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Tyson C, Punnoose P. Coordinated System of Care Approaches for Pediatric Emergency and Crisis Stabilization, Mobile Treatment, and Wraparound Services. Child Adolesc Psychiatr Clin N Am 2024; 33:609-626. [PMID: 39277315 DOI: 10.1016/j.chc.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Youth have been increasingly struggling with their mental health, leading to an unprecedented rise in emergency room visits and inpatient psychiatric admissions. It is prudent for mental health providers to be familiar with all services within a continuum of care that can address the early phases of a crisis, allowing youth to remain in the community while being treated. The system of care (SOC) approach has demonstrated positive effects in mitigating the need for hospital-based services. There is a call among experts to integrate SOC concepts during inpatient psychiatric admissions to promote youth remaining within a community after discharge.
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Affiliation(s)
- Colby Tyson
- Department of Psychiatry and Behavioral Sciences, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
| | - Priya Punnoose
- Department of Psychiatry and Behavioral Sciences, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA
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2
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Odes R, Looper P, Manjanatha D, McDaniel M, Goldman ML. Mobile Crisis Teams' Implementation in the Context of new Medicaid Funding Opportunities: Results from a National Survey. Community Ment Health J 2024; 60:1399-1407. [PMID: 38831197 DOI: 10.1007/s10597-024-01296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/12/2024] [Indexed: 06/05/2024]
Abstract
This cross-sectional survey study describes characteristics of mobile crisis teams (MCTs) in the United States. Mobile crisis teams (MCTs) are increasingly recognized as essential responders to help those experiencing mental health crises get urgent and appropriate care. Recent enhanced federal funding is designed to promote adoption of MCTs, but little is known about their current structure and function and whether teams meet new Medicaid rules governing their utilization. Survey participants (N = 554) are a convenience sample of MCT representatives recruited through professional organizations, listservs, and individual email contacts from October 2021 - May 2022. Respondents most frequently identified themselves as MCT program director/manager (N = 237, 43%). 63% (N = 246) of respondents reported billing insurance for services provided (including Medicaid), while 25% (N = 98) rely on state or county general funds only. Nearly all respondents (N = 390, 98%) reported including behavioral health clinicians on their teams, and 71% (N = 281) reported operating on a 24/7 basis, both of which are required by Medicaid's enhanced reimbursement. Just over half of respondents (N = 191, 52%) reported being staffed with 11 or more FTE staff members, our estimated number required for adequate 2-person coverage on a 24/7 basis. MCTs are a popular policy initiative to reduce reliance on law enforcement to handle mental health emergencies, and enhanced federal funding is likely to expand their utilization. Federal rule makers have a role in establishing guidelines for best practices in staffing, billing, and outcomes tracking, and can help ensure that stable financing is available to improve stability in service delivery.
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Affiliation(s)
- Rachel Odes
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Deepa Manjanatha
- Department of Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA, USA
| | - Megan McDaniel
- University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Matthew L Goldman
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
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3
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Foster AA, Zabel M, Schober M. Youth Crisis: The Current State and Future Directions. Psychiatr Clin North Am 2024; 47:595-611. [PMID: 39122348 DOI: 10.1016/j.psc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
The number of children and youth experiencing behavioral health crisis in the United States is substantially increasing. Currently, there are shortages to home-based and community-based services as well as psychiatric outpatient and inpatient pediatric care, leading to high emergency department utilization. This article introduces a proposed crisis continuum of care, highlights existing evidence, and provides opportunities for further research and advocacy.
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Affiliation(s)
- Ashley A Foster
- Department of Emergency Medicine, University of California, San Francisco, 550 16th Street, Box 0649, San Francisco, CA 94143, USA.
| | - Michelle Zabel
- Innovations Institute, University of Connecticut School of Social Work, 38 Prospect Street, Hartford, CT 06103, USA
| | - Melissa Schober
- Innovations Institute, University of Connecticut School of Social Work, 38 Prospect Street, Hartford, CT 06103, USA
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Wilson R, Jennings A, Redaniel MT, Samarakoon K, Dawson S, Lyttle MD, Savović J, Schofield B. Factors associated with repeat emergency department visits for mental health care in adolescents: A scoping review. Am J Emerg Med 2024; 81:23-34. [PMID: 38631148 DOI: 10.1016/j.ajem.2024.04.018] [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: 11/24/2023] [Revised: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The aim of this review was to identify factors associated with multiple visits to emergency department (ED) services for mental health care in adolescents. METHODS Electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and ProQuest Dissertations & Thesis Global) were searched for evidence that presented an association between risk factors or correlates of multiple visits to the emergency departmental for mental health care by 10-24 year olds. High impact use was defined as at least one return ED visit for mental health care. Primary studies of any quantitative design were included, with no exclusions based on language or country and all possible risk factors were considered. Data were extracted and synthesised using quantitative methods; frequencies of positive, negative and null associations were summarised for categories of potential risk factors. RESULTS Sixty-five studies were included in the review. Most studies were from North America and reported a wide range of measures of high impact ED use, the most common being a binary indicator of multiple ED visits. Sex/gender and age were the most frequently reported risk factors. Measure of previous or concurrent access to mental health care was consistently positively associated with high impact use. Having private health insurance, compared with public or no insurance, was generally negatively associated with high impact use. Proxy measures of socioeconomic position (SEP) showed associations between lower SEP and more high impact use in a small number of studies. No other factors were consistently or uniformly associated with high impact use. CONCLUSIONS The review identified a substantial evidence base but due to the variability in study design and measurement of both risk factors and outcomes, no consistent risk factors emerged. More research is needed, particularly outside North America, using robust methods and high quality routinely collected data.
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Affiliation(s)
- Rebecca Wilson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | | | - Maria Theresa Redaniel
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Kithsiri Samarakoon
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Mark D Lyttle
- University of the West of England, Bristol, UK; Bristol Royal Hospital for Children, Bristol, UK.
| | - Jelena Savović
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
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5
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Lui JHL, Chen BC, Benson LA, Lin YJR, Ruiz A, Lau AS. Inpatient Care Utilization Following Mobile Crisis Response Encounters Among Racial/Ethnic Minoritized Youth. J Am Acad Child Adolesc Psychiatry 2024; 63:720-732. [PMID: 37422107 DOI: 10.1016/j.jaac.2023.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE There has been an increase in youth psychiatric emergencies and psychiatric inpatient hospitalizations in recent years. Mobile crisis response (MCR) services offer an opportunity to meet acute youth mental health needs in the community and to provide linkage to care. However, an understanding of MCR encounters as a care pathway is needed, including how patterns of subsequent care may vary by youth race/ethnicity. The current study examines racial/ethnic differences in the rates of inpatient care use following MCR among youth. METHOD Data included Los Angeles County Department of Mental Health (LACDMH) administrative claims for MCR in 2017 and psychiatric inpatient hospitalizations and outpatient services from 2017-2020 for youth aged 0 to 18 years. RESULTS In this sample of 6,908 youth (70.4% racial/ethnic minoritized youth) who received an MCR, 3.2% received inpatient care within 30 days of their MCR, 18.6% received inpatient care beyond 30 days of their MCR, and 14.7% received repeated inpatient care episodes during the study period. Multivariate models revealed that Asian American/Pacific Islander (AAPI) youth were less likely to receive inpatient care, whereas American Indian/Alaska Native (AI/AN) youth were more likely to receive inpatient care following MCR. Youth age, primary language, primary diagnosis, and insurance status also predicted future inpatient episodes. CONCLUSION Findings highlight differential rates of inpatient use following MCR among AAPI and AI/AN youth relative to youth from other groups. Alternative interpretations for the findings are offered related to differential levels of need and disparate penetration of community-based outpatient and prevention-focused services. PLAIN LANGUAGE SUMMARY The study investigates racial and ethnic differences in the rates of inpatient care receipt after youth experience a psychiatric emergency in Los Angeles County. A total of 6,908 youth received mobile crisis response services and participated in the study. No racial/ethnic differences emerged in inpatient care use within the first month of receiving mobile crisis response services, but in the longer-term, Asian American/Pacific Islander youth were the least likely to receive inpatient care, and American Indian/Alaska Native youth were the most likely to receive inpatient. No differences in inpatient care use were observed for Black and Latinx youth relative to other youth in the study. Given the high costs for inpatient care, it remains critical to connect high-risk minoritized youth to less costly community-based care.
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Affiliation(s)
| | - Belinda C Chen
- University of California, Los Angeles, Los Angeles, California
| | - Lisa A Benson
- Los Angeles County Department of Mental Health, Los Angeles, California
| | - Yen-Jui R Lin
- Los Angeles County Department of Mental Health, Los Angeles, California
| | - Amanda Ruiz
- Los Angeles County Department of Mental Health, Los Angeles, California
| | - Anna S Lau
- University of California, Los Angeles, Los Angeles, California
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Becker-Haimes EM, Schaechter T, Green KL, Bridges K, Jager-Hyman S. Mobile Crisis Services: A Clinician Survey of Current Suicide Prevention Practices and Barriers to Care Delivery. Community Ment Health J 2024; 60:562-571. [PMID: 37982974 DOI: 10.1007/s10597-023-01208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
Mobile crisis teams (MCTs) deploy clinicians to assist individuals in acute crisis in the community. Little is known about the extent to which these teams provide evidence-based practices (EBPs) for suicide prevention nor the barriers they face. We surveyed 120 MCT clinicians across the United States about their: (1) use of suicide risk screening and assessment tools; (2) strategies used to address suicide risk (both EBPs and non-EBPs); and (3) perceived barriers to high-quality MCT services. Nearly all clinicians reported use of validated suicide screening tools and generic "safety planning." However, a sizeable minority also reported use of non-EBPs. Open-ended responses suggested many client/family-, clinician-, and systems-level barriers to MCT use of EBPs for suicide prevention. We identified several targets for future implementation efforts, including the need for de-implementation strategies to reduce use of ineffective and potentially harmful practices, and unique aspects of MCTs that require tailored implementation supports.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Temma Schaechter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Kelly L Green
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | | | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
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Santillanes G, Foster AA, Ishimine P, Berg K, Cheng T, Deitrich A, Heniff M, Hooley G, Pulcini C, Ruttan T, Sorrentino A, Waseem M, Saidinejad M. Management of youth with suicidal ideation: Challenges and best practices for emergency departments. J Am Coll Emerg Physicians Open 2024; 5:e13141. [PMID: 38571489 PMCID: PMC10989674 DOI: 10.1002/emp2.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self-harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self-harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home- and community-based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on-site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community- and home-based services, pediatric-receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.
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Affiliation(s)
- Genevieve Santillanes
- Department of Emergency Medicine, Keck School of Medicine of USCLos Angeles General Medical CenterLos AngelesCaliforniaUSA
| | - Ashley A. Foster
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Paul Ishimine
- Departments of Emergency Medicine and PediatricsUniversity of California, San Diego School of Medicine, UC San Diego Health and Rady Children's HospitalSan DiegoCaliforniaUSA
| | - Kathleen Berg
- Department of Pediatrics, Dell Medical SchoolThe University of TexasAustinTexasUSA
| | - Tabitha Cheng
- Department of Emergency MedicineHarbor UCLA Medical CenterDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Ann Deitrich
- Division Chief Pediatric Emergency MedicineDepartment of Emergency MedicinePrisma HealthUniversity of South Carolina School of MedicineGreenvilleSouth CarolinaUSA
| | - Melanie Heniff
- Departments of Emergency Medicine and PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gwen Hooley
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Christian Pulcini
- Department of Emergency Medicine and PediatricsUniversity of Vermont Larner College of MedicineBurlingtonVermontUSA
| | - Timothy Ruttan
- Department of PediatricsDell Medical SchoolThe University of Texas at Austin. US Acute Care SolutionsCantonOhioUSA
| | - Annalise Sorrentino
- Department of Pediatrics, Division of Emergency MedicineUniversity of AlabamaBirminghamAlabamaUSA
| | - Muhammad Waseem
- Lincoln Medical Center, Bronx New York; Weill Cornell MedicineNew YorkUSA
| | - Mohsen Saidinejad
- Departments of Emergency Medicine and PediatricsDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
- The Lundquist Institute for Biomedical Innovation at Harbor UCLATorranceCaliforniaUSA
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Burns A, Menachemi N, Mazurenko O, Salyers MP, Yeager VA. State Policies Associated with Availability of Mobile Crisis Teams. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01368-0. [PMID: 38498103 PMCID: PMC11408699 DOI: 10.1007/s10488-024-01368-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/20/2024]
Abstract
Mobile crisis teams are comprised of multidisciplinary mental health professionals that respond to mental health crisis calls in community settings. This study identified counties with mobile crisis teams and examined state policies associated with mobile crisis teams. Descriptive statistics and geographic information system software were used to quantify and map counties with mobile crisis teams in the United States. Relationships between state policies and mobile crisis teams were examined using an adjusted logistic regression model, controlling for county characteristics and accounting for clustering by state. Approximately 40% (n = 1,245) of all counties in the US have at least one mobile crisis team. Counties in states with legislation in place to fund the 988 Suicide and Crisis Lifeline were more likely to have a mobile crisis team (Adjusted Odds Ratio (AOR): 2.0; Confidence Interval (CI): 1.23-3.26), whereas counties in states with 1115 waivers restricting Medicaid benefits were less likely to have a mobile crisis team (AOR: 0.43; CI: 0.21-0.86). Additionally, counties with the largest population were more likely to have a mobile crisis team (AOR: 2.20; CI:1.43-3.38) than counties with the smallest population. Having a mobile crisis teams was positively associated with legislation to fund 988. Legislation that encourages expansion of existing crisis care services, specifically funding aimed at mobile crisis teams, may help increase availability of services for people who are experiencing a mental health crisis in the community.
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Affiliation(s)
- Ashlyn Burns
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - Nir Menachemi
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Olena Mazurenko
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University School of Science, Indianapolis, IN, USA
| | - Valerie A Yeager
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
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Hoffmann JA, Kshetrapal A, Pergjika A, Foster AA, Wnorowska JH, Johnson JK. A Qualitative Assessment of Barriers and Proposed Interventions to Improve Acute Agitation Management for Children With Mental and Behavioral Health Conditions in the Emergency Department. J Acad Consult Liaison Psychiatry 2024; 65:167-177. [PMID: 38070778 PMCID: PMC11032221 DOI: 10.1016/j.jaclp.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/11/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Mental health visits to the emergency department (ED) by children are rising in the United States, and acute agitation during these visits presents safety risks to patients and staff. OBJECTIVE We sought to assess barriers and strategies for providing high-quality care to children who experience acute agitation in the ED. METHODS We conducted semistructured interviews with 6 ED physicians, 6 ED nurses, 6 parents, and 6 adolescents at high risk for developing agitation. We asked participants about their experiences with acute agitation care in the ED, barriers and facilitators to providing high-quality care, and proposed interventions. Interviews were coded and analyzed thematically. RESULTS Participants discussed identifying risk factors for acute agitation, worrying about safety and the risk of injury, feeling moral distress, and shifting the culture toward patient-centered, trauma-informed care. Barriers and facilitators included using a standardized care pathway, identifying environmental barriers and allocating resources, partnering with the family and child, and communicating among team members. Nine interventions were proposed: opening a behavioral observation unit with dedicated staff and space, asking screening questions to identify risk of agitation, creating personalized care plans in the electronic health record, using a standardized agitation severity scale, implementing a behavioral response team, providing safe activities and environmental modifications, improving the handoff process, educating staff, and addressing bias and inequities. CONCLUSIONS Understanding barriers can inform solutions to improve care for children who experience acute agitation in the ED. The perspectives of families and patients should be considered when designing interventions to improve care.
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Affiliation(s)
- Jennifer A Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Anisha Kshetrapal
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alba Pergjika
- Prtizker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ashley A Foster
- Department of Emergency Medicine, University of California San Francisco, UCSF Benioff Children's Hospital, San Francisco, CA
| | | | - Julie K Johnson
- Department of Surgery, Northwestern Quality Improvement Research and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Dailey SF, Dubrow S. Police-mental health partnerships and persons with severe mental illness: An exploratory study of perceived risk and use of force. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 93:101968. [PMID: 38394859 DOI: 10.1016/j.ijlp.2024.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/30/2023] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
There is a need to maximize understanding of conditions under which officers are most likely to use lethal force when interacting with persons with severe mental illness (SMI) and whether utilization of a mental health professional (MHP) serves to reduce use of force (UoF) severity. Using a mixed methods concurrent triangulation design framework, this exploratory study examined UoF with individuals exhibiting signs of psychosis and whether police-MHP partnerships decrease UoF severity. Findings indicate officers use more severe forms of force with armed individuals displaying signs of psychosis and that MHP presence did not reduce force severity in such cases. Qualitative themes provide context for these findings and include (1) concerns for MHP safety, (2) planned collaborations support safety, and (3) MHPs support de-escalation. Discussion highlights a need for increased officer education on SMI, appropriate de-escalation strategies, co-created engagement/disengagement protocols for MHPs, and defined standards of practice for police-mental health collaborations.
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Affiliation(s)
- Stephanie F Dailey
- College of Education and Human Development, George Mason University, Fairfax, VA, USA.
| | - Samantha Dubrow
- Homeland Security Systems Engineering and Development Institute (HSSEDI), Fairfax, VA, USA
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Edwards D, Carrier J, Csontos J, Evans N, Elliott M, Gillen E, Hannigan B, Lane R, Williams L. Review: Crisis responses for children and young people - a systematic review of effectiveness, experiences and service organisation (CAMH-Crisis). Child Adolesc Ment Health 2024; 29:70-83. [PMID: 36785997 DOI: 10.1111/camh.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND In England, one in six children aged 5-19 has a probable diagnosable mental health disorder. This is a major public health problem, with multiple agencies adopting varying approaches to care delivery for children and young people (CYP) in crisis. OBJECTIVES To examine the organisation of crisis services across education, health, social care and voluntary sectors; the experiences and perceptions of CYP, families and staff; the effectiveness of current approaches to care and the goals of crisis intervention. METHODS A systematic review of all relevant English language evidence regarding the provision and receipt of crisis support for CYP aged 5-25 (PROSPERO-CRD42019160134). Seventeen databases were searched from 1995 to 2021 and relevant UK-only grey literature was identified. Critical appraisal was conducted using appropriate design specific appraisal tools. A narrative approach to synthesis was conducted. RESULTS In total, 138 reports (48 reports covering 42 primary research studies; 36 reports covering 39 descriptive accounts of the organisation services and 54 UK-only grey literature reports) were included. The evidence suggests that crisis services were organised as follows: triage/assessment-only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, four themes were identified: (a) barriers and facilitators to seeking and accessing appropriate support; (b) what children and young people want from crisis services; (c) children's, young people's and families' experiences of crisis services; and (d) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of crisis services were identified. DISCUSSION Despite a lack of high-quality international studies, findings suggest that support prior to reaching crisis point is important. From this work, various aspects of crisis care have been identified that can be incorporated into existing services across education, health, social care and the voluntary sector.
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Affiliation(s)
- Deborah Edwards
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Judith Carrier
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Judit Csontos
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nicola Evans
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Mair Elliott
- Independent Service User Researcher, Cardiff, UK
| | - Elizabeth Gillen
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ben Hannigan
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Rhiannon Lane
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Liz Williams
- Independent Service User Researcher, Cardiff, UK
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12
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Kraus CK, Ferry J. Emergency Department Care of the Patient with Suicidal or Homicidal Symptoms. Emerg Med Clin North Am 2024; 42:31-40. [PMID: 37977751 DOI: 10.1016/j.emc.2023.06.021] [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] [Indexed: 11/19/2023]
Abstract
Patients frequently present to the emergency department (ED) with acute suicidal and homicidal thoughts. These patients require timely evaluation, with determination of disposition by either voluntary or involuntary hospitalization or discharge with appropriate outpatient follow-up. Safety concerns should be prioritized for patients as well as ED staff. Patient dignity and autonomy should be respected throughout the process.
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Affiliation(s)
- Chadd K Kraus
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA; University of South Florida Morsani College of Medicine.
| | - James Ferry
- Department of Emergency Medicine, Geisinger, Danville, Pennsylvania, USA
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13
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Mark TL, Henretty K, Gibbons BJ, Zarkin GA. Association of Arizona's Implementation of a Behavioral Health Crisis Response System With Suicide Hospitalizations. Psychiatr Serv 2024; 75:148-154. [PMID: 37554005 DOI: 10.1176/appi.ps.20220628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE In July 2022, the 988 Suicide and Crisis Lifeline went live. The Lifeline is part of larger federal and state efforts to build comprehensive behavioral health crisis response systems that include mobile crisis units and crisis diversion and stabilization centers. Comprehensive response systems are anticipated to reduce hospitalizations for suicide and other behavioral health crises; however, research testing this assumption has been limited. The authors used Arizona-a state known for its comprehensive crisis system-to determine the association between state implementation of a comprehensive behavioral health crisis response system and suicide-related hospitalizations. METHODS A comparative interrupted time-series (CITS) design was used to compare changes in suicide-related hospitalizations after the 2015 implementation of Arizona's crisis response system (N=215,063). Data were from the 2010-2019 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Nevada (N=84,091 hospitalizations) was used as a comparison state because it is a western state that had not yet implemented a comprehensive crisis system and had available HCUP SID data. The CITS model included controls for time-varying differences in state demographic composition. RESULTS From 2010 to 2014 to 2019, annual suicide-related hospitalizations in Arizona increased from 122.0 to 324.2 to 584.5, respectively, per 100,000 people, and in Nevada, hospitalizations increased from 94.7 to 263.2 to 595.5, respectively, per 100,000 people. Arizona's crisis response system was associated with a significant relative decrease in the quarterly trend of 2.57 suicide-related hospitalizations per 100,000 people (p=0.033). CONCLUSIONS More research is needed to understand how the implementation of a comprehensive crisis response system may affect suicide-related hospitalizations.
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Skinner A, Occhipinti JA, Song YJC, Scott EM, Hickie IB. Dynamic modelling of the impact of community-based acute mental health services for children and adolescents. Aust N Z J Psychiatry 2023; 57:1562-1569. [PMID: 37641519 PMCID: PMC10666480 DOI: 10.1177/00048674231195555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To evaluate the potential impact of the recently announced 'Safeguards' initiative on mental health-related emergency department presentation rates for children and adolescents (0-17 years). This state-funded initiative aims to establish 25 Child and Adolescent Acute Response Teams across New South Wales. METHODS We estimated the effects of the 'Safeguards' initiative using a state-level dynamic model of child and adolescent acute mental health care. Potential reductions in total numbers of mental health-related emergency department presentations and re-presentations (i.e. presentations within 3 months of an initial presentation) were assessed via a series of simulation experiments in which we systematically varied the total number of Child and Adolescent Acute Response Teams and the mean duration of care per patient. RESULTS Assuming a mean treatment duration of 6 weeks per patient, 25 Child and Adolescent Acute Response Teams are projected to reduce total numbers of mental health-related emergency department presentations and re-presentations over the period 2022-2031 by 15.0% (95% interval, 12.0-18.2%) and 31.7% (26.2-37.8%), respectively. Increasing the total number of Child and Adolescent Acute Response Teams above 25 has minimal additional impact on projected reductions in numbers of emergency department presentations and re-presentations, provided the mean duration of care is no more than 8 weeks. However, where the mean duration of care is greater than 4 weeks, a decrease in the number of Child and Adolescent Acute Response Teams below 25 reduces the potential effectiveness of the 'Safeguards' initiative significantly. CONCLUSION Our simulation results indicate that full and timely implementation will be critical if the potentially substantial impact of the 'Safeguards' initiative on demand for hospital-based emergency mental health care is to be realised.
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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15
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Hutchison M, Theriault KM, Seng K, Vanderploeg J, Conner KR. Youth Mobile Response and Stabilization Services: Factors Associated with Multiple Episodes of Care. Community Ment Health J 2023; 59:1619-1630. [PMID: 37347420 DOI: 10.1007/s10597-023-01153-7] [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] [Received: 01/09/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
Mobile response and stabilization services (MRSS) provide short-term, community-based, care to individuals in crisis. Minimal studies have explored which factors are associated with multiple episodes of MRSS care. We used a retrospective cohort design of MRSS electronic health records to explore demographic and clinical characteristics associated with multiple episodes of care among 2,641 youth ages 5-21 years old in New York, USA. Youth with multiple episodes of care (n = 585; 22.2%) were more likely to be non-Hispanic, have treatment histories including presenting problems related to adjustment, conduct, mood, or suicidal thoughts and behaviors, have high-level mental health visits, and more follow-up visits. Future research should examine the unmet needs of non-Hispanic populations and whether characteristics associated with multiple MRSS episodes are consistent across populations to inform procedures targeting unmet needs that prevent or minimize repeated use during crises.
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Affiliation(s)
- Morica Hutchison
- Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY, 14642, United States.
| | - Kayla M Theriault
- Child Health and Development Institute, 270 Farmington Avenue #367, 06032, Farmington, CT, United States
| | - Kagnica Seng
- Child Health and Development Institute, 270 Farmington Avenue #367, 06032, Farmington, CT, United States
| | - Jeffrey Vanderploeg
- Child Health and Development Institute, 270 Farmington Avenue #367, 06032, Farmington, CT, United States
| | - Kenneth R Conner
- Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY, 14642, United States
- Department of Emergency Medicine, University of Rochester Medical Center, 265 Crittenden Boulevard, Rochester, NY, 14642, United States
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16
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Bajaj MA, Wilcox HC, Adams LB, Berman AL, Cwik M, Kitchen C, Miller L, Nestadt PS, Slade EP, Haroz EE. Demographic predictors of emergency service utilization patterns in youth at risk of suicide. Suicide Life Threat Behav 2023; 53:702-712. [PMID: 37431982 PMCID: PMC10916713 DOI: 10.1111/sltb.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/08/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To explore demographic predictors of Emergency Department (ED) utilization among youth with a history of suicidality (i.e., ideation or behaviors). METHODS Electronic health records were extracted from 2017 to 2021 for 3094 8-22 year-old patients with a history of suicidality at an urban academic medical center ED in the Mid-Atlantic. Logistic regression analyses were used to assess for demographic predictors of ED utilization frequency, timing of subsequent visits, and reasons for subsequent visits over a 24-month follow-up period. RESULTS Black race (OR = 1.45, 95% CI = 1.11-1.92), Female sex (OR = 1.59, 95% CI = 1.26-2.03), and having Medicaid insurance (OR = 1.71, 95% CI = 1.37-2.14) were associated with increased utilization, while being under 18 was associated with lower utilization (<12: OR = 0.38, 95% CI = 0.26-0.56; 12-18: OR = 0.47, 95% CI = 0.35-0.63). These demographics were also associated with ED readmission within 90 days, while being under 18 was associated with a lower odds of readmission. CONCLUSIONS Among patients with a history of suicidality, those who identify as Black, young adults, patients with Medicaid, and female patients were more likely to be frequent utilizers of the ED within the 2 years following their initial visit. This pattern may suggest inadequate health care access for these groups, and a need to develop better care coordination with an intersectional focus to facilitate utilization of other health services.
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Affiliation(s)
- Mira A. Bajaj
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Holly C. Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Leslie B. Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alan L. Berman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mary Cwik
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher Kitchen
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Leslie Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eric P. Slade
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily E. Haroz
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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17
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Foster AA, Watkins K, Trivedi TK, Cruz‐Romero M, Leibovich SA, Daftary RK, Kornblith AE, Grupp‐Phelan J, Sporer KA, Kellison C, Glomb NW. Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting. J Am Coll Emerg Physicians Open 2023; 4:e13016. [PMID: 37600903 PMCID: PMC10432898 DOI: 10.1002/emp2.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/24/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
Objective Emergency medical services (EMS) transport for mental and behavioral health (MBH) emergencies occurs frequently in children, yet little is understood regarding prehospital physical restraint use despite the potential for serious adverse events. We aim to describe restraint use prevalence and primary impressions among children with MBH emergencies. Methods This is a retrospective cross-sectional study of children with MBH emergencies evaluated by Alameda County (ALCO), California EMS from January 1, 2012 to December 31, 2018. Patient demographics and clinical variables were collected from the EMS records including sex, age at time of encounter, year of encounter, transport destination, medication use, and primary impression(s). The primary outcome was the use of physical restraints. Descriptive statistics were used to characterize the primary outcome and associated demographic and diagnostic features, as well as temporal use patterns. Sex and age were compared between restrained and non-restrained youth using chi-square analysis. Results Over the 7-year study period, ALCO EMS transported 9775 children with MBH emergencies. Of these transports, 1205 (12.3%) were physically restrained. Most children restrained had the primary impression of "behavioral/psychiatric crisis" (51.1%), "psychiatric crisis" (27.4%), and "behavioral-other" (12.4%) and the remaining children (9.1%) had a non-psychiatric/behavioral health primary impression. Over time, there was no statistically significant change in either number of children with MBH emergencies transported or physical restraint rate. Conclusions More than 1 in 8 children with MBH emergencies are being physically restrained during EMS transport. Restraint rate did not substantially change over time. Further studies to understand existing restraint rates and EMS resources available to address acute agitation in children are needed to inform quality and care enhancing initiatives.
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Affiliation(s)
- Ashley A. Foster
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kenshata Watkins
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Tarak K. Trivedi
- Department of Emergency MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Marisol Cruz‐Romero
- Department of Behavioral HealthUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Sara A. Leibovich
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Rajesh K. Daftary
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Aaron E. Kornblith
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Karl A. Sporer
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Colleen Kellison
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Nicolaus W. Glomb
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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18
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Herrera CN, Oblath R, Duncan A. Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2321798. [PMID: 37410466 PMCID: PMC10326644 DOI: 10.1001/jamanetworkopen.2023.21798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023] Open
Abstract
Importance Psychiatric boarding occurs when patients needing intensive psychiatric services who are already under clinical supervision experience delays in their admission to psychiatric facilities. Initial reports have suggested that the US had a psychiatric boarding crisis during the COVID-19 pandemic; however, little is known about the consequences of this crisis for publicly insured youths. Objective To estimate pandemic-associated changes in psychiatric boarding rates and discharge modalities for people aged 4 to 20 years who accessed psychiatric emergency services (PES) through a mobile crisis team (MCT) evaluation and were covered by Medicaid or health safety net programs. Design, Setting, and Participants This retrospective cross-sectional study used data from the MCT encounters of a multichannel PES program in Massachusetts. A total of 7625 MCT-initiated PES encounters with publicly insured youths who lived in Massachusetts between January 1, 2018, and August 31, 2021, were assessed. Main Outcomes and Measures Encounter-level outcomes (psychiatric boarding status, repeat visits, and discharge disposition) during a prepandemic period (January 1, 2018, to March 9, 2020) were compared with outcomes during a pandemic period (March 10, 2020, to August 31, 2021). Descriptive statistics and multivariate regression analysis were used. Results Among 7625 MCT-initiated PES encounters, the mean (SD) age of publicly insured youths was 13.6 (3.7) years; most youths identified as male (3656 [47.9%]), were of Black race (2725 [35.7%]) or Hispanic ethnicity (2708 [35.5%]), and spoke English (6941 [91.0%]). During the pandemic period, the mean monthly boarding encounter rate was 25.3 percentage points higher than the prepandemic period. After adjustment for covariates, the odds of an encounter resulting in boarding doubled during the pandemic (adjusted odds ratio [AOR], 2.03; 95% CI, 1.82-2.26; P < .001), and boarding youths were 64% less likely to be discharged to inpatient psychiatric care (AOR, 0.36; 95% CI, 0.31-0.43; P < .001). Publicly insured youths who boarded during the pandemic had significantly higher rates of 30-day readmissions (incidence rate ratio, 2.17; 95% CI, 1.88-2.50; P < .001). Boarding encounters during the pandemic were significantly less likely to end in discharge to inpatient psychiatric units (AOR, 0.36; 95% CI, 0.31-0.43; P < .001) or community-based acute treatment facilities (AOR, 0.70; 95% CI, 0.55-0.90; P = .005). Conclusions and Relevance In this cross-sectional study, publicly insured youths were more likely to experience psychiatric boarding during the COVID-19 pandemic and, if boarding, were less likely to transfer to a 24-hour level of care. These findings suggest that psychiatric service programs for youths were not prepared to support the levels of acuity and demand that emerged from the pandemic.
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Affiliation(s)
- Carolina-Nicole Herrera
- Department of Health, Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
- Boston Emergency Services Team Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, Massachusetts
| | - Rachel Oblath
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
- Boston Emergency Services Team Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, Massachusetts
| | - Alison Duncan
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
- Boston Emergency Services Team Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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19
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Goldman ML, Ponce AN, Thomas M, Felder S, Wu S, Loewy R, Mangurian C. Field Visit Contact Rate by Mobile Crisis Teams as a Crisis System Performance Metric. Psychiatr Serv 2023; 74:756-759. [PMID: 36510763 PMCID: PMC10261499 DOI: 10.1176/appi.ps.202100736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The authors investigated associations between rates of contact with individuals in distress during field visits by mobile crisis teams and client and referral source characteristics. METHODS In this retrospective observational study of an urban mobile crisis program, call logs (N=2,581) were coded for whether an attempted field visit resulted in a client evaluation. Logistic regression analyses examined potential associations with client age, gender, race-ethnicity, primary language, living situation, insurance, and referral source. RESULTS Contact was made with 77% of adults and 97% of children referred to mobile crisis teams. Field visit contact rates differed by age. Unsuccessful visits were more likely when the referral source was from institutional settings than from individuals. CONCLUSIONS Approximately one-quarter of attempted field visits with adults by an urban mobile crisis team were not completed, particularly among referrals from institutional settings. As mobile crisis services proliferate, field visit contact rate could be a key performance metric for these critical services.
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Affiliation(s)
- Matthew L Goldman
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Andrea N Ponce
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Marilyn Thomas
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Stephanie Felder
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Stephen Wu
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Rachel Loewy
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Christina Mangurian
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
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20
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Ding X, Wuerth K, Sakakibara B, Schmidt J, Parde N, Holsti L, Barbic S. Understanding Mobile Health and Youth Mental Health: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e44951. [PMID: 37220197 PMCID: PMC10278734 DOI: 10.2196/44951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/30/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy. OBJECTIVE The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth's access to mental health services and health outcomes. METHODS Guided by the methods of Arksey and O'Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis. RESULTS The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non-youth-centered approaches to implementing results. CONCLUSIONS This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths' engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time.
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Affiliation(s)
- Xiaoxu Ding
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Kelli Wuerth
- Foundry, Providence Health Care, Vancouver, BC, Canada
| | - Brodie Sakakibara
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - Julia Schmidt
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Natalie Parde
- Department of Computer Science, University of Illinois Chicago, Chicago, IL, United States
- Natural Language Processing Laboratory, University of Illinois Chicago, Chicago, IL, United States
| | - Liisa Holsti
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Skye Barbic
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
- Foundry, Providence Health Care, Vancouver, BC, Canada
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC, Canada
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Bommersbach TJ, McKean AJ, Olfson M, Rhee TG. National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020. JAMA 2023; 329:1469-1477. [PMID: 37129655 PMCID: PMC10155071 DOI: 10.1001/jama.2023.4809] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/13/2023] [Indexed: 05/03/2023]
Abstract
Importance There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. Objective To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Design, Setting, and Participants Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Main Outcomes and Measures Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. Results From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Conclusions and Relevance Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.
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Affiliation(s)
| | - Alastair J McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington
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22
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Hoge MA, Vanderploeg J, Paris M, Lang JM, Olezeski C. Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda. Community Ment Health J 2022; 58:1225-1239. [PMID: 35038073 PMCID: PMC8762987 DOI: 10.1007/s10597-022-00937-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
Abstract
There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.
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Affiliation(s)
- Michael A. Hoge
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jeffrey Vanderploeg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Child Health and Development Institute, Farmington, CT USA
- Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Manuel Paris
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jason M. Lang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Child Health and Development Institute, Farmington, CT USA
- Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Christy Olezeski
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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23
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Marcus N, Stergiopoulos V. Re-examining mental health crisis intervention: A rapid review comparing outcomes across police, co-responder and non-police models. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1665-1679. [PMID: 35103364 DOI: 10.1111/hsc.13731] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/29/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Police are the default first responders in most mental health crisis intervention models worldwide, resulting in a heavy burden on police, perceived criminalization of individuals with complex mental health needs, and escalation of aggression that resort to violence. Models, such as crisis intervention teams (CIT), and co-response programmes aim to improve service user experiences and outcomes by providing mental health training to police, or pairing law enforcement officers with mental health clinicians, respectively. Despite these efforts, mental health-related calls continue to result in negative outcomes, and activists and policymakers are advocating for non-police models of crisis intervention. Evidence-based practice in mental health crisis intervention is urgently needed. The present review's main objective was to examine, synthesise and compare outcomes across police, co-responder and non-police models of mental health crisis intervention internationally using a rapid review framework. A systematic search of four electronic databases of studies published between 2010-2020 and a grey literature search was conducted, yielding (n = 1008) articles. A total of 62 articles were included in the present review. Studies were largely observational, lacking control groups and were of low-moderate quality with a high potential for bias. Overall, there is little evidence to suggest that the CIT model impacts crisis outcomes. Co-responder models evidenced improved outcomes compared to police only models, however, evidence was often mixed. Non-police models varied significantly, and studies tended to be too low quality to make comparisons or draw conclusions, however, research on youth models and crisis resolution home treatment suggested positive outcomes. Findings highlight the need for high-quality studies and policies to facilitate the implementation and evaluation of novel approaches not involving police. Cross-sectorial collaboration and service user input are urgently needed to inform, develop, test and disseminate effective models of crisis intervention acceptable to service users.
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Affiliation(s)
- Natania Marcus
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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24
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McClellan SR, Hunt M, Olsho LEW, Dasgupta A, Chowdhury M, Sparks AC. Satisfaction and Mental Health Outcomes Associated with a Large Regional Helpline. Community Ment Health J 2022; 58:1214-1224. [PMID: 35015179 PMCID: PMC8749345 DOI: 10.1007/s10597-021-00931-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
We surveyed users of a behavioral health helpline serving New York City and surroundings, to assess their helpline experiences, changes in psychological distress after contacting the helpline, and factors associated with differences in these measures. We surveyed users twice: roughly 2 weeks following their helpline contact, from 4/2019 to 9/2019 (N = 1097 respondents) and again 6 months following contact, from 10/2019 to 3/2020 (N = 732 respondents). Eighty-nine percent of respondents reported that contacting the helpline helped them deal a little or a lot more effectively with their problems. Rates of psychological distress decreased from 41.3% 2 weeks following helpline contact to 29.0% 6 months after (P < 0.05). Improvements in psychological distress were found across a range of demographic characteristics and were greatest for repeat users. Users reported broadly positive experiences with the helpline and improved psychological distress 6 months later. Behavioral health helplines can offer beneficial services to diverse populations, complementing the formal behavioral healthcare system.
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Affiliation(s)
- Sean R McClellan
- Division of Health and Environment, Abt Associates, 10 Fawcett St., Cambridge, MA, 02138, USA.
| | - Meaghan Hunt
- Division of Health and Environment, Abt Associates, 10 Fawcett St., Cambridge, MA, 02138, USA
| | - Lauren E W Olsho
- Division of Health and Environment, Abt Associates, 10 Fawcett St., Cambridge, MA, 02138, USA
| | - Amrita Dasgupta
- NYC Health + Hospitals, 125 Worth St., New York, NY, 10013, USA
| | - Mifta Chowdhury
- NYC Health + Hospitals, 125 Worth St., New York, NY, 10013, USA
| | - Alicia C Sparks
- Division of Health and Environment, Abt Associates, 10 Fawcett St., Cambridge, MA, 02138, USA
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25
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Balfour ME, Hahn Stephenson A, Delany-Brumsey A, Winsky J, Goldman ML. Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies. Psychiatr Serv 2022; 73:658-669. [PMID: 34666512 DOI: 10.1176/appi.ps.202000721] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.
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Affiliation(s)
- Margaret E Balfour
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Arlene Hahn Stephenson
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Ayesha Delany-Brumsey
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Jason Winsky
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Matthew L Goldman
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
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26
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Xie M, Wodzinski M, Gajaria A, Battaglia M, Rotem A. Review: Impact of urgent youth outpatient mental health care on patient and health system outcomes - a scoping review. Child Adolesc Ment Health 2022; 28:287-298. [PMID: 35509220 DOI: 10.1111/camh.12565] [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] [Accepted: 04/14/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Young people often face barriers to psychiatric care and are increasingly seeking crisis services for mental health issues through the emergency department (ED). Urgent psychiatric care models provide youth in crisis with rapid access to time-limited mental health care on an outpatient basis. This scoping review aims to evaluate the impact of such urgent psychiatric services for youth aged 13-25 on patient and health system outcomes. METHODS We conducted a literature search on PubMed, EMBASE, MEDLINE, PsycINFO, and the Cochrane Database of Systematic Reviews for studies published from inception to November 20, 2020. We included studies that described outpatient psychiatric services designed for youth aged 13 to 25, took place in a clinical setting, and offered any combination of assessment, treatment, and referral. We excluded studies describing suicide intervention programmes. RESULTS Our search yielded six studies, four of which were descriptive studies and two of which were randomized controlled trials. Most studies found that access to urgent psychiatric care for youth was associated with reduced ED volumes, fewer health system costs, and fewer hospitalizations. None of the studies presented evidence that urgent psychiatric services are associated with improved patient symptomatology or functioning. CONCLUSIONS The results of this scoping review highlight the scarcity of robust evidence evaluating the effectiveness of urgent care for youth mental health. Further experimental studies and a set of standardized quality measures for evaluating these services are needed to bridge this critical gap in mental health care for youth in crisis.
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Affiliation(s)
- Mary Xie
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Wodzinski
- Residency Training Program, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amy Gajaria
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marco Battaglia
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Amit Rotem
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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27
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Dubuque-Gallo C, Kurz B, Becker J, Fendrich M, Vanderploeg J. Providers’ Perspectives on Implementing Mobile Crisis Services for Children and Youth in Connecticut. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-021-09670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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28
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Vakkalanka JP, Neuhaus RA, Harland KK, Clemsen L, Himadi E, Lee S. Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis. West J Emerg Med 2021; 22:1086-1094. [PMID: 34546884 PMCID: PMC8463043 DOI: 10.5811/westjem.2021.6.52276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Mental health and substance use disorder (MHSUD) patients in the emergency department (ED) have been facing increasing lengths of stay due to a shortage of inpatient beds. Previous research indicates mobile crisis outreach (MCO) reduces long ED stays for MHSUD patients. Our objective was to assess the impact of MCO contact on future ED utilization. METHODS We conducted a retrospective chart review of patients presenting to a large Midwest university ED with an MHSUD chief complaint from 2015-2018. We defined the exposure as those who had MCO contact and any MHSUD-related ED visit within 30 days of MCO contact. The MCO patients were 2:1 propensity score-matched by demographic data and comorbidities matched to patients with no MCO contact. Outcomes were all-cause and psychiatric-specific reasons for return to the ED within one year of the index ED visit. We report descriptive statistics and odds ratios (OR) to describe the difference between the two groups, and hazard ratios (HR) to estimate the risk of return ED visit. RESULTS The final sample included 106 MCO and 196 non-MCO patients. The MCO patients were more likely to be homeless (OR 14.8; 95% confidence interval [CI],1.87, 117), less likely to have adequate family or social support (OR 0.51; 95% CI, 0.31, 0.84), and less likely to have a hospital bed requested for them in the index visit by ED providers (OR 0.50; 95% CI, 0.29, 0.88). For those who returned to the ED, the median time for all-cause return to the ED was 28 days (interquartile range [IQR]: 6-93 days) for the MCO patients and 88 days (IQR: 20-164 days) for non-MCO patients. The risk of all-cause return to the ED was greater among MCO patients (67%) compared to non-MCO patients (49%) (adjusted HR: 1.66; 95% CI, 1.22, 2.27). CONCLUSION The MCO patients had less family and social support; however, they were less likely to require hospitalization for each visit, likely due to MCO involvement. Patients with MCO contact presented to the ED more frequently than non-MCO patients, which implies a strong linkage between the ED and MCO in our community. An effective referral to community service from the ED and MCO and collaboration could be the next step to improve healthcare utilization.
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Affiliation(s)
- J. Priyanka Vakkalanka
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
- University of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa
| | - Ryan A. Neuhaus
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
| | - Karisa K. Harland
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
- University of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa
| | - Lance Clemsen
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
| | - Elaine Himadi
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa
| | - Sangil Lee
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
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