Individuals in U.S. More Likely to Be Referred to Psychiatric EDs by Police Than in Other Countries

Nearly a quarter of referrals to psychiatric emergency departments (PEDs) in the United States are made by police, a rate dramatically higher than the global average, according to a report published today in Psychiatric Services.

Patients referred to PEDs by police tended to be homeless males with a diagnosis of substance use and/or psychotic disorders and were more likely to display aggressive behavior, according to the report.

“Because police-referred patients share many characteristics with incarcerated psychiatric patients, early psychiatric treatment may help reduce the risk for incarceration of police-referred patients,” wrote Thomas Goldschmidt, M.D., of the Frei Universität and Humboldt Universität, Berlin, and colleagues.

The researchers performed a literature search for articles reporting the proportion of adult psychiatric patients brought by police to PEDs in university or general hospitals or comparable settings (such as general medical-surgical hospitals that serve as psychiatric emergency receiving facilities). They included 34 study samples from 28 articles in their analysis, representing 542,143 psychiatric emergency admissions between 1986 and 2021 in 11 countries: the United States, Australia, Belgium, Canada, Croatia, Germany, Israel, Italy, Switzerland, Taiwan, and Turkey. Of the total admissions, 61,647 involved law enforcement.

On average, 13.7% of PED admissions globally were referred by police, compared with 22.8% in the United States. Compared with patients not referred by police, police-referred patients globally were more than four times as likely to show aggressive behavior, 1.84 times as likely to be homeless, and 1.33 times and 1.45 times as likely to have a diagnosis of a substance use or a psychotic disorder, respectively. Police-referred patients were also four times more likely to be involuntarily admitted to a hospital.

Goldschmidt and colleagues said that further research is needed on the effect of early intervention on referrals to PEDS. “Interventions to reduce homelessness among psychiatric patients and other preventive approaches might be especially useful to reduce police referrals,” they concluded.

For related information, see the Psychiatric News article “Stanford Team Examines Intersection of Homelessness, Mental Illness, Police Conduct.”

(Image: Getty Images/iStock/pablohart)

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Breast Cancer Patients Benefit From Tailored Approach to Depression Screening

Developing tailored strategies that encourage staff at oncology clinics to routinely screen patients with breast cancer for depression can help increase the number of patients connected with behavioral health services, suggests a report published today in JAMA.

Depression is known to be associated with worse outcomes in cancer patients, including decreased social and physical functioning and poor quality of life. The American College of Surgeons Commission on Cancer recommends that health professionals screen cancer patients for distress; however, patients with breast cancer are often underdiagnosed and undertreated for depression and depressive symptoms, wrote Erin E. Hahn, Ph.D., M.P.H., of Kaiser Permanente Southern California and colleagues.

Hahn and colleagues wanted to know whether a depression screening program tailored to individual oncology clinics might increase the proportion of patients receiving referrals to behavioral health services compared with an education-only strategy. They randomized six medical centers within Kaiser Permanente Southern California that were treating patients diagnosed with a new primary breast cancer to one of two interventions: three centers received a tailored intervention; the other three received general education about the program. All centers were encouraged to screen newly diagnosed patients with the nine-item Patient Health Questionnaire (PHQ-9) and, as indicated based on PHQ-9 scores, refer patients for additional behavioral health services.

The clinical teams at tailored intervention sites were educated about the PHQ-9 and the scoring-referral algorithm, engaged in regular check-ins with a nurse researcher, and received tailored audit and feedback reports of progress compared with those of the other intervention sites throughout the study. The teams at the education-only sites were provided with general information about the screening program, including the PHQ-9 questionnaire and scoring-referral algorithm.

The trial included 1,436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018; these patients were followed up to May 31, 2019, insurance disenrollment, or death. Regardless of PHQ-9 screening, a significantly greater number of patients in the tailored intervention group received a referral for any behavioral health service compared with patients treated at the education-only clinics during the study period: 135 patients (18%) vs. 74 (11%), the authors reported.

“Given the high burden of depression in patients with breast cancer, effective screening and referral programs are needed. In the current era of heightened health-related concerns due to SARS-CoV-2, which may disproportionately affect patients with cancer and survivors, systematic depression screening and referral for patients with cancer may be even more important,” Hahn and colleagues concluded.

For related information, see the Psychiatric Services article “Factors Influencing Receipt of Mental Health Services Among Medicaid Beneficiaries With Breast Cancer.”

(Image: iStock/FatCamera)

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