Urgent psychiatric care

BACKGROUND: Veteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA). OBJECTIVE: To examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors. METHODS: Retrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011-2016 associated with 111 VHA hospitals with acute inpatient psychiatric units...

OBJECTIVES: To report on the perceived barriers surrounding the use of telepsychiatry for emergency assessments and our approach to overcoming those barriers to achieve successful implementation of a program to increase access to emergency psychiatric assessment in a Canadian urban setting. METHODS: We conducted a survey of emergency care staff to inform the implementation of an emergency telepsychiatry program in the urban setting of Winnipeg, Manitoba, where hospitals have variable on-site emergency psychiatric coverage...

OBJECTIVE: Follow-up after psychiatric emergency department (ED) contact is key to optimizing outcomes for vulnerable patients. We aimed to quantify the likelihood of receiving outpatient mental health care after psychiatric ED visits in a population-level sample. METHODS: Among individuals who presented for a psychiatric ED visit in Ontario, Canada (2010-2012) and were not admitted to hospital (N=143,662), the authors estimated the likelihood of outpatient physician mental health care within 14 days post-ED visit and compared this across presenting diagnoses...

OBJECTIVE: Hospital at home (HAH) services have been developed to replace traditional inpatient care but there is little recent published data about their efficacy. This study evaluates HAH treatment for people with an acute episode of psychiatric illness who would otherwise have been admitted to hospital. METHOD: The staffing and operation of the service is described, along with admission criteria. Patients could be visited by the HAH team up to three times a day, 7 days a week...

BACKGROUND: Admission rate to child and adolescent mental health inpatient units in Germany is high (54,467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support. METHODS: Of 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n=54) and control groups (n=46)...

OBJECTIVE: Emergency departments (EDs) are often the first point of care for youth with psychotic disorders; however, the care and aftercare they receive have not been well described. The aim of this study was to examine care and aftercare following first ED visit for psychotic disorder among youth. METHODS: We conducted a population-based retrospective cohort study of first ED presentations for psychotic disorder among youth 16 to 24 years old (N = 2,875) in Ontario, Canada...

Urgent psychiatric care programs are hospital- or community-based outpatient services that expedite access to mental health care for high-risk individuals, yet these services are rarely evaluated from the perspectives of clients. A qualitative thematic analysis of 13 participant interviews of a psychiatric urgent care program allowed researchers to address this gap. Communication, responsiveness, and continuous availability were identified as critical in helping clients articulate their perceived self-stigma, needs, and preferences...

No abstract text is available yet for this article.

This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users...

Long psychiatric hospital stays are unpopular with services users, harmful, and costly. Economic pressures alongside a drive for recovery-orientated care in the least restrictive contexts have led to increasing pressure to discharge people from hospital early. Hospital discharge is, however, complex, stressful, and risky for service users and families. This rapid literature review aimed to assess what is known about early discharge in acute mental health. Searches were conducted in nine bibliographic databases, reference lists, and targeted grey literature sources...

OBJECTIVE: While mental illness is a risk factor for suicidal behaviour and many suicide decedents receive mental health care prior to death, there is a comparative lack of research that explores their experiences of mental illness and care. Suicide notes offer unique insight into these subjective experiences. Our study explores the following questions: "How are mental illness and mental health care experienced by suicide decedents who leave suicide notes?" and "What role do these experiences play in their paths to suicide?" METHOD: We used a constructivist grounded theory framework to select a focus of qualitative analysis and engage in line-by-line open coding, axial coding, and theorizing of the data...

INTRODUCTION: About half of people who die by suicide visit their primary care provider (PCP) within 1 month of doing so, compared with fewer than 1 in 5 contacting specialty mental health. Thus, primary care is an important setting for improving identification and treatment of suicide risk. This review identifies and summarizes evidence for the effectiveness of intervention components for suicide risk in primary care. METHOD: We searched the PsycINFO database to identify relevant articles...

OBJECTIVE: To identify existing evidence on interagency collaboration between law enforcement, emergency services, statutory services and third sector agencies regarding people with mental ill health. DESIGN: Systematic scoping review. Scoping reviews map particular research areas to identify research gaps. DATA SOURCES AND ELIGIBILITY: ASSIA, CENTRAL, the Cochrane Library databases, Criminal Justice Abstracts, ERIC, Embase, MEDLINE, PsycINFO, PROSPERO and Social Care Online and Social Sciences Citation Index were searched up to 2017, as were grey literature and hand searches...

OBJECTIVE: Evidence suggests that suicide attempts by self-inflicted gunshot wound (GSW) are underreported and may in turn affect disposition following hospitalization. This study aimed to evaluate the clinical characteristics and use of services among individuals who do not disclose suicidal intent following a self-inflicted GSW. METHODS: Electronic medical record data from 128 survivors of self-inflicted GSWs at a level 1 trauma center were analyzed to identify factors associated with nondisclosure of a suicide attempt to medical staff...

Safety planning is an emerging evidence-based practice that is effective at decreasing suicidal behaviors. As electronic medical records and patient portals become more prevalent, patients and clinicians have recognized the value of using this technology in the safety planning process. This column describes the experience of one federally qualified health center, the Institute for Family Health, in integrating safety plans into the patient portal. The authors argue that incorporating safety plans into patient portals may unlock a new to way to expand safety planning efforts in health settings-a way that may ultimately save lives...

BACKGROUND: Evidence supporting the effectiveness of care management programs for complex patients has been inconclusive. However, past reviews have not focused on complexity primarily defined by multimorbidity and healthcare utilization. We conducted a systematic review of care management interventions targeting the following three patient groups: adults with two or more chronic medical conditions, adults with at least one chronic medical condition and concurrent depression, and adults identified based solely on high past or predicted healthcare utilization...

There is variation in the way mental health services respond to urgent and emergency presentations, with few evidence-based models reported in the literature, and no agreed on best practice models. To inform the development of urgent and emergency psychiatric care models, a literature review was performed. The review sought to identify strengths and critiques of varying models, evidence gaps, and areas for future research. After review, significant variation was found in the design and scope of urgent and emergency care models...

OBJECTIVE: Use of psychiatric emergency services in emergency departments (EDs) and inpatient psychiatry units contributes substantially to the cost of mental health care. Among patients who utilize psychiatric emergency services, a small percentage ("high utilizers") contributes a disproportionate share of the total cost, yet little is known about the context of care for these patients. This study employed qualitative methods to identify barriers to and facilitators of reducing use of psychiatric emergency services among high utilizers...

BACKGROUND: Boarding of patients with suicide risk in emergency departments (EDs) negatively affects both patients and society. Factors other than clinical severity may frequently preclude safe outpatient dispositions among suicidal patients boarding for psychiatric admission in the ED. OBJECTIVE: To determine the extent to which nonclinical factors preclude safe outpatient discharge from the ED among patients boarding for psychiatric admission based on suicide risk...

In hospitals, use of constant observation (CO) causes significant economic burden without demonstrated reduction in adverse events. A novel quality improvement (QI) project was developed to reduce use of CO by integrating proactive behavioral health management of all patients requiring CO in a general hospital. Specific nonpharmacologic and pharmacologic interventions used in this project, which included 491 patients, are discussed. Data collected were compared with data from a baseline period before project implementation...