Admission decisions following contact with an emergency mental health assessment and intervention service.
OBJECTIVE
To define the demographic and clinical profile of individuals referred to an emergency mental health assessment team. To identify factors associated with being admitted to inpatient psychiatric services or not admitted following an emergency assessment.


BACKGROUND
Crisis resolution and home treatment services are being developed across the UK, targeted towards people with severe mental health problems, who would otherwise require hospitalization. Further information about people presenting to an emergency mental health assessment service may clarify the skills that are required to deliver effective crisis resolution and home treatment services.


METHODS
Over a six-month period referrals to, and admission decisions by, an emergency mental health assessment team were recorded. Measures used were the Health of the Nation Outcome Scale and the Crisis Triage Rating Scale. Age, sex and postcode data were recorded. Postcode data were used to identify the Townsend Deprivation Index for each individual. Reasons given for the referral were categorized. A preliminary descriptive analysis was performed for all people referred. The Demographic and clinical characteristics of referrals admitted and not admitted were then compared. A multivariate logistic regression was performed in order to investigate the possible impact of demographic and clinical characteristics on admission status.


RESULTS
A total of 375 individuals were referred. Forty-eight (12.8%) were admitted. Higher referral rates were significantly associated with more deprived areas of the city. Referrers most frequently identified suicide risk as the reason for referral, followed by deterioration of an existing serious mental health problem. The mean Health of the Nation Outcome Scale score of all people referred was 10.5. Those admitted had a significantly greater mean Health of the Nation Outcome Scale score than those not admitted. The mean Crisis Triage Rating Scale score of all people referred was 11.0. Those admitted had a significantly lower (worse) mean Crisis Triage Rating Scale score than those not admitted. Individuals with lower Crisis Triage Rating Scale scores tended to have a higher (more deprived) Townsend index scores. Crisis Triage Rating Scale and Health of the Nation Outcome Scale scores were significantly negatively correlated. Conclusions. Crisis resolution and home treatments need to target areas of greatest deprivation. Social interventions will be important. Presentations related to suicide risk are likely to be common. The Crisis Triage Rating Scale may be a useful brief alternative to Health of the Nation Outcome Scale.


CONCLUSIONS
This study highlights the valuable role of mental health nurses in frontline emergency mental health care in particular mental health nurses skills in conducting a risk assessment in an emergency.
Brooker
Charlie
C
Health Services Research Unit, Institute of Psychiatry, Lincoln, UK. cbrooker@lincoln.ac.uk
Ricketts
Thomas
T
Bennett
Simon
S
Lemme
Francesca
F
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D000368:Aged; D003419:Crisis Intervention / Q000458:organization & administration*; D003659:Decision Making, Organizational; D004637:Emergency Services, Psychiatric / Q000458:organization & administration*; D004739:England / Q000453:epidemiology; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D010343:Patient Admission / Q000706:statistics & numerical data; D018579:Patient Selection; D011204:Poverty Areas; D011568:Psychiatric Nursing / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D014218:Triage / Q000458:organization & administration