outcomes. Further examination of re-presentations by young persons is warranted to inform prevention and intervention strategies.
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Affiliation(s)
- Lisa Wittenhagen
- School of Public Health: Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - Emily Hielscher
- Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Carla S Meurk
- School of Public Health: Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
- Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
- Child and Youth Mental Health Service, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Megan L Steele
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - Emma Bosley
- Information Support, Research & Evaluation, Office of the Medical Director, Queensland Ambulance Service, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shelby Watson
- State Domestic Family Violence and Vulnerable Persons Unit, Domestic Family Violence and Vulnerable Persons Command, Queensland Police Service, Brisbane, Queensland, Australia
| | - Ed Heffernan
- School of Public Health: Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
- Queensland Forensic Mental Health Service, Metro North Mental Health Service, Brisbane, Queensland, Australia
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Khlaisuk A, Seeherunwong A, Utriyaprasit K, Poungkaew A, Tongsai S. Incident of violence escalation of patients with psychiatric emergencies boarding in the emergency department in the central region of Thailand and its association: a prospective observational study. BMC Health Serv Res 2024; 24:768. [PMID: 38937780 PMCID: PMC11210055 DOI: 10.1186/s12913-024-11228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND This study investigates the incidence of violence escalation among psychiatric emergency patients admitted to general emergency departments in hospitals in central Thailand. In addition, patient and service delivery system factors associated with the survival time of violence escalation in 16 emergency departments in the central region of Thailand are determined. This is a prospective observational study, and the study sample includes 507 psychiatric emergency patients who are ≥ 18 years old. The patients are selected through stratified random and purposive sampling. METHODS Patient data-including demographic data, emergency services used, and clinical characteristics-are analyzed using descriptive statistics. The Kaplan-Meier method estimates the violence escalation curve, and the log-rank test compares the violence escalation-free time between the levels of the violent behavior group. In addition, univariable and multivariable Cox proportional hazard analyses are performed to investigate the factors affecting violence escalation. RESULTS The incidence of violence escalation in psychiatric emergency patients in the emergency department is 7.3%, whereas the incidence rate of violence escalation is 3 per 100 psychiatric emergency patient visit hours. Factors affecting violence escalation include the violent behavior score at triage (aHR = 2.004; 95% CI: 1.051-3.823) and the nurse competency score (aHR = 0.147; 95% CI: 0.032-0.680). CONCLUSIONS Assessing the violent behavior of psychiatric emergency patients at triage may assist emergency providers in monitoring patient behavior and providing early intervention to prevent the escalation of violent behavior. Furthermore, training emergency nurses in psychiatric emergency care is necessary.
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Affiliation(s)
| | - Acharaporn Seeherunwong
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
| | - Ketsarin Utriyaprasit
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Autchariya Poungkaew
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sasima Tongsai
- Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Watkeys OJ, O'Hare K, Dean K, Laurens KR, Tzoumakis S, Harris MAClinEpi F, Carr VJ, Green MJ. Patterns of health service use for children with mental disorders in an Australian state population cohort. Aust N Z J Psychiatry 2024:48674241258599. [PMID: 38912687 DOI: 10.1177/00048674241258599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
OBJECTIVES The rate of mental health services provided to children and young people is increasing worldwide, including in Australia. The aim of this study was to describe patterns of hospital and ambulatory mental health service use among a large population cohort of adolescents followed from birth, with consideration of variation by age, sex and diagnosis. METHODS Characteristics of services provided for children with mental disorder diagnoses between birth and age 17.5 years were ascertained for a population cohort of 85,642 children (52.0% male) born between 2002 and 2005, from 'Admitted Patients', 'Emergency Department' and 'Mental Health Ambulatory' records provided by the New South Wales and Australian Capital Territory Health Departments. RESULTS A total of 11,205 (~13.1%) children received at least one hospital or ambulatory health occasion of service for a mental health condition in the observation period. More than two-fifths of children with mental disorders had diagnoses spanning multiple categories of disorder over time. Ambulatory services were the most heavily used and the most common point of first contact. The rate of mental health service contact increased with age across all services, and for most categories of mental disorder. Girls were more likely to receive services for mental disorders than boys, but boys generally had an earlier age of first service contact. Finally, 3.1% of children presenting to mental health services experienced involuntary psychiatric inpatient admission. CONCLUSIONS The extent of hospital and ambulatory-based mental healthcare service among children emphasises the need for primary prevention and early intervention.
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Affiliation(s)
- Oliver J Watkeys
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Kirstie O'Hare
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Kimberlie Dean
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- Justice Health & Forensic Mental Network, Matraville, NSW, Australia
| | - Kristin R Laurens
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Stacy Tzoumakis
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- Griffith Criminology Institute, Griffith University, Southport, QLD, Australia
- School of Criminology and Criminal Justice, Griffith University, Southport, QLD, Australia
| | - Felicity Harris MAClinEpi
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Vaughan J Carr
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Melissa J Green
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
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Wardrop R, Ranse J, Chaboyer W, Young JT, Kinner SA, Crilly J. Profile and Outcomes of Emergency Department Mental Health Patient Presentations Based on Arrival Mode: A State-Wide Retrospective Cohort Study. J Emerg Nurs 2023; 49:951-961. [PMID: 37610408 DOI: 10.1016/j.jen.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/08/2023] [Accepted: 06/28/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION People arriving to the emergency department with mental health problems experience varying and sometimes inferior outcomes compared with people without mental health problems, yet little is known about whether or how their arrival mode is associated with these outcomes. This study describes and compares demographics, clinical characteristics, and patient and health service outcomes of adult mental health emergency department patient presentations, based on arrival mode: brought in by ambulance, privately arranged transport, and brought in by police. METHODS Using a retrospective observational study design with state-wide administrative data from Queensland, Australia, mental health presentations from January 1, 2012, to December 31, 2017, were analyzed using descriptive and inferential analyses. RESULTS Of the 446,815 presentations, 51.8% were brought in by ambulance, 37.2% arrived via privately arranged transport, and 11.0% were brought in by police. Compared with other arrival modes, presentations brought in by ambulance were more likely to be older and female and have more urgent triage categories and a longer length of stay. Presentations arriving by privately arranged transport were more likely than other arrival modes to present during the day, be assigned a less urgent triage category, be seen within their recommended triage time, have a shorter length of stay in the emergency department, have higher rates of discharge, and have waited longer to be seen by a clinician. Presentations brought in by police were more likely than other arrival modes to be younger and male and experience a shorter time to be seen by a clinician. DISCUSSION Discrepancies between arrival modes indicates a need for further investigation to support inter- and intra-agency mental health care interventions.
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Stubbs JM, Chong S, Achat HM, Brakoulias V. Sociodemographic characteristics and clinical outcomes for people presenting to emergency departments with mental health diagnoses. Int Emerg Nurs 2023; 71:101372. [PMID: 37852061 DOI: 10.1016/j.ienj.2023.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Hospital emergency departments (EDs) are experiencing a growth in presentations with mental health (MH) diagnoses. AIM Describe and compare sociodemographic characteristics and clinical outcomes for people with MH and non-MH diagnoses. METHODS A retrospective study examined routinely collected data for ED presentations in a health district in western Sydney, Australia from 2016 to 2019. Regression models examined variables according to MH status, overall and by age. RESULTS Individuals with MH diagnoses accounted for 3.4% of 647,787 ED presentations. MH presentations were most commonly female (51.5%), aged 16-39 years (62.5%), arrived after hours (60.3%) and via ambulance (52.8%). MH presentations were more likely to be triaged category 2 (OR = 1.58,95%CI = 1.54-1.63) and not seen on time (OR = 1.20,95%CI = 1.17-1.24). They had higher odds of a longer ED stay (OR = 1.96,95%CI = 1.90-20.1), after which they were less likely to be admitted (OR = 0.56, 95%CI = 0.55-0.58) and more likely to be transferred (OR = 3.81,95%CI = 3.66-3.97) or leave before treatment was completed (OR = 1.83,95%CI = 1.74-1.92). CONCLUSION Characteristics and outcomes for people presenting to ED with a MH diagnosis significantly differ from those without a MH diagnosis. Provision of timely care is a particular concern. Identifying causes for delays within and external to the ED, and implementing targeted strategies to ameliorate them are required to optimise care.
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Affiliation(s)
- Joanne M Stubbs
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Shanley Chong
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Helen M Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Vlasios Brakoulias
- Mental Health Service, Western Sydney Local Health District, Westmead, NSW, Australia; School of Medicine and Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia; Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Tang AS, Shieh MS, Pekow PS, Prentiss KA, Lindenauer PK, Westafer LM. Treatment of pediatric behavioral health patients with intravenous and intramuscular chemical restraints: Results from a nationwide sample of emergency departments. Acad Emerg Med 2023; 30:1029-1038. [PMID: 37259900 PMCID: PMC11075781 DOI: 10.1111/acem.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Behavioral health crises in pediatric emergency department (ED) patients are increasingly common. Chemical restraints can be utilized for patients who present imminent danger to self or others. We sought to describe the use of intravenous (IV)/intramuscular (IM) chemical restraints for pediatric behavioral health ED patients across a nationwide sample of hospitals and describe factors associated with restraint use. METHODS This was a retrospective study of patients ages 8-17 treated at 822 EDs contributing data to the Premier Healthcare Database between January 1, 2018, and December 31, 2020, with a behavioral health discharge diagnosis. The primary outcome was the use of IV/IM chemical restraint medication. We developed a hierarchical model to examine patient and hospital-level factors associated with treatment with IV/IM chemical restraint medications. RESULTS Of 630,384 cases, 4.8% received IV/IM chemical restraint. Patient factors associated with higher odds of chemical restraint were older age (ages 13-17 years [adjusted odds ratio {AOR} 1.53, 95% confidence interval {CI} 1.48-1.58]), anxiety disorders (AOR 1.69, 95% CI 1.64-1.74), disruptive disorders (AOR 1.61, 95% CI 1.53-1.69), suicide/self-injury (AOR 1.3, 95% CI 1.26-1.34), substance use (AOR 1.24, 95% CI 1.20-1.28), and bipolar disorder (AOR 1.23, 95% CI 1.17-1.30). Participants with complex comorbidities were more likely to receive chemical restraint (AOR 1.32, 95% CI 1.26-1.39). After patient and hospital factors were adjusted for, the median OR indicating the influence of the individual hospital on the odds of chemical restraint was 1.43 (95% CI 1.40-1.47). CONCLUSIONS We found that age and certain behavioral health diagnoses were associated with receipt of IV/IM chemical restraint during pediatric behavioral health ED visits. Additionally, whether a patient was treated with chemical restraints was strongly influenced by the hospital to which they presented for treatment.
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Affiliation(s)
- Andrew S Tang
- Pediatric Emergency Medicine, Rady Children's Hospital, San Diego, California, USA
- Pediatric Emergency Medicine, University of California-San Diego, San Diego, California, USA
| | - Meng-Shiou Shieh
- Department of Healthcare Delivery & Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Penelope S Pekow
- Department of Healthcare Delivery & Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Kimball A Prentiss
- Department of Emergency Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Peter K Lindenauer
- Department of Healthcare Delivery & Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
- Division of Hospital Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lauren M Westafer
- Department of Healthcare Delivery & Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
- Department of Emergency Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
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Iorfino F, McHugh C, Richards M, Skinner A, Prodan A, Occhipinti JA, Song YJC, Chiu S, Judkins S, Scott E, Hickie IB. Patterns of emergency department presentations for a youth mental health cohort: data-linkage cohort study. BJPsych Open 2023; 9:e170. [PMID: 37706294 PMCID: PMC10594097 DOI: 10.1192/bjo.2023.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/23/2023] [Accepted: 06/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear. AIMS To describe the emergency department presentation patterns of a help-seeking youth mental health cohort. METHOD Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12-30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other). RESULTS During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86-0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086-1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation. CONCLUSIONS Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Catherine McHugh
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Richards
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adam Skinner
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ante Prodan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia; and School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Jo-an Occhipinti
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; and Computer Simulation & Advanced Research Technologies, Sydney, New South Wales, Australia
| | | | - Simon Chiu
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Elizabeth Scott
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; and St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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Neil AL, Chappell K, Wagg F, Miller A, Judd F. The Tasmanian Conception to Community (C2C) Study Database 2008-09 to 2013-14: Using linked health administrative data to address each piece in the puzzle. Soc Sci Med 2021; 284:114216. [PMID: 34274707 DOI: 10.1016/j.socscimed.2021.114216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Tasmania, Australia has a small widely dispersed regional and rural population. The Conception to Community (C2C) Study Database was established as a research platform to inform service planning and policy development and improve health outcomes for Tasmanian mothers and children. The aims of this study were to establish by maternal socio-demographic characteristics: 1) the distribution of births in Tasmania; 2) hospital utilisation for children from birth to 5-years; and 3) the association between child and maternal emergency department (ED) presentation rates. METHODS Perinatal and public hospital ED and admitted patient data were linked for every child born in Tasmania between 2008-09 to 2013-14, and their mothers. Individualised rates of ED presentations and hospital admissions were calculated from birth to 5-years. Frequent presenters to ED were defined as having at least four presentations per annum. Ratios of ED presentation and hospital admission rates by sociodemographic characteristics (region (north, north-west, south), rurality, maternal age, and area socioeconomic disadvantage) were estimated using mixed-effects negative binomial models, with random intercepts for each child and family. RESULTS The C2C Database is comprised of records for 37,041 children and 27,532 mothers. One-in-ten Tasmanian babies lived in a remote area. The mean yearly rate of ED presentations per child varied by sex, age, region and rurality. Frequent presenters were more likely to reside in the north-west or north, in urban areas, have mothers under 20- years, be male, and live in more disadvantaged areas, with 2.3% of children frequent presenters in their first year of life. The odds of a child being a frequent presenter during their first-year was 6.1- times higher if the mother was a frequent presenter during this period. CONCLUSION Associations between maternal and child health service use and combined effects of regionality and rurality highlight opportunities for targeted intervention and service innovations.
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Affiliation(s)
- Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Australia.
| | - Kate Chappell
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Fiona Wagg
- Child and Adolescent Mental Health Services South, Tasmanian Health Service, Hobart, Australia
| | - April Miller
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Fiona Judd
- Menzies Institute for Medical Research, University of Tasmania, Australia; Perinatal and Infant Mental Health Team, CAMHS South, Tasmanian Health Service, Hobart, Australia
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Occhipinti JA, Skinner A, Carter S, Heath J, Lawson K, McGill K, McClure R, Hickie IB. Federal and state cooperation necessary but not sufficient for effective regional mental health systems: insights from systems modelling and simulation. Sci Rep 2021; 11:11209. [PMID: 34045644 PMCID: PMC8160145 DOI: 10.1038/s41598-021-90762-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022] Open
Abstract
For more than a decade, suicide rates in Australia have shown no improvement despite significant investment in reforms to support regionally driven initiatives. Further recommended reforms by the Productivity Commission call for Federal and State and Territory Government funding for mental health to be pooled and new Regional Commissioning Authorities established to take responsibility for efficient and effective allocation of ‘taxpayer money.’ This study explores the sufficiency of this recommendation in preventing ongoing policy resistance. A system dynamics model of pathways between psychological distress, the mental health care system, suicidal behaviour and their drivers was developed, tested, and validated for a large, geographically diverse region of New South Wales; the Hunter New England and Central Coast Primary Health Network (PHN). Multi-objective optimisation was used to explore potential discordance in the best-performing programs and initiatives (simulated from 2021 to 2031) across mental health outcomes between the two state-governed Local Health Districts (LHDs) and the federally governed PHN. Impacts on suicide deaths, mental health-related emergency department presentations, and service disengagement were explored. A combination of family psychoeducation, post-attempt aftercare, and safety planning, and social connectedness programs minimises the number of suicides across the PHN and in the Hunter New England LHD (13.5% reduction; 95% interval, 12.3–14.9%), and performs well in the Central Coast LHD (14.8% reduction, 13.5–16.3%), suggesting that aligned strategic decision making between the PHN and LHDs would deliver substantial impacts on suicide. Results also highlighted a marked trade-off between minimising suicide deaths versus minimising service disengagement. This is explained in part by the additional demand placed on services of intensive suicide prevention programs leading to increases in service disengagement as wait times for specialist community based mental health services and dissatisfaction with quality of care increases. Competing priorities between the PHN and LHDs (each seeking to optimise the different outcomes they are responsible for) can undermine the optimal impact of investments for suicide prevention. Systems modelling provides essential regional decision analysis infrastructure to facilitate coordinated federal and state investments for optimal impacts.
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Affiliation(s)
- Jo-An Occhipinti
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia. .,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia. .,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia. .,Translational Health Research Institute, Western Sydney University, Penrith, Australia.
| | - Adam Skinner
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia
| | - Samantha Carter
- Hunter New England & Central Coast Primary Health Network, Newcastle, Australia
| | - Jacinta Heath
- Everymind, Hunter New England Local Health District, Newcastle, Australia
| | - Kenny Lawson
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Katherine McGill
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, Australia.,MH-READ, Hunter New England Local Health District, Newcastle, Australia
| | - Rod McClure
- Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Ian B Hickie
- Systems Modelling, Simulation, and Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia
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11
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Say DF, Carison A, Hill A, Hiscock H, Babl FE, O'Donnell SM. Mental health presentations to the paediatric emergency department: A retrospective study. J Paediatr Child Health 2021; 57:684-695. [PMID: 33404176 DOI: 10.1111/jpc.15313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/27/2020] [Accepted: 11/30/2020] [Indexed: 02/05/2023]
Abstract
AIM To describe a cohort of patients aged 7-17 years presenting with mental health (MH) problems to an Australian tertiary paediatric emergency department (ED), in order to identify: (i) predictors of admission; and (ii) prolonged length of stay (LOS); (iii) reasons for ED presentation based on diagnosis and (iv) differences between major diagnostic groups. METHODS Data for all presentations from 1 January 2018 to 31 December 2018 were extracted and analysed from the hospital's electronic medical record system. MH presentations were identified though rule-based coding and manual file review. RESULTS In this 12-month period, 1071 children had 1690 emergency MH presentations constituting 6.7% of all ED presentations for children aged 7-17 years. Collectively, the leading cause for presentations was suicidal ideation, self-harm or drug overdose (55%). Compared to discharged patients, admitted patients were more likely to be female (odds ratio (OR) 1.82, confidence interval (CI) 1.41-2.35), aged over 14-years (OR 2.50, CI 1.98-3.15), triaged with high acuity (OR 2.70, CI 2.00-3.65) and arrive by ambulance or police (OR 1.31, CI 1.04-1.64). The highest risk diagnosis associated with admission was eating disorders (OR 9.19, CI 5.48-15.40). Patients with a prolonged LOS (>8 h) were more likely to need admission (OR 5.38, CI 3.81-7.61) and be diagnosed with drug overdose (OR 2.39, CI 1.51-3.80) or acute behavioural disturbance (OR 1.61, CI 1.09-2.39). CONCLUSION Mental health presentations constitute a large proportion of ED presentations. Suicidal behaviour and self-harm account for half of them. We have identified patients at increased risk of admission and prolonged ED LOS.
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Affiliation(s)
- Daniela F Say
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anna Carison
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ashley Hill
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Sinead M O'Donnell
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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12
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O'Donnell SM, Carison A, Hill A, Say D, Hiscock H, Babl FE. Psychotropic medication use for paediatric mental health patients in an emergency department. Emerg Med Australas 2020; 33:292-301. [PMID: 33000554 DOI: 10.1111/1742-6723.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is paucity of evidence for psychotropic medication use in children and adolescents presenting with mental health (MH) problems to the ED. We set out to describe paediatric psychotropic medication use in the ED. METHODS We conducted a retrospective electronic medical record review of ED patients with MH discharge codes at a tertiary paediatric ED in 2018. We assessed the epidemiology and management of patients who received a psychotropic medication. We calculated the odds ratios (ORs with 95% confidence intervals [CIs]) of key demographic factors of medicated versus non-medicated MH patients. RESULTS During 2018 there were 1695 MH-related presentations to the ED. Of these, 280 presentations resulted in the patient receiving a psychotropic medication (16.5%). Medicated children with MH illness were more likely to be male (OR 1.50, 95% CI 1.16-1.96), have a more acute triage category (OR 3.37, 95% CI 2.28-4.98), have an ED length of stay greater than 12 h (OR 3.96, 95% CI 2.56-6.13) and present after hours (OR 1.51, 95% CI 1.16-1.96). Most had a diagnosis of acute behavioural disturbance or suicidal ideation. A variety of treatment regimens were used but children primarily received a single oral agent (diazepam or olanzapine). Parenteral medications were given in 8.6%. No adverse events were recorded. CONCLUSION A minority of children with MH presentations to the ED were medicated. It will require multicentre research to determine the most effective and safe acute psychotropic agents for oral and parenteral use in children in the ED.
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Affiliation(s)
- Sinead M O'Donnell
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Anna Carison
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ashley Hill
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Daniela Say
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Thiessen M, Cui Q, Hu XJ, Rosychuk RJ. Exploring spatio-temporal patterns in mental health related emergency department use from children and adolescents. Spat Spatiotemporal Epidemiol 2020; 34:100358. [PMID: 32807398 DOI: 10.1016/j.sste.2020.100358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 12/01/2022]
Abstract
To understand the spatio-temporal patterns and associated risk factors with the frequency, we analyze records of mental health related emergency department (MHED) visits from youth. The data are extracted for the period 2002--2011 from the population-based, provincial health administrative data systems of Alberta, Canada. Guided by a descriptive analysis, we conduct generalized linear regression analyses of the counts of MHED visits from various health areas. Seasonal effects are examined via three different types of functions, including trigonometric functions. We specify the temporal correlation using an autoregressive model of order 1 and formulate the spatial correlation by a random effects model. Our analysis reveals a strong seasonal pattern and indicates that the MHED visit counts are significantly associated with age, gender, and a proxy for socio-economic status. The final statistical model may be used to forecast future MHED use and identify regions and groups at a higher risk to the MHEDs.
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Affiliation(s)
- Michelle Thiessen
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada; Winnipeg, Manitoba, Canada
| | - Qi Cui
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - X Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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14
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Carison A, Babl FE, Hill A, O'Donnell SM. Children and adolescents with severe acute behavioural disturbance in the emergency department. Emerg Med Australas 2020; 32:747-755. [DOI: 10.1111/1742-6723.13515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Carison
- Emergency Department The Royal Children's Hospital Melbourne Victoria Australia
| | - Franz E Babl
- Emergency Department The Royal Children's Hospital Melbourne Victoria Australia
- Department of Paediatrics, The University of Melbourne Melbourne Victoria Australia
- Department of Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Ashley Hill
- Department of Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Sinead M O'Donnell
- Emergency Department The Royal Children's Hospital Melbourne Victoria Australia
- Department of Clinical Sciences Murdoch Children's Research Institute Melbourne Victoria Australia
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15
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Tran QN, Lambeth LG, Sanderson K, Graaff B, Breslin M, Huckerby EJ, Tran V, Neil AL. Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004–05 to 2016–17. Emerg Med Australas 2020; 32:190-201. [DOI: 10.1111/1742-6723.13451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Quang Nhat Tran
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Leonard G Lambeth
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Kristy Sanderson
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
- School of Health SciencesUniversity of East Anglia Norwich UK
| | - Barbara Graaff
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Monique Breslin
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Emma J Huckerby
- Emergency Department, Royal Hobart HospitalTasmanian Health Service, Tasmanian Government Hobart Tasmania Australia
| | - Viet Tran
- Emergency Department, Royal Hobart HospitalTasmanian Health Service, Tasmanian Government Hobart Tasmania Australia
- School of MedicineCollege of Health and Medicine, University of Tasmania Hobart Tasmania Australia
| | - Amanda L Neil
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
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16
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Tran QN, Lambeth LG, Sanderson K, de Graaff B, Breslin M, Tran V, Huckerby EJ, Neil AL. Emergency department presentations with a mental health diagnosis in Australia, by jurisdiction and by sex, 2004-05 to 2016-17. Emerg Med Australas 2019; 32:383-392. [PMID: 31854113 DOI: 10.1111/1742-6723.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/15/2019] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine trends in ED presentations with a mental health diagnosis (MHdx ) in Australia by jurisdiction and by sex, between 2004-05 and 2016-17. METHODS Data were captured in the National Non-Admitted Patient Emergency Department Care Database. Outcomes were the proportion of ED presentations with a principal diagnosis of ICD-10-AM F00-F99 (MHdx ), and the rate of all ED and MHdx presentations per 10 000 population. RESULTS Between 2004-05 and 2016-17, MHdx presentations experienced compounding annual growth of 5.9% nationally, and increased from 3.3% to 3.7% of all ED presentations with a diagnosis. Most growth occurred between 2010-11 and 2015-16. Northern Territory (NT) had the highest level of MHdx presentations per 10 000 population, more than double the Australian average. The proportion of MHdx presentations was highest in South Australia (SA) in most years, and the average annual proportion of MHdx presentations was statistically significantly higher than the national average in SA, Queensland (QLD) and Western Australia (WA). The proportion of MHdx presentations increased in each jurisdiction, with significant increases for Victoria, QLD, WA, Australian Capital Territory and NT. Males experienced greater numbers and rates of all ED and MHdx presentations, while the proportion of MHdx presentations was 8% higher for females. CONCLUSIONS The proportion of ED presentations for MH conditions, narrowly defined, has increased in all Australian jurisdictions between 2004-05 and 2016-17, but particularly since 2010-11. Differences between jurisdictions indicate jurisdictional specific issues. However, significant or upward trend of MHdx presentations across all jurisdictions indicates generic issues necessitating concern and policy development at a national level.
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Affiliation(s)
- Quang Nhat Tran
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Leonard G Lambeth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,School of Health Sciences, University of East Anglia, Norwich, UK
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Viet Tran
- Emergency Department, Royal Hobart Hospital, Tasmanian Health Service, Tasmanian Government, Hobart, Tasmania, Australia.,School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Emma J Huckerby
- Emergency Department, Royal Hobart Hospital, Tasmanian Health Service, Tasmanian Government, Hobart, Tasmania, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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