title: How Norwegian casualty clinics handle contacts related to mental illness: A prospective observational study.
abstract: BACKGROUND
  Low-threshold and out-of-hours services play an important role in the emergency care for people with mental illness. In Norway casualty clinic doctors are responsible for a substantial share of acute referrals to psychiatric wards. This study's aim was to identify patients contacting the casualty clinic for mental illness related problems and study interventions and diagnoses.
  
  
  METHODS
  At four Norwegian casualty clinics information on treatment, diagnoses and referral were retrieved from the medical records of patients judged by doctors to present problems related to mental illness including substance misuse. Also, routine information and relation to mental illness were gathered for all consecutive contacts to the casualty clinics.
  
  
  RESULTS
  In the initial contacts to the casualty clinics (n = 28527) a relation to mental illness was reported in 2.5% of contacts, whereas the corresponding proportion in the doctor registered consultations, home-visits and emergency call-outs (n = 9487) was 9.3%. Compared to other contacts, mental illness contacts were relatively more urgent and more frequent during night time. Common interventions were advice from a nurse, laboratory testing, prescriptions and minor surgical treatment. A third of patients in contact with doctors were referred to in-patient treatment, mostly non-psychiatric wards. Many patients were not given diagnoses signalling mental problems. When police was involved, they often presented the patient for examination.
  
  
  CONCLUSIONS
  Most mental illness related contacts are managed in Norwegian casualty clinics without referral to in-patient care. The patients benefit from a wide range of interventions, of which psychiatric admission is only one.
authors.affiliation: National Centre for Emergency Primary Health Care, Uni Health, Uni Research, Kalfarveien 31, 5018, Bergen, Norway. ingrid.johansen@uni.no.
authors.forename: Ingrid H
authors.initials: IH
authors.lastname: Johansen
authors.forename: Tone
authors.initials: T
authors.lastname: Morken
authors.forename: Steinar
authors.initials: S
authors.lastname: Hunskaar