Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

Abstract

ObjectivesInformation on emergency department (ED) visits for mental and substance use disorders (MSUDs) is important for planning services but has not been explored in British Columbia (BC), Canada. We describe all MSUD ED visits for people ages 15 and older in the province of BC in 2017/2018 and document trends in MSUD ED visits between 2007/2008 and 2017/2018 by disorder group.DesignPopulation-based linked administrative data comprised of ED records and physician billings capturing all MSUD ED visits in BC.SettingBC is Canada’s westernmost province with a population of approximately 5 million. Permanent residents receive first-dollar coverage for all medically necessary services provided by licensed physicians or in hospitals, including ED services.PopulationAll people age >15 with MSUD ED visits during the study period.MeasuresAll claims with a service location in the ED or corresponding to fee items billed only in the ED were examined alongside ED visits reported through a national reporting system. Patient characteristics (sex/gender, age, location of residence, income, treated disorders and comorbidities) and previous outpatient service use for all ED visits by visit diagnosis are also described.ResultsA total of 72 363 people made 134 063 visits to the ED in 2017/2018 for needs related to MSUD. MSUD ED visits have increased since 2010, particularly visits for substance use and anxiety disorders. People with more frequent visits were more likely to be male, on public prescription drug plans for income assistance, prescribed psychiatric medications, and living in lower-income neighbourhoods. They used more community-based primary care and psychiatry services and had lower continuity of primary care.ConclusionsMSUD ED visits are substantial and growing in BC. Findings underscore a need to strengthen and target community healthcare services and adequately resource and support EDs to manage growing patient populations.

Acute care utilization and its associated determinants among patients with substance‐related disorders: A worldwide systematic review and meta‐analysis

“…In addition, individuals with SRDs and co‐occurring MHDs or chronic physical disorders are more likely to have ED use since their complex conditions may not be properly managed in an outpatient health centre (Huynh et al, 2016). Also, individuals with co‐occurring SRDs and MHDs may search for treatment for each of their conditions separately since healthcare systems usually do not provide suitable integrated care (Lavergne et al, 2022).…”

Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

“…Between 1988 and 2014, Taiwan saw a rise in visits to ED associated with depression disorders, suicide attempts, as well as trauma and stressor-related disorders, which are emotional and behavioral problems that may be caused by childhood traumatic and stressful experiences [ 9 ]. On the basis of available data, research in Canada is consistent with trends in the USA, with anxiety disorders and substance abuse disorders showing the most upward trends [ 6 ].…”

“…EDs play a crucial role in the delivery of health care. Globally, EDs have seen ever-increasing volumes of patients seeking psychiatric treatment over the past decade across varied populations and contexts [ 6 ]. For example, adult ED visits for mental health disorders increased by over 30% in the United States between 2006 and 2015.…”

“…For example, adult ED visits for mental health disorders increased by over 30% in the United States between 2006 and 2015. The majority of these visits were related to alcohol use disorders, followed by mood disorders and anxiety disorders [ 6 ]. A similar trend was also observed between 1992 and 2001 [ 6 , 7 ].…”

“…The majority of these visits were related to alcohol use disorders, followed by mood disorders and anxiety disorders [ 6 ]. A similar trend was also observed between 1992 and 2001 [ 6 , 7 ]. In Australia, the number of ED visits concerning mental health issues increased between 2004/2005 and 2016/2017, largely due to psychoactive substance abuse which involves drugs or other substances that affect mood, awareness, thoughts, feelings, or behavior such as alcohol, caffeine, nicotine, and certain pain medicines, etc., followed by anxiety and mood disorders [ 8 ].…”