title: Changing demand for mental health services in the emergency department of a public hospital.
abstract: OBJECTIVE
  Deinstitutionalization and mainstreaming may have contributed to increased attendance in public emergency departments by people with mental health problems. This study describes changing patterns of attendances by patients with mental health problems to the emergency department (ED) of a public teaching hospital in Adelaide, South Australia.
  
  
  METHODS
  Records from a 10-year period from the ED were examined to identify changes in the number of, and diagnoses for, patients attending for primarily mental health concerns. Admission rates, detention and length of stay (LOS) were also examined in an attempt to identify trends.
  
  
  RESULTS
  A tenfold increase in the number of patients attending the ED with primarily mental health problems has occurred over the 10-year period. This is within the context of relatively stable total ED presentations. The increase has been observed in all diagnostic categories although the greatest increase, by percentage, has been for psychotic disorders. A lesser increase was observed for patients presenting with overdose. People presenting with psychotic disorders are also more likely to be detained and admitted. LOS in the ED has also increased along with increasing demand.
  
  
  CONCLUSIONS
  Reasons for the increased demand are likely multifactorial. While deinstitutionalization and mainstreaming have contributed, the closure of the ED at the local psychiatric hospital does not account entirely for the change. Insufficient community-based mental health services may also contribute to the reasons why people present to the ED and lack of inpatient beds contributes to the increasing LOS experienced in the ED.
authors.affiliation: Department of Psychiatry, Flinders Medical Centre, Bedford Park, South Australia, Australia. ross.kalucy@fmc.sa.gov.au
authors.forename: Ross
authors.initials: R
authors.lastname: Kalucy
authors.forename: Lyndall
authors.initials: L
authors.lastname: Thomas
authors.forename: Diane
authors.initials: D
authors.lastname: King
mesh_terms: D003430:Cross-Sectional Studies; D003688:Deinstitutionalization / Q000706:statistics & numerical data; D062787:Drug Overdose / Q000453:epidemiology* / Q000534:rehabilitation; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000600:supply & distribution*; D005544:Forecasting; D006271:Health Facility Closure / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006742:Hospital Bed Capacity; D006778:Hospitals, Psychiatric / Q000600:supply & distribution; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D010343:Patient Admission / Q000706:statistics & numerical data; D013021:South Australia