Psychiatric Emergency Services and the System of Care

School of Public Health, University of California, Berkeley 94720, USA.
Psychiatric Services (Impact Factor: 2.41). 04/2003; 54(3):351-5. DOI: 10.1176/
Source: PubMed


Admissions to psychiatric emergency services have frequently been cited as a gauge of how well a mental health system manages behavioral disorders. However, few measurements of the longitudinal association between psychiatric emergencies and characteristics of a mental health system have been described. The purpose of this study was to assess whether weekly admissions to psychiatric emergency services would increase when outpatient services were reduced, whether weekly admissions would increase when greater effort was made to identify and treat persons with acute mental illness, and whether weekly admissions would decrease when emergency services were enhanced to include postrelease case management.
Time-series methods were applied to approximately 29,010 admissions to three psychiatric emergency services of the San Francisco Department of Public Health over a 180-week period.
Reduced outpatient services, efforts to identify acutely ill persons, and changes in emergency services themselves were found to affect admissions to emergency services. However, community events such as extreme weather, holidays, job loss, and the scheduling of receipt of income also affected the workload of the emergency service.
The causes and course of mental illness inextricably tie a psychiatric emergency service to the overall mental health system and to events in the community it serves. These connections make it possible for managers to anticipate the use of emergency services and to detect disruptions in the remainder of the mental health services systems.

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Available from: Peter Forster, Mar 25, 2015
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    • "The major role of Psychiatric Emergency Services (PES) is to cater for patients with acute mental health problems or crisis, after which the patients are discharged to continue treatment in routine mental health settings. However, studies have demonstrated a tremendous increase in the number of visits to PES and a trend towards the utilisation of the PES as the sole point of care for patients with nonurgent problems or those whose presentation could have been avoided by adherence with routine outpatient care [3] [4] [5] [6] [7] [8] [9]. "
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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.
    Full-text · Article · Jan 2014
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    • "These results were attributed to deteriorating health during times of low unemployment. Other studies have found increased mental health utilization including psychiatric emergency services [34] and admissions to mental health facilities for alcohol-related disorders [35]. "
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    ABSTRACT: Background In the U.S., economic conditions are intertwined with labor market decisions, access to health care, health care utilization and health outcomes. The Veterans Affairs (VA) health care system has served as a safety net provider by supplying free or reduced cost care to qualifying veterans. This study examines whether local area labor market conditions, measured using county-level unemployment rates, influence whether veterans obtain health care from the VA. Methods We used survey data from the Behavioral Risk Factor Surveillance System in years 2000, 2003 and 2004 to construct a random sample of 73,964 respondents self-identified as veterans. VA health service utilization was defined as whether veterans received all, some or no care from the VA. Hierarchical ordered logistic regression was used to address unobserved state and county random effects while adjusting for individual characteristics. Local area labor market conditions were defined as the average 12-month unemployment rate in veterans’ county of residence. Results The mean unemployment rate for veterans receiving all, some and no care was 5.56%, 5.37% and 5.24%, respectively. After covariate adjustment, a one percentage point increase in the unemployment rate in a veteran’s county of residence was associated with an increase in the probability of receiving all care (0.34%, p-value = 0.056) or some care (0.29%, p-value = 0.023) from the VA. Conclusions Our findings suggest that the important role of the VA in providing health care services to veterans is magnified in locations with high unemployment.
    Full-text · Article · Mar 2013 · BMC Health Services Research
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    • "Previous research has established some connections between the economy and mental health utilization [1]. For example, one study reported an increase in admission to mental health facilities for alcohol-related disorders during an economic downturn [2]. "

    Full-text · Article · May 2011 · General hospital psychiatry
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