Monday, February 24, 2020

Most Emergency Department Patients With Mental Health Problems Don’t Receive Timely Follow-up Care

Less than half of individuals who were seen in an emergency department (ED) in Ontario for a mental health–related issue had a follow-up visit with a physician within two weeks after discharge, according to a study published today in Psychiatric Services in Advance. Those who had a substance use disorder were even less likely to have a follow-up visit with a physician during this period compared with those who did not have a substance use disorder, the study found.

“Whether individuals present voluntarily because of subjective distress or involuntarily (for example, with police escort) because of acute risk, psychiatric ED visits suggest an urgent need for care,” wrote Lucy Barker, M.D., of the University of Toronto and colleagues. “[Y]et mental health–related crises cannot usually be managed in a single visit. Urgent outpatient mental health care is crucial for ongoing assessment and management and for preventing repeat visits to the ED and other negative outcomes.”

Barker and colleagues accessed health data from the Ontario health system for this study. They identified all people aged 19 and older who came to an ED with a psychiatric issue but were not admitted to the hospital from April 2010 through March 2012. They next assessed how many of these patients had a follow-up visit with any physician for mental health care within 14 days of ED discharge. 

The final sample included 143,662 adults. Of these, 40.2% had a follow-up mental health visit within 14 days of ED discharge.

“ED visits related to substance use represented more than one-fifth of the total ED presentations (22%), and only 1 in 4 received any follow-up care in the 14-day follow-up period (and only approximately 3% received follow-up care from a psychiatrist),” Barker and colleagues wrote. “Rates of follow-up with a psychiatrist were also low among those with the serious mental disorders of schizophrenia and bipolar disorder, where about 1 in 4 and 1 in 3 received follow-up, respectively.”

They concluded, “The gaps that we observed in mental health care continuity in Ontario highlight the need for systemwide and coordinated solutions to successfully transition patients … from the ED to outpatient care. … In particular, for those presenting with substance use disorders, for whom there may only be a short window of motivation to seek care and a similarly short window before rapid deterioration occurs, provider- and system-level barriers to addictions care … warrant careful attention.”

For related information, see the Psychiatric News article “Emergency Department Intervention May Reduce Suicide Attempts in At-Risk Patients.”

(Image: iStock/saravuth-photohut)

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