Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons

Abstract

In this qualitative study, the experiences of persons who frequently visit the emergency department (ED) for mental health-related reasons were explored. Interpretive Description guided the design, and data were collected through interviews with 10 adults who made 12+ ED visits within a 1-year time frame (2015). Thematic analysis was used to analyze data inductively. The participants' experiences were described with the help of three themes emerging from the data: The Experience, The Providers, and Protective Factors. The participants felt compelled to come to hospital. For them, every visit was necessary, and dismissal of their needs by staff was interpreted as disrespect and prejudice. We noted differences in ED utilization patterns according to psychiatric diagnosis, and more research is needed to explore the phenomenon of frequent use by particular patient populations. Furthermore, health care providers implementing interventions designed to improve emergency care should consider tailored approaches rather than a one-size-fits-all strategy.

Professionals’ Perspective on Needs of Persons Who Frequently Use Psychiatric Emergency Services

“…Furthermore, they lacked daytime activities and were dissatisfied with their housing situation and with the limited availability and quality of the support and healthcare services. Those findings can be confirmed by previous studies of persons with mental illness in an emergency care context that applied a patient perspective (Fleury et al, 2013;Schmidt et al, 2018b;Vandyk et al, 2018). Those findings may support a socialpsychiatric approach, implying that more attention should be paid to people's social contexts, that is, not only to the individual's immediate social context, but also to the political responses to societal structures at the local, national, and international levels (Priebe, 2015).…”

“…However, this study could not find evidence of malingering among the patients, which may simply indicate that this was not an issue in the local context under study. Instead, the included professions in this study highlighted the patients' suffering as well as the importance of understanding their subjective experiences, which was supported by other studies stressing the unavoidability and necessity of each visit as expressed by the patients (Vandyk et al, 2018;Wise-Harris et al, 2017).…”

“…The main finding is that the PES professionals report a complex picture of the patients' needs based on their personal and social life circumstances and on the healthcare and support context. The needs identified by the professionals correspond relatively well with those expressed by persons who frequently visit PES or emergency departments themselves Schmidt et al, 2018b;Vandyk et al, 2018Vandyk et al, , 2019Wise-Harris et al, 2017), stressing the complexity of the patients' needs and the subjective component of the patients' suffering, lack of health and well-being, and the need for human contact and social interaction. In particular, the patients' feelings of loneliness, their internal and external struggle, and their negative self-image leading to feelings of worthlessness and hopelessness were common topics discussed in studies about persons with (severe) mental illness visiting other mental health or healthcare services (Ådnøy Eriksen, Sundfør, Karlsson, Råholm, & Arman, 2012;Fleury, Grenier, Bamvita, & Tremblay, 2013;Lindgren, Sundbaum, Eriksson, & Graneheim, 2014).…”

“…In a recent Swedish mixedmethods study including persons who frequently visit PES, the participants self-reported having needs to reduce acute suffering, feel secure, and have caring encounters with PES staff, as well as needs to reduce psychological distress and psychotic symptoms and to have daytime activities (Schmidt et al, 2018b). Reviews of studies focusing on persons who frequently visit PES or emergency departments, and on their needs in particular, indicated that explanatory research has dominated the field so far (Schmidt, 2018;Vandyk, Harrison, VanDenKerkhof, Graham, & Ross-White, 2013), while exploratory research has been scarce (Vandyk, Bentz, Bissonette, & Cater, 2019;Vandyk, Young, MacPhee, & Gillis, 2018;Wise-Harris et al, 2017). In-depth qualitative studies of an explorative nature may be required to more fully understand this complex group's needs and the reasons and life circumstances underlying those needs.…”

Experience of being a frequent user of primary care and emergency department services: a qualitative systematic review and thematic synthesis

“…I find that difficult, how you're perceived, whether or not they think you're there to get well, or to get something, right? 30 My husband would say to me, 'Go to the doctor's if you don't get any better.' I would say, 'But why go, they don't know what is wrong with me and I am just wasting their time'.…”