title: Use of critical access hospital emergency rooms by patients with mental health symptoms.
abstract: BACKGROUND
  National data demonstrate that mental health (MH) visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture of this issue.
  
  
  OBJECTIVE
  This study investigates the use of critical access hospital (CAH) ERs by patients with MH problems to understand the role these facilities play in rural MH needs and the challenges they face.
  
  
  METHODS
  Primary data were collected through the combination of a telephone survey and ER visit logs. Our sampling frame was the universe of CAHs at the time the survey was fielded.
  
  
  RESULTS
  About 43% of CAHs surveyed operate in communities with no MH services, while 9.4% of all logged visits were by patients identified as having some type of MH problem. The most common problems identified were affective disorders, substance abuse, anxiety, and psychotic disorders. Only 32% of CAHs have access to on-site detoxification and 2% have inpatient psychiatric services, meaning that patients in need of these services typically must leave their communities to gain treatment.
  
  
  CONCLUSIONS
  The lack of community resources may impact CAHs' ability to assist patients with MH problems. Among those with a primary MH condition, 21% left the ER with no or unknown treatment, as did 51% of patients whose MH condition was secondary to their emergent problem. Patients in need of detoxification or inpatient psychiatric services often must travel over an hour to obtain these services, potentially creating significant issues for themselves and their families.
authors.affiliation: Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, ME 04104, USA. davidh@usm.maine.edu
authors.forename: David
authors.initials: D
authors.lastname: Hartley
authors.forename: Erika C
authors.initials: EC
authors.lastname: Ziller
authors.forename: Stephenie L
authors.initials: SL
authors.lastname: Loux
authors.forename: John A
authors.initials: JA
authors.lastname: Gale
authors.forename: David
authors.initials: D
authors.lastname: Lambert
authors.forename: Anush E
authors.initials: AE
authors.lastname: Yousefian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000453:epidemiology*; D008875:Middle Aged; D019964:Mood Disorders; D020380:Needs Assessment; D010865:Pilot Projects; D011618:Psychotic Disorders; D019966:Substance-Related Disorders; D014481:United States / Q000453:epidemiology