Improving access to acute mental health services in a general hospital

Abstract

The UCC model of care contributed to improved access to psychiatric evaluation and short-term treatment. This inter-professional model could be applied to other health care settings to meet the needs of patients requiring acute psychiatric services.

Urgent Psychiatric Services: A Scoping Review

“…The rationale for a multidisciplinary approach was rarely explicitly stated; however, it may be intended to expand the volume of patients who could be seen (for example, through joint assessment, either in a single appointment or asynchronously) and (or) to expand the comprehensiveness of services (for example, psychotherapies). 10,22,23 Few programs specifically described how providers of different disciplines interfaced in the care of patients. Thus it is unclear whether care was truly interprofessional and teambased (as opposed to multidisciplinary), how roles were defined and negotiated, how communication occurred, and how clinical deterioration and (or) risks were handled.…”

“…Overall, programs reported improvements in clinical outcomes, including clinician-assessed mental health and psychosocial functioning 10 and various patient-reported clinical outcomes, including: improvements in levels of distress, 22,27 self-efficacy, 27 mental health symptom severity, 10 and mental health-related quality of life and subjective well-being. 10 However, in the RCT of the Rapid Response Outpatient Team, Greenfield et al 17 reported no between-group differences in overall functioning (measured by the Children's Global Assessment Scale) or levels of suicidality (measured by the Spectrum of Suicidal Behavior Scale) for the intervention group (n = 158), compared with the usual care group (n = 128), at 6-month follow-up.…”

“…Urgent psychiatric services provide rapid access to psychiatric assessment and short-term treatment in an outpatient setting for patients with acute mental health needs. 10 As an intermediate level of care between community-based services and acute care (for example, ED or inpatient) services, urgent psychiatric care programs may serve the dual roles of prevention of escalation of an urgent situation to an emergency situation, and ongoing assessment and stabilization during a period of sustained urgency after an ED visit or inpatient admission. Regarding the former, the CPA recommends that patients experiencing "clinical conditions that are unstable, with the potential to deteriorate quickly and result in emergency admission" 11, p 2 should wait no more than 2 weeks to access psychiatric services after referral from a family physician.…”

The Role of Entrapment in Crisis-Focused Psychotherapy Delivered in Psychiatric Emergency Settings: A Comparative Study

“…This rise in number of referrals to psychiatric emergency services has led many medical centers to develop crisis intervention facilities aimed at delivering emergency psychological and medical care to patients suffering from acute distress. These crisis intervention units offer immediate and proximal interventions delivered by an interdisciplinary team of well-trained professionals in the fields of psychiatry, psychology, social work, and psychiatric nursing (Kowal et al, 2011). Although the settings, treatment approaches, and durations of intervention vary from one unit to another, most of the crisis intervention units also deliver short-term, intensive, and crisis-focused psychotherapy (see Sunderji et al, 2015 for review).…”

“…Most studies assessing crisis intervention have focused on the outcomes of these interventions, and in general showed a favorable outcome. For example, Kowal et al (2011) evaluated the effectiveness of an urgent consultation clinic (UCC) and found significant improvements in life satisfaction, overall functioning, and mental quality of life. Wand et al (2012) evaluated an emergency-department-based mental health outpatient service and found decreases in patients’ levels of distress.…”