Utilization of Emergency Departments for Psychiatric Treatment

Abstract

A survey of four Edmonton hospital emergency department records for a one month period was carried out to determine the frequency of utilization by patients suffering from psychiatric disorders. Male attenders outnumbered females and the majority of patients fell into the 21 — 50 year age range. Alcohol-related illness was almost three times more frequent in males than females, whereas females were more frequently categorized as suffering “personal distress” or presented as suicide attempts. Overall, seventy-three percent of the patients were discharged; of those admitted, females outnumbered males. The changing pattern of emergency department utilization was compared by examining data from one hospital for the years 1972, 1974 and 1976. During this four-year period the annual number of visits by psychiatric patients increased by almost eighty percent, largely due to dramatic increases in alcohol related problems in males and those described as “personal distress” in females. The establishment of intoxication recovery centres in 1973 paralleled a drop in the proportion of patients admitted to inpatient wards for alcohol-related, street drugs and overdose problems. The results of the present survey are compared to those reported in the relevant literature, and the methodological problems encountered in carrying out a retrospective study of emergency services from clinical records are described.

Crisis intervention and the avoidance of hospitalization

“…The authors also reported on a cost-benefit study citing the greatly decreased cost when hospitalization was avoided and the decreased cost to families in terms of time lost as well as absence of the identified patient from the expected family responsibilities. Watson (1978) studied the use of general hospital emergency rooms for psychiatric treatment. He suggests that the emergency department should function as a portal of entry into the mental health care system and that it should be an ideal site for the application of community mental health approaches.…”

Patients perceived as having psychosocial problems in a general hospital emergency room: A study of registered and unregistered patients.

“…Alcohol-related illnesses constituted about one third of the total visits, while drug overdoses and other self-inflicted injuries were presenting complaints in 16 percent of the psychiatric patients. A recent trend, noted in several other studies, has been the rapid increase in the number of patients with psychiatric problems seen in emergency services (Watson, 1978;Tyson, Miller, & Browning, 1970).…”

“…Kass, Karasu, and Walsh (1979) found that over one third of the patients presenting to a psychiatric emergency service were already in psychiatric treatment. In one Canadian study (Watson, 1978), males outnumbered females 10 to 7 among patients who presented to the psychiatric emergency services within a general hospital ER. Sixty-five percent of these patients were 21 to 50 years old.…”