Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004–05 to 2016–17

Abstract

Objective To examine trends of ED presentations with a mental health (MH) diagnosis in Australia and its jurisdictions by diagnostic group between 2004–05 and 2016–17. Methods Data comprised ED presentations with a principal diagnosis of ICD‐10‐AM F00–F99 (MHdx) captured within the National Non‐Admitted Patient Emergency Department Care Database. Trends in absolute number and rates of MHdx presentations per 10 000 population were assessed as differences (x‐fold) and annual growth rates (average and compound). Results Increased presentation rates were observed for most diagnostic groups, except for mental retardation (F70–F79) and mood disorders (F30–F39). The greatest absolute increase was for psychoactive substance use‐related disorders (F10–F19), and relative increase, unspecified mental disorder (F99). There was differentiation across jurisdictions regarding rates of and growth in presentations. In 2016–17, rates at least twice the national average were observed for psychoactive substance‐use (F10–F19), schizophrenia and psychotic disorders (F20–F29) and childhood and adolescence onset disorders (F90–F98) in the Northern Territory, F90–F98 in South Australia, personality disorders (F60–F69) in Tasmania and unspecified mental disorder (F99) in New South Wales. The most marked growth was observed for F99 in New South Wales. Conclusion Between 2004–05 and 2016–17, rates of ED presentations increased across most MH diagnostic groups, but particularly psychoactive substance use‐related disorders. To reduce the need for MH crisis care in Australian EDs, strategies are required to reduce psychoactive substance use in the community, and policies may be needed to strengthen the capability of community MH services and primary care professionals to recognise, diagnose and treat earlier in the course of illness.

Emergency department presentations with a mental health diagnosis in Australia, by jurisdiction and by sex, 2004–05 to 2016–17

“…The individual collections are also the best available evidence, these administrative data used for other analyses . However, administrative data are also subject to a general lack of understanding of their potential usefulness, and thus the importance of robust coding practices . Further, as the jurisdictional collections and NNAPEDCD have historically only recorded one diagnostic code, there is an underestimation of MH presentations, as self‐harm and suicide‐related presentations are not coded as an F‐code but as X60‐X84, and may even be coded as injury (U50‐Y98) .…”

Registered nurses’ experiences of assessing patients with mental illness in emergency care: A qualitative descriptive study

“…41 Summarised, the need to develop and expand the RNs’ understanding of the holistic aspects of their professional role is important and should be taken into account in when arranging EC. This is especially so when the care of people with mental illness in emergency departments may increase 6,7 and be adversely affected by diagnostic overshadowing and avoidance by clinical staff. 42…”

“…5 From an international perspective, an Australian study shows that the number of emergency department presentations increased between 2004 and 2016 across most mental illness diagnostic groups, but particularly psychoactive substance use-related disorders. 6 In addition, a US study showed that the number of children visiting emergency care with mental health illness had risen by 60% between 2007 and 2016. 7 Taken together, this provides a picture of mental illness increasing internationally for all ages and more specifically, an increase in emergency care (EC) visits due to such conditions.…”

Months of May: Mental health presentations and the impact of a psychiatric emergency care centre on an inner‐city emergency department

“…Intoxication is a primary barrier to quick assessment, and incidence of intoxication as a presenting or comorbid complaint is steadily rising. 1 Alcohol intoxication so heavily affects the reliability of assessment that disposition decisions often cannot be made, so patients may wait in ED until sober (possibly up to 12 h). Stimulant intoxication causes severe behavioural disturbance such that patients may require chemical restraint, which also significantly delays assessment.…”