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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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2
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Stewart SL, Semovski V, Lapshina N. Adolescent Inpatient Mental Health Admissions: An Exploration of Interpersonal Polyvictimization, Family Dysfunction, Self-Harm and Suicidal Behaviours. Child Psychiatry Hum Dev 2024; 55:963-974. [PMID: 36315373 PMCID: PMC11245427 DOI: 10.1007/s10578-022-01450-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
The mental health system is impacted by extreme delays in the provision of care, even in the face of suicidal behaviour. The failure to address mental health issues in a timely fashion result in a dependence on acute mental health services. Improvement to the mental health care system is impacted by the paucity of information surrounding client profiles admitted to inpatient settings. Using archival data from 10,865 adolescents 12-18 years of age (Mage = 14.87, SDage = 1.77), this study aimed to examine the characteristics of adolescents admitted to psychiatric inpatient services in Ontario, Canada. Multivariate binary logistic regression revealed that adolescents reporting interpersonal polyvictimization, greater family dysfunction and higher risk of suicide and self-harm had a greater likelihood of an inpatient mental health admission. The interRAI Child and Youth Mental Health assessment can be used for care planning and early intervention to support adolescents and their families before suicide risk is imminent.
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Affiliation(s)
- Shannon L Stewart
- Faculty of Education, The University of Western Ontario, 1137 Western Road, N6G 1G7, London, ON, Canada
| | - Valbona Semovski
- Faculty of Education, The University of Western Ontario, 1137 Western Road, N6G 1G7, London, ON, Canada.
| | - Natalia Lapshina
- Faculty of Education, The University of Western Ontario, 1137 Western Road, N6G 1G7, London, ON, Canada
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3
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Kvestad CA, Holte IR, Reitan SK, Chiappa CS, Helle GK, Skjervold AE, Rosenlund AMA, Watne Ø, Brattland H, Helle J, Follestad T, Hara KW, Holgersen KH. Measuring the Effect of the Early assessment Team (MEET) for patients referred to outpatient mental health care: a study protocol for a randomised controlled trial. Trials 2024; 25:179. [PMID: 38468321 DOI: 10.1186/s13063-024-08028-6] [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: 10/06/2023] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Referrals to specialised mental health care (such as community mental health centres; CMHC) have increased over the last two decades. Patients often have multifaceted problems, which cannot only be solved by such care. Resources are limited, and triaging is challenging. A novel method which approaches patients early and individually upon referral to a CMHC-possibly with a brief intervention-is an Early assessment Team (EaT). In an EaT, two therapists meet the patient early in the process and seek to solve the present problem, often involving community services, primary health care, etc.; attention is paid to symptoms and functional strife, rather than diagnoses. This is in contrast to treatment as usual (TAU), where the patient (after being on a waiting list) meets one therapist, who focuses on history and situation to assign a diagnosis and eventually start a longitudinal treatment. The aim of this study is to describe and compare EaT and TAU regarding such outcomes as work and social adjustment, mental health, quality of life, use of health services, and patient satisfaction. The primary outcome is a change in perceived function from baseline to 12-month follow-up, measured by the Work and Social Adjustment Scale. METHOD Patients (18 years and above; n = 588) referred to outpatient health care at a CMHC are randomised to EaT or TAU. Measures (patient self-reports and clinician reports, patients' records, and register data) are collected at baseline, after the first and last meeting, and at 2, 4, 8, 12, and 24 months after inclusion. Some participants will be invited to participate in qualitative interviews. TRIAL DESIGN The study is a single-centre, non-blinded, RCT with two conditions involving a longitudinal and mixed design (quantitative and qualitative data). DISCUSSION This study will examine an intervention designed to determine early on which patients will benefit from parallel or other measures than assessment and treatment in CMHC and whether these will facilitate their recovery. Findings may potentially contribute to the development of the organisation of mental health services. TRIAL REGISTRATION ClinicalTrials.gov NCT05087446. Registered on 21 October 2021.
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Affiliation(s)
- Camilla Angelsen Kvestad
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ingvild Rønneberg Holte
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Klæbo Reitan
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte S Chiappa
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunn Karin Helle
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne E Skjervold
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Marit A Rosenlund
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Watne
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Heidi Brattland
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Helle
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Turid Follestad
- Clinical Research Unit Central Norway, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karen Walseth Hara
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Trondheim, Norway
- Norwegian Labour and Welfare Administration Trøndelag, Trondheim, Norway
| | - Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Stigter-Outshoven C, Van de Glind G, Wieberdink LJ, van Zelm R, Braam A. Competencies Emergency and Mental Health Nurses Need in Triage in Acute Mental Health Care: A Narrative Review. J Emerg Nurs 2024; 50:55-71. [PMID: 37791945 DOI: 10.1016/j.jen.2023.08.005] [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: 03/02/2023] [Accepted: 08/11/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Emergency and mental health nurses are, in many countries, the designated professionals to conduct acute mental health triage. This review aimed to identify competencies these nurses need in major acute health care services such as emergency and accident departments and mental health crisis services for triage for psychiatric patients in crisis. METHODS For familiarization and construction of an initial thematic framework, we have searched the databases MEDLINE, CINAHL, Academic Search Premier, and PsycINFO since 1975. For indexing and sorting, the web-based application Rayyan was used to identify relevant studies. ATLAS.ti 22 was used for data extraction, reviewing, summary, and display using labels relevant for our research questions: knowledge, skills, and attitude. For appraisal of the included studies, the Mixed Methods Appraisal Tool and the Scale of the Assessment for Narrative Reviews were used. RESULTS Thirty one studies were included and were overall rated as adequate, mostly published since 2000. Competencies needed by nurses in AMHT contain a high level of specialist knowledge (risk assessment, de-escalation, triage tools, psychopathology, law/regulations, care pathways), skills (clinical skills, communication, collaboration, coordinating care), and attitude (nonjudgmental, confidence). DISCUSSION Emergency and mental health nurses require a significant amount of competencies beyond basic nursing education in acute mental health triage. Most described competencies pertain both to knowledge and skills. Less is known about attitude. To integrate the several competencies knowledge, skills, and attitude, clinical reasoning is needed to organize chaos in unpredictable and complex patient situations.
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Clibbens N, Booth A, Sharda L, Baker J, Thompson J, Ashman M, Berzins K, Weich S, Kendal S. Explaining context, mechanism and outcome in adult community mental health crisis care: A realist evidence synthesis. Int J Ment Health Nurs 2023; 32:1636-1653. [PMID: 37574714 DOI: 10.1111/inm.13204] [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: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Mental health crises cause significant distress and disruption to the lives of individuals and their families. Community crisis care systems are complex, often hard to navigate and poorly understood. This realist evidence synthesis aimed to explain how, for whom and in what circumstances community mental health crisis services for adults work to resolve crises and is reported according to RAMESES guidelines. Using realist methodology, initial programme theories were identified and then tested through iterative evidence searching across 10 electronic databases, four expert stakeholder consultations and n = 20 individual interviews. 45 relevant records informed the three initial programme theories, and 77 documents, were included in programme theory testing. 39 context, mechanism, outcome configurations were meta-synthesized into three themes: (1) The gateway to urgent support; (2) Values based crisis interventions and (3) Leadership and organizational values. Fragmented cross-agency responses exacerbated staff stress and created barriers to access. Services should focus on evaluating interagency working to improve staff role clarity and ensure boundaries between services are planned for. Organizations experienced as compassionate contributed positively to perceived accessibility but relied on compassionate leadership. Attending to the support needs of staff and the proximity of leaders to the front line of crisis care are key. Designing interventions that are easy to navigate, prioritize shared decision-making and reduce the risk of re-traumatizing people is a priority.
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Affiliation(s)
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Leila Sharda
- School of Healthcare, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jill Thompson
- Health Sciences School, University of Sheffield, Sheffield, UK
| | | | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
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6
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Clibbens N, Baker J, Booth A, Berzins K, Ashman MC, Sharda L, Thompson J, Kendal S, Weich S. Explanation of context, mechanisms and outcomes in adult community mental health crisis care: the MH-CREST realist evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-161. [PMID: 37837344 DOI: 10.3310/twkk5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Background Mental health crises cause significant disruption to individuals and families and can be life-threatening. The large number of community crisis services operating in an inter-agency landscape complicates access to help. It is unclear which underpinning mechanisms of crisis care work, for whom and in which circumstances. Aim The aim was to identify mechanisms to explain how, for whom and in what circumstances adult community crisis services work. Objectives The objectives were to develop, test and synthesise programme theories via (1) stakeholder expertise and current evidence; (2) a context, intervention, mechanism and outcome framework; (3) consultation with experts; (4) development of pen portraits; (5) synthesis and refinement of programme theories, including mid-range theory; and (6) identification and dissemination of mechanisms needed to trigger desired context-specific crisis outcomes. Design This study is a realist evidence synthesis, comprising (1) identification of initial programme theories; (2) prioritisation, testing and refinement of programme theories; (3) focused realist reviews of prioritised initial programme theories; and (4) synthesis to mid-range theory. Main outcome The main outcome was to explain context, mechanisms and outcomes in adult community mental health crisis care. Data sources Data were sourced via academic and grey literature searches, expert stakeholder group consultations and 20 individual realist interviews with experts. Review methods A realist evidence synthesis with primary data was conducted to test and refine three initial programme theories: (1) urgent and accessible crisis care, (2) compassionate and therapeutic crisis care and (3) inter-agency working. Results Community crisis services operate best within an inter-agency system. This requires compassionate leadership and shared values that enable staff to be supported; retain their compassion; and, in turn, facilitate compassionate interventions for people in crisis. The complex interface between agencies is best managed through greater clarity at the boundaries of services, making referral and transition seamless and timely. This would facilitate ease of access and guaranteed responses that are trusted by the communities they serve. Strengths and limitations Strengths include the identification of mechanisms for effective inter-agency community crisis care and meaningful stakeholder consultation that grounded the theories in real-life experience. Limitations include the evidence being heavily weighted towards England and the review scope excluding full analysis of ethnic and cultural diversity. Conclusions Multiple interpretations of crises and diverse population needs present challenges for improving the complex pathways to help in a crisis. Inter-agency working requires clear policy guidance with local commissioning. Seamless transitions between services generate trust through guaranteed responses and ease of navigation. This is best achieved where there is inter-agency affiliation that supports co-production. Compassionate leaders engender staff trust, and outcomes for people in crisis improve when staff are supported to retain their compassion. Future work Further work might explore inter-agency models of crisis delivery, particularly in rural communities. Future work could focus on evaluating outcomes across crisis care provider agencies and include evaluation of individual, as well as service-level, outcomes. The implementation and effect of mental health triage could be explored further, including via telehealth. Barriers to access for marginalised populations warrant a specific focus in future research. Study registration The study is registered as PROSPERO CRD42019141680. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Leila Sharda
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jill Thompson
- Health Sciences School, University of Sheffield, Sheffield, UK
| | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
| | - Scott Weich
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
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Oblath R, Herrera CN, Were LPO, Syeda HS, Duncan A, Ferguson T, Kalesan B, Perez DC, Taglieri J, Borba CPC, Henderson DC. Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team. Community Ment Health J 2023; 59:370-380. [PMID: 36001197 PMCID: PMC9399566 DOI: 10.1007/s10597-022-01015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005-2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.
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Affiliation(s)
- Rachel Oblath
- Department of Psychiatry, Boston Medical Center, Boston, USA. .,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.
| | - Carolina N Herrera
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
| | - Lawrence P O Were
- Department of Health Sciences, Boston University's College of Health and Rehabilitation Sciences: Sargent College, Boston, USA.,Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Haniya Saleem Syeda
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Alison Duncan
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Tasha Ferguson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Bindu Kalesan
- Department of Medicine, Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, USA
| | - Daisy C Perez
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Joan Taglieri
- Department of Psychiatry, Boston Medical Center, Boston, USA.,Department of Psychiatry, Cambridge Health Alliance, Cambridge, USA.,Boston University School of Medicine, Boston, USA
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
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Semovski V, King CB, Stewart SL. Mental Health Service Urgency in Children's Mental Health: Factors Impacting the Need for Expedited Services. Child Psychiatry Hum Dev 2022; 53:765-775. [PMID: 33835279 DOI: 10.1007/s10578-021-01161-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
Delayed access to mental health services for children and adolescents has been linked to an increased risk of harm and nonattendance to scheduled appointments. While studies suggest that the lack of standardized assessments for prioritizing individuals has contributed to long wait times, the inconsistent use of assessments across service sectors in Ontario continues to persist. This has contributed to a paucity of information surrounding which children and adolescents may require urgent mental health services. Using a large secondary data set, this study examined whether service sector (e.g., school), and other individual client characteristics (e.g., age, sex, legal guardianship, interpersonal and school conflict) predicted greater mental health service urgency in 61,448 children and adolescents assessed using the interRAI Child and Youth Mental Health Screener. Binary logistic regression revealed that all predictors, except for sector, showed a significant effect on service urgency. Findings are instrumental in prioritization, reducing the likelihood that children with acute needs remain on waitlists.
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Affiliation(s)
- Valbona Semovski
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada.
| | - Colin B King
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada
| | - Shannon L Stewart
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada
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9
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Patient and Provider Perspectives on Emergency Department Care Experiences among People with Mental Health Concerns. Healthcare (Basel) 2022; 10:healthcare10071297. [PMID: 35885824 PMCID: PMC9315815 DOI: 10.3390/healthcare10071297] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
Emergency departments (EDs) are an important source of care for people with mental health (MH) concerns. It can be challenging to treat MH in EDs, and there is little research capturing both patient and provider perspectives of these experiences. We sought to summarize the evidence on ED care experiences for people with MH concerns in North America, from both patient and provider perspectives. Medline and EMBASE were searched using PRISMA guidelines to identify primary studies. Two reviewers conducted a qualitative assessment of included papers and inductive thematic analysis to identify common emerging themes from patient and provider perspectives. Seventeen papers were included. Thematic analysis revealed barriers and facilitators to optimal ED care, which were organized into three themes each with sub-themes: (1) interpersonal factors, including communication, patient–staff interactions, and attitudes and behaviours; (2) environmental factors, including accommodations, wait times, and restraint use; and (3) system-level factors, including discharge planning, resources and policies, and knowledge and expertise. People with MH concerns and ED healthcare providers (HCPs) share converging perspectives on improving ED connections with community resources and diverging perspectives on the interplay between system-level and interpersonal factors. Examining both perspectives simultaneously can inform improvements in ED care for people with MH concerns.
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10
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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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11
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Challen K, Westafer L, Milne WK. Hot off the press: We care a lot: The EmPATH study. Acad Emerg Med 2022. [PMID: 35451205 DOI: 10.1111/acem.14510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Psychiatric attendances and prolonged delays in transfer of care are common in Emergency Medicine. We discuss an article by Kim et al published in Academic Emergency Medicine, February 2022, on the effect of establishing a multidisciplinary EmPATH unit for the care of medically stable patients attending with suicide attempts or suicidal ideation. We provide critical analysis of the article, and summarize the social media discussion and a podcast in which the authors discuss their work.
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Affiliation(s)
- Kirsty Challen
- Department of Emergency Medicine Lancashire Teaching Hospitals NHS Trust Lancashire UK
| | - Lauren Westafer
- Department of Emergency Medicine University of Massachusetts Chan Medical School–Baystate Springfield Massachusetts USA
| | - William Ken Milne
- Department of Emergency Medicine University of Western Ontario London Ontario Canada
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12
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Kim AK, Vakkalanka JP, Heukelom PV, Tate J, Lee S. Emergency psychiatric assessment, treatment, and healing (EmPATH) unit decreases hospital admission for patients presenting with suicidal ideation in rural America. Acad Emerg Med 2022; 29:142-149. [PMID: 34403550 PMCID: PMC8850530 DOI: 10.1111/acem.14374] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The objective was to evaluate the impact of an emergency psychiatric assessment, treatment, and healing (EmPATH) unit in the emergency department (ED) on hospital admissions, ED length of stay, and 30-day follow-up for patients presenting with suicidal ideation or attempt. METHODS This study was a before-and-after analysis of introducing the EmPATH unit within a Midwestern academic medical center on outcomes of adult patients (≥18 years) presenting with suicidal ideation or suicidal attempt. The primary outcome in this study was the change in proportion of inpatient psychiatric admission of suicidal patients presenting to the ED before and after implementation of the EmPATH unit. Secondary outcomes compared were changes in proportion of any admission, incomplete admission defined as discharge from the ED after admission request placed, outpatient follow-up, return ED visits within 30 days of admission, and ED boarding time. Association between the EmPATH unit implementation and categorical outcomes were determined using log-binomial regression to estimate relative risks (RRs) and 95% confidence intervals (CIs). Continuous outcomes were log-transformed and generalized estimating equations were used to examine as the mean difference by time period. RESULTS There were 962 patients presenting with suicidal ideation (n = 435 before EmPATH unit, n = 527 after EmPATH unit). Compared to the pre-EmPATH-unit period, there was a reduction in psychiatric admission (RR = 0.48, 95% CI = 0.40 to 0.56), any admission (RR = 0.65, 95% CI = 0.58 to 0.73), incomplete admission (RR = 0.22, 95% CI = 0.11 to 0.43), and 30-day return to the ED (RR = 0.74, 95% CI = 0.56 to 0.98). ED boarding time among admitted patients was reduced by approximately two-thirds both in admitted patients (RR = 0.34, 95% CI = 0.30 to 0.39) and among those with incomplete admissions (RR = 0.37, 95% CI = 0.23 to 0.61). There was a 60% increase in a 30-day follow-up care established at the time of discharge (RR = 1.60, 95% CI = 1.40 to 1.82). CONCLUSIONS The introduction of the EmPATH unit has improved management of patients presenting to the ED with suicidal attempts/ideation by reducing ED boarding and unnecessary admissions and establishing post-ED follow-up care.
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Affiliation(s)
- Allison K. Kim
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - J. Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA,Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Paul Van Heukelom
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jodi Tate
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Sangil Lee
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA,Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
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Du K, Hsiang W, Schmutte T. Characteristics of Behavioral Urgent Care Centers: A National Study During the COVID-19 Pandemic. Psychiatr Serv 2021; 72:235. [PMID: 33517688 DOI: 10.1176/appi.ps.202000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katherine Du
- Yale School of Medicine, New Haven, Connecticut (Du, Hsiang); Department of Psychiatry, Yale School of Medicine (Schmutte)
| | - Walter Hsiang
- Yale School of Medicine, New Haven, Connecticut (Du, Hsiang); Department of Psychiatry, Yale School of Medicine (Schmutte)
| | - Timothy Schmutte
- Yale School of Medicine, New Haven, Connecticut (Du, Hsiang); Department of Psychiatry, Yale School of Medicine (Schmutte)
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Parwani V, Goldenberg M, Venkatesh A. Emergency Department Psychiatric Observation Units: Good Care and Good Money? Acad Emerg Med 2021; 28:141-143. [PMID: 33140472 DOI: 10.1111/acem.14167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Vivek Parwani
- Department of Emergency Medicine Yale University School of Medicine GuilfordCTUSA
| | - Matthew Goldenberg
- Department of Psychiatry Yale University School of Medicine New Haven CTUSA
| | - Arjun Venkatesh
- Department of Emergency Medicine Yale University School of Medicine GuilfordCTUSA
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Health needs assessment in a regional community pharmacy using the PRECEDE-PROCEED model. Res Social Adm Pharm 2020; 17:1151-1158. [PMID: 32912831 DOI: 10.1016/j.sapharm.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Community pharmacies have capacity to provide a variety of professional pharmacy services. However, planning models are underutilised when guiding pharmacists in assessing local health and social needs for providing tailored services to meet community needs and priorities. OBJECTIVE The objective of this was to utilize the PRECEDE-PROCEED model to perform a health needs assessment to identify health concerns in a regional Australian community for guiding professional pharmacy service development. METHODS A health needs assessment using the PRECEDE-PROCEED model was conducted in November 2019 using a convergent mixed-methods design through: (1) convenience sampling of pharmacy customers with a survey, (2) purposive sampling of a sole community pharmacist with a semi-structured interview, and (3) collection of regional health and social data from online databases. RESULTS The community survey response rate was 44.8%. Of 113 participants, the majority were female (71.7%) and town dwellers (89.4%), representing 6.4% of the town's population. Mental illness was cited by 35.3% of community survey participants to be impacting local health and wellbeing, with depression/anxiety the most prevalent self-reported condition (44.2%), predominantly affecting women (72%). The community pharmacist and regional secondary data provided additional support for the prioritization of mental illness. Depression/anxiety was associated with delays/avoidance of prescription medicine due to cost (p = .002), poor self-rated health (p = .012), worsening health over the past year (p < .001), seeking advice from a pharmacist about health or medicines (p = .03), and receipt of emergency care in the past year (p = .001). The lack of a local general practitioner, social isolation, and environmental issues also impacted health and wellbeing. CONCLUSIONS The PRECEDE-PROCEED model identified mental health as the greatest health priority in the community, using multiple data sources and participatory methods. Using this model provides insight into the development of tailored community pharmacy interventions that address health priorities such as mental health needs in a community.
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Barker LC, Sunderji N, Kurdyak P, Stergiopoulos V, Gonzalez A, Kopp A, Vigod SN. Urgent Outpatient Care Following Mental Health ED Visits: A Population-Based Study. Psychiatr Serv 2020; 71:616-619. [PMID: 32089079 DOI: 10.1176/appi.ps.201900466] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Follow-up after psychiatric emergency department (ED) contact is key to optimizing outcomes for vulnerable patients. We aimed to quantify the likelihood of receiving outpatient mental health care after psychiatric ED visits in a population-level sample. METHODS Among individuals who presented for a psychiatric ED visit in Ontario, Canada (2010-2012) and were not admitted to hospital (N=143,662), the authors estimated the likelihood of outpatient physician mental health care within 14 days post-ED visit and compared this across presenting diagnoses. RESULTS About 40.2% (N=57,797) had a follow-up mental health visit within 14 days post-ED. Follow-up was lower among individuals presenting with substance use disorders (25.2%) than among those presenting with disorders not primarily related to substance use (44.5%) (χ2=3,784.7, df=1, p<0.001). Follow-up differed among those presenting with schizophrenia (46.4%), bipolar disorder (56.1%), and major depressive disorder (51.1%) (χ2=61.7, df=2, p<0.001). CONCLUSIONS Post-ED outpatient mental health follow-up is low. Systemwide coordination is needed to connect these high-acuity patients with care, especially those with presentations related to substance use.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Nadiya Sunderji
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Paul Kurdyak
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Vicky Stergiopoulos
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Alejandro Gonzalez
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Alexander Kopp
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez)
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Tzur Bitan D, Otmazgin A, Shani Sela M, Segev A. The Role of Entrapment in Crisis-Focused Psychotherapy Delivered in Psychiatric Emergency Settings: A Comparative Study. Front Psychol 2019; 10:2600. [PMID: 31803124 PMCID: PMC6873799 DOI: 10.3389/fpsyg.2019.02600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/01/2019] [Indexed: 11/19/2022] Open
Abstract
Although many mental health centers offer crisis intervention services as part of their psychiatric emergency facilities, studies assessing outcome, and process of crisis intervention psychotherapy are scarce. One potential psychological construct that might be unique to crisis intervention psychotherapy is entrapment, a psychological construct which reflects an individual's subjective perception of being in uncontrollable, unremitting, and inescapable circumstances. In this study we aimed to investigate whether changes in entrapment affect the process and outcome of crisis intervention psychotherapy, as compared to its effect in short-term psychotherapy delivered in outpatient units. Sixty-nine patients were recruited for the study. Patients were assessed for level of entrapment, symptoms, well-being, and the working alliance at three time points. The moderating effect of the type of therapy on the associations between changes in entrapment and changes in symptoms, well-being, and the working alliance were assessed using the Hayes process script. The dynamics of change following crisis intervention psychotherapy, as well as the effect of changes in entrapment on symptomatic relief, were illustrated using a clinical vignette of a patient treated in the crisis unit. Results of the moderation analyses indicated that entrapment had a more substantial effect on symptom distress in crisis intervention psychotherapy as compared to its effect in the short-term psychotherapy. Further, the difference in the effect of entrapment across the study groups was manifested primarily in internal entrapment, whereas no moderating effect was found for external entrapment. Clinical vignettes demonstrated the dynamics through which crisis intervention psychotherapy produces changes in entrapment by offering potential outlets from internal thoughts and interpretations of life circumstances. These results suggest that entrapment is a potential underlying process unique to crisis intervention psychotherapy. Limitations, directions for future research, and clinical implications are discussed.
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Affiliation(s)
- Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
- Shalvata Mental Health Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Otmazgin
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Mirit Shani Sela
- Shalvata Mental Health Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviv Segev
- Shalvata Mental Health Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Vandyk A, Bentz A, Bissonette S, Cater C. Why go to the emergency department? Perspectives from persons with borderline personality disorder. Int J Ment Health Nurs 2019; 28:757-765. [PMID: 30779279 DOI: 10.1111/inm.12580] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2019] [Indexed: 01/22/2023]
Abstract
Through this qualitative study, we explored frequent emergency department use by persons with borderline personality disorder from their perspective. Interpretive description guided the study design, and data were collected through interviews with six individuals diagnosed with borderline personality disorder who had at least 12 emergency department visits for reasons related to their mental illness within a 1-year timeframe. Using thematic data analysis, we articulate the participants' experiences through two broad themes: cyclic nature of emergency department use and coping skills and strategies. Unstable community management that leads to self- or crisis presentation to the emergency department often perpetuated emergency department use by our participants and the ensuing interventions aimed at acute stabilization. The participants identified a desire for human interaction and feelings of loneliness, failure of community resources (such as crisis lines or therapy), and safety concerns following suicidal ideation, self-harm, or substance use as the main drivers for their emergency department visits. Our participants identified several potential strategies to protect them against unnecessary emergency department use and improve their health care overall. More work is needed to explore the viability and effectiveness of these suggestions.
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Affiliation(s)
- Amanda Vandyk
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea Bentz
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Bissonette
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Caitlyn Cater
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Kalb LG, Stapp EK, Ballard ED, Holingue C, Keefer A, Riley A. Trends in Psychiatric Emergency Department Visits Among Youth and Young Adults in the US. Pediatrics 2019; 143:e20182192. [PMID: 30886112 PMCID: PMC6564072 DOI: 10.1542/peds.2018-2192] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Visits to the emergency department (ED) for psychiatric purposes are an indicator of chronic and acute unmet mental health needs. In the current study, we examined if psychiatric ED visits among individuals 6 to 24 years of age are increasing nationwide. METHODS ED data came from the 2011-2015 National Hospital Ambulatory Medical Care Survey, a national survey of ED visits across the United States. Psychiatric ED visits were identified by using the International Classification of Diseases, Ninth Revision and reason-for-visit codes. Survey-weighted logistic regression analyses were employed to examine trends in as well as correlates of psychiatric ED visits. Data from the US Census Bureau were used to examine population rates. RESULTS Between 2011 and 2015, there was a 28% overall increase (from 31.3 to 40.2) in psychiatric ED visits per 1000 youth in the United States. The largest increases in psychiatric ED visits per 1000 US youth were observed among adolescents (54%) and African American (53%) and Hispanic patients (91%). A large increase in suicide-related visits (by 2.5-fold) was observed among adolescents (4.6-11.7 visits per 1000 US youth). Although psychiatric ED visits were long (51% were ≥3 hours in length), few (16%) patients were seen by a mental health professional during their visit. CONCLUSIONS Visits to the ED for psychiatric purposes among youth are rising across the United States. Psychiatric expertise and effective mental health treatment options, particular those used to address the rising suicide epidemic among adolescents, are needed in the ED.
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Affiliation(s)
- Luther G Kalb
- Departments of Mental Health and
- Kennedy Krieger Institute, Baltimore, Maryland; and
| | | | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland
| | | | - Amy Keefer
- Kennedy Krieger Institute, Baltimore, Maryland; and
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Anne Riley
- Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Trethewey SP, Deepak S, Saad S, Hughes E, Tadros G. Evaluation of the Psychiatric Decisions Unit (PDU): effect on emergency department presentations and psychiatric inpatient admissions. Postgrad Med J 2019; 95:6-11. [DOI: 10.1136/postgradmedj-2018-135788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 12/28/2018] [Accepted: 01/03/2019] [Indexed: 11/04/2022]
Abstract
BackgroundBusy emergency departments (EDs) are not the optimum environment for assessment of patients in mental health crisis. The Psychiatric Decisions Unit (PDU) was developed by the Birmingham and Solihull Mental Health Foundation Trust as an enhanced assessment service to ensure patients in mental health crisis receive optimal care.AimsTo evaluate the activities of the PDU and its impact on the frequency of ED presentations and inpatient admissions, and to explore patient satisfaction.MethodsData were collected over a 6-month period during 2015 regarding patient demographics, referral sources, length of stay, and frequency of mental health-related ED presentations and inpatient psychiatric admissions. Comparison group data were used to evaluate the impact of the PDU. Patient satisfaction was measured using the ‘Friends and Family Test’ and structured feedback forms.ResultsIn total, 385 patients were referred to the PDU during the study period. Implementation of the PDU was associated with a 39% decrease in the number of patients taken to the ED by Street Triage and a 26% fall in inpatient psychiatric admissions via the Trusts’ in-hospital liaison psychiatry team. Ninety-eight per cent of patients surveyed felt that they were treated with respect and understanding, and 94% reported that they were likely or extremely likely to recommend the service to friends and family.ConclusionsImplementation of the PDU was associated with a reduction in the frequency of ED presentations and inpatient psychiatric admissions. This study suggests that patients are satisfied with the care provided at the PDU.
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Bergmans Y, Ninkovic D, Sunderji N, Simpson-Barrette D. Client Evaluation of an Interprofessional Urgent Mental Health Care Program. J Psychosoc Nurs Ment Health Serv 2018; 57:17-24. [PMID: 30376584 DOI: 10.3928/02793695-20181019-01] [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: 04/17/2018] [Accepted: 08/07/2018] [Indexed: 11/20/2022]
Abstract
Urgent psychiatric care programs are hospital- or community-based outpatient services that expedite access to mental health care for high-risk individuals, yet these services are rarely evaluated from the perspectives of clients. A qualitative thematic analysis of 13 participant interviews of a psychiatric urgent care program allowed researchers to address this gap. Communication, responsiveness, and continuous availability were identified as critical in helping clients articulate their perceived self-stigma, needs, and preferences. A well-coordinated interprofessional team proactively reaching out to facilitate client engagement in care was noted as helpful. Successful transitions to ongoing care partially mitigated the frustration of a time-limited program. Researchers found that an interprofessional team enabled timely and ongoing contact, assistance with system navigation, and the ability to meet a broader range of urgent client needs, including addressing social determinants of health. Recommendations to improve the service included extended hours, improved access to psychotherapy, and integrated telephone crisis support. [Journal of Psychosocial Nursing and Mental Health Services, 57(3), 17-24.].
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Coates D. Service Models for Urgent and Emergency Psychiatric Care: An Overview. J Psychosoc Nurs Ment Health Serv 2018; 56:23-30. [DOI: 10.3928/02793695-20180212-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/10/2018] [Indexed: 11/20/2022]
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Bland R. Valuable New Insights Into Access to Mental Health Care Services. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:377-8. [PMID: 26454724 PMCID: PMC4574712 DOI: 10.1177/070674371506000901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Roger Bland
- Professor Emeritus, Department of Psychiatry, Walter Mackenzie Centre, University of Alberta, Edmonton, Alberta
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