title: Urgent Psychiatric Services: A Scoping Review.
abstract: OBJECTIVE
  Urgent psychiatric services can provide timely access to ambulatory psychiatric assessment and short-term treatment for patients experiencing a mental health crisis or risk of rapid deterioration requiring hospitalization, yet little is known about how best to organize mental health service delivery for this population. Our scoping review was conducted to identify knowledge gaps and inform program development and quality improvement.
  
  
  METHODS
  We searched MEDLINE, PsycINFO, CINAHL, Embase, and EBM Reviews for English-language articles, published from January 1993 to June 2014, using relevant key words and subject headings. Reverse and forward citations were manually searched using reference lists and Google Scholar. Articles were included if they described programs providing ambulatory psychiatric assessment (with or without treatment) within 2 weeks of referral.
  
  
  RESULTS
  We identified 10 programs providing urgent psychiatric services. Programs targeted a diagnostically heterogeneous population with acute risks and intensive needs. Most programs included a structured process for triage, strategies to improve accessibility and attendance, interprofessional staffing, short-term treatment, and efforts to improve continuity of care. Despite substantial methodological limitations, studies reported improvements in symptom severity, distress, psychosocial functioning, mental health-related quality of life, subjective well-being, and satisfaction with care, as well as decreased wait times for post-emergency department (ED) ambulatory care, and averted ED visits and admissions.
  
  
  CONCLUSIONS
  Urgent psychiatric services may be an important part of the continuum of mental health services. Further work is needed to clarify the role of urgent psychiatric services, develop standards or best practices, and evaluate outcomes using rigorous methodologies.
authors.affiliation: Staff Psychiatrist and Medical Director, Ambulatory Care, St Michael's Hospital, Toronto, Ontario; Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Nadiya
authors.initials: N
authors.lastname: Sunderji
authors.affiliation: Research Coordinator, St Michael's Hospital, Toronto, Ontario.
authors.forename: Jason Tan
authors.initials: JT
authors.lastname: de Bibiana
authors.affiliation: Clinician Scientist, Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario; Psychiatrist-in-Chief, St Michael's Hospital, Toronto, Ontario; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Vicky
authors.initials: V
authors.lastname: Stergiopoulos
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D006801:Humans; D008605:Mental Health Services / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*