(Oct. 31, 2017) Research Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about serious mental illness and summarizes recently published research reports or developments. This month will focus on emergency services and psychiatric crisis care.
DATAPOINT of the Month
- 29 of 46 responding states report boarding psychiatric patients in emergency departments because of lack of hospital beds
A 2015 survey of 46 responding states by the National Association of State Mental Health Program Directors Research Institute, Inc., reports that more than 60% of states board psychiatric patients due to a lack of hospital beds for those that need them. In addition, 38 states responded that they are currently working with general hospital emergency services to improve crisis care for psychiatric patients.
RESEARCH of the Month
- Emergency department use among homeless individuals in the United States
Almost half of emergency department (ED) visits resulting in a hospital admission for homeless individuals with a mental or substance use disorder were for schizophrenia, according to a new government report. The Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality analyzed characteristics of ED visits by homeless individuals in the United States in 2014. Homeless individuals are three times more likely to use ED services compared to the general population. In addition, homeless individuals with psychiatric disorders often use EDs as their only source of healthcare due to barriers to treatment, according to the report. The authors found that 25% of ED visits by homeless individuals that resulted in immediate release to the community were for mood disorders, and 10% were for schizophrenia and other psychotic disorders. For ED visits resulting in hospital admission, 39% of visits were for schizophrenia and 26% were for mood disorders.
Sun, R et al. (2017, October). "Characteristics of homeless individuals using emergency department services in 2014." Healthcare Cost and Utilization Project. - High utilization, persistent and frequent emergency department use among individuals with mental illness
Persistent and frequent ED users are more likely to have a mental illness than nonpersistent and frequent ED users, according to a new research article in Health Affairs. Hemal Kanzaria, MD, and colleagues from the University of California, San Francisco analyzed California ED visits to nonfederal hospitals from 2005 to 2015 across all payers. The authors noted that frequent ED users represent 4-8% of ED patients and account for 21-28% of all ED visits. However, frequent ED users are not a uniform group. Differentiating between persistent and nonpersistent frequent ED users to examine characteristics of high utilization patterns may improve health outcomes, according to the article. More than half of frequent ED users who were persistent high utilizers for 11 years had a mental health diagnosis. In addition, persistent users are more likely to have public insurance, Medicare or Medicaid, than private insurance, according to the study.
Kanzaria, H. et al. (2017, October). "Persistent frequent emergency department use: Core group exhibits extreme levels of use for more than a decade." Health Affairs. - Reducing suicide risk among emergency department patients through follow-up care
Outpatient interventions are effective in reducing suicide risk among emergency department patients, according to a report in Psychiatric Services. Peter Denchev and colleagues from the National Institute of Mental Health (NIMH) analyzed three outpatient ED-initiated suicide prevention interventions and the cost-effectiveness of implementing the programs. These interventions consisted of follow-up care letters, telephone outreach and suicide-focused cognitive-behavioral therapy. The authors concluded that their results indicate a strong basis for widespread implementation of all three of these programs due to their effectiveness in reducing suicide risk among ED patients at relatively low cost.
Denchev, P. (2017, September). "Modeling the cost-effectiveness of interventions to reduce suicide risk among hospital emergency department patients." Psychiatric Services.
Elizabeth Sinclair
Research Associate
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Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.
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