Trends in U.S. Emergency Department Visits for Mental Health Conditions, 1992 to 2001

Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Charles Sprague 2.122, Dallas, Texas 75390-8579, USA.
Psychiatric Services (Impact Factor: 2.41). 07/2005; 56(6):671-7. DOI: 10.1176/
Source: PubMed


The objective of this study was to ascertain trends in mental health-related visits to U.S. emergency departments.
Data were obtained from the National Hospital Ambulatory Medical Care Survey by using mental health-related ICD-9-CM, E, and V codes as well as mental health-related reasons for visit.
From 1992 to 2001, there were 53 million mental health-related visits, representing an increase from 4.9 percent to 6.3 percent of all emergency department visits and an increase from 17.1 to 23.6 visits per 1,000 U.S. population across the decade. The most prevalent diagnoses were substance-related disorders (22 percent of visits), mood disorders (17 percent), and anxiety disorders (16 percent). Mental health-related visits increased significantly among non-Hispanic whites, patients older than 70 years, and patients with insurance. Medications were administered during 61 percent of all mental health-related visits, most commonly psychotropic medication, the prescription rate of which increased from 22 percent to 31 percent of visits over the decade. Ten-year increases in mental health-related emergency department visits were significant for all U.S. geographic regions except the Midwest.
Mental health-related visits constitute a significant and increasing burden of care in U.S. emergency departments.

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Available from: Gregory Luke Larkin, Aug 25, 2015
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    • "The oversubscription of the PES by patients without urgent problems exerts constraint on the resources available to cater for patients in acute crisis and leads to overcrowding of the emergency department, thereby compromising the delivery of timely efficient interventions for patients who require emergency attention [3]. It is also costly, imposing a huge financial burden on health systems. "
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    ABSTRACT: Psychiatric emergencies are acute mental health disturbances that require immediate intervention. However, the emergency department is increasingly being utilised for nonurgent mental health problems, thereby compromising the quality of care available for patients with urgent problems. This study assessed the level and correlates of urgency of mental health problems among patients presenting to an emergency department in Nigeria. The Crisis Triage Rating Scale, Clinical Global Impression Scale and a supplementary questionnaire were administered to 700 attendees at the emergency department of the Federal Neuro-Psychiatric Hospital Yaba, Lagos. Only 29.1% of the presentations constituted an "emergency" 10.9% were "urgent," while 60% were "nonurgent." The most common reason for nonurgent presentations was the need for medication refill. On regression analysis, level of urgency of presentations was independently associated with employment status, need for medication refill, substance abuse, suicidality, routine clinic attendance, and use of physical restraint before presentation. The majority of visits to the emergency department are for apparently "nonurgent problems." However in a resource-poor setting, the emergency department may be the only safety net for the attendees. Our findings point to a need for education of service users and policy shifts in mental health care financing and organisation.
    01/2014; 2014:479081. DOI:10.1155/2014/479081
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    • "The reason for this considerable difference is not related to number of psychiatric visits because in other countries the average visits was between 60-90 people per month in comparison with the 50 people in our study. However the real reason maybe is the great number of visitors to theED of the Rasoul-e-Akram Hospital as a major hospital in Tehran (1, 4, 8).In this study, only 51% of patients had the indication of emergency psychiatric visit.Itis very common to see non-urgent use of EDs in many parts of the world and all medical fieldsandit is reported that such visits take 85-95% of visits.Surprisingly, outpatient visits had a 50% increase from 1955 to 1970, whereas emergency visits increased by312% in the same period in the US(10).Although 52% is more heartwarming than 85-95 % for non-urgent medical visits in EDs in other countries, regardinglimited sources for psychiatric emergencies, long visiting times(which was in average 42 minutes in this study) and the need to have special facilities for such visits, this percentage can still hinder the process of giving services to real emergency psychiatric patients (11). "
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    ABSTRACT: Background: More psychiatric visits, especially non-emergency ones, to emergency departments (EDs) of general hospitals have been observed in recent years. The aim of this study was to determine the characteristics of psychiatric visits to the ED of Rasoul-e-Akram Hospital, Tehran, Iran. Methods: In this cross-sectional study, during a two-month period, all psychiatric presentations and consultations to the ED of the studied hospital were included. The required data were gathered by psychiatry chief residents and were documented in pre-designed checklists. Results: About 0.01% of all patients presenting to the ED needed the psychiatric visits. Men consisted 50% of the total patients with mean (±SD) age of 36.41 (±14.7) years. About 51% of them had the indication of the emergency psychiatric visit while 47% had the indication of hospitalization in the psychiatric ward. Non-emergency visits were not related to demographic characteristic, previous psychiatric disorders, substance abuse and physical diseases Conclusions: Non-emergency visits take a high percentage of psychiatric visits in ED and regarding limited sources for psychiatric emergencies and Long visiting time, this percentage can hinder the process of giving services to real emergency psychiatric patients.
    03/2012; 6(2):42-47.
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    • "Research has shown a disproportionate increase in mental health–related ED visits, in comparison to ED visits in general. Between 1992 and 2001, the number of documented mental health–related ED visits increased by 38%, compared to an 8% increase in overall ED usage.23 "
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    ABSTRACT: This is an observational study of emergency departments (ED) in California to identify factors related to the magnitude of ED utilization by patients with mental health needs. In 2010, an online survey was administered to ED directors in California querying them about factors related to the evaluation, timeliness to appropriate psychiatric treatment, and disposition of patients presenting to EDs with psychiatric complaints. One hundred twenty-three ED directors from 42 of California's 58 counties responded to the survey. The mean number of hours it took for psychiatric evaluations to be completed in the ED, from the time referral was placed to completed evaluation, was 5.97 hours (95% confidence interval [CI], 4.82-7.13). The average wait time for adult patients with a primary psychiatric diagnosis in the ED, once the decision to admit was made until placement into an inpatient psychiatric bed or transfer to an appropriate level of care, was 10.05 hours (95% CI, 8.69-11.52). The average wait time for pediatric patients with a primary psychiatric diagnosis was 12.97 hours (95% CI, 11.16-14.77). The most common reason reported for extended ED stays for this patient population was lack of inpatient psychiatric beds. The extraordinary wait times for patients with mental illness in the ED, as well as the lack of resources available to EDs for effectively treating and appropriately placing these patients, indicate the existence of a mental health system in California that prevents patients in acute need of psychiatric treatment from getting it at the right time, in the right place.
    The western journal of emergency medicine 02/2012; 13(1):51-6. DOI:10.5811/westjem.2011.6.6732
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