Impact of changes in community psychiatric service provision on mental health presentations to the emergency department
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ORIGINAL ARTICLE
Impact of changes in community psychiatric service provision on mental health presentations to the emergency department Caoimhe McLoughlin 1 & Ahad Abdalla 2 & Siobhan MacHale 1 & Helen Barry 1 Received: 13 August 2020 / Accepted: 18 November 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background The reconfiguration of many Irish stand-alone psychiatric units has led to many patients in acute mental health need now being assessed in emergency departments (EDs). This has implications for ED resources and raises questions about appropriate assessment location for this group. Aims This report aims to examine the impact of removal of a direct community access point for patients in acute mental health need on ED presentations in a Dublin hospital. Methods We examined data on ED referrals to psychiatry over 5 years: 12 months before the service change, and four subsequent 12-month periods. We compared numbers referred, mode of referral, average ED length of stay, proportion with no physical issue requiring psychiatric assessment only, and numbers who did not wait for psychiatry assessment. Results In the year directly after the service change, referrals to psychiatry from ED increased by 200%, remaining at this level for the subsequent 3 years. Of these, 32.5% were referred by a GP—more than a threefold increase in numbers from the previous year, with both numbers remaining similarly elevated over subsequent years. In the year after the service change, 52.1% of total ED to psychiatry presented solely for mental health reasons—nearly a fourfold increase in cases from the previous year, and remained high. Conclusions Removing a direct community access point for this group resulted in a substantial increase in ED presentations, many of which did not have physical needs. This study has implications for future policy to address the needs of this group, especially in light of the pandemic. Keywords Emergency department . Liaison psychiatry . Mental health
Introduction Where should psychiatric emergencies be seen? There is no clear international consensus on where patients with acute mental health needs should be assessed. International guidelines regarding the optimal setting for emergency psychiatric assessment vary, but common emphasis is placed on the provision of a thoughtfully designed, designated safe space for
* Caoimhe McLoughlin [email protected] 1
Department of Liaison Psychiatry, Beaumont Hospital, Beaumont Rd, Dublin 9, Ireland
2
Department of Medicine, University Limerick Hospital Group, Limerick, Ireland
patients, with prompt assessment by skilled specialists [1–3]. In the Irish context, there are clear established frameworks for the treatment of patients who experience mental health difficulty in the emergency setting, which state that patients in mental health crisis, without physical need, should have direct access to their local community psychiatric teams over a 24-h period, without recourse to the ED [4, 5]. Furthermore, it has been recognised that when mental health ser
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