title: Characteristics of people who rapidly and frequently reattend the emergency department for mental health needs.
abstract: OBJECTIVE
  This paper identifies the characteristics of emergency department (ED) attendees with a referral to their Mental Health Liaison Service (MHLS) who are at increased risk for rapidly reattending, attending frequently, or attending intensely at this service (which is defined here as rapid and frequent reattendance).
  
  
  METHODS
  A retrospective 5-year longitudinal study was conducted of all visitors (n=24 010) attending four busy EDs with a referral to their MHLS from the beginning of 2009 until the end of 2013. A Cox proportional hazards regression was used to identify factors associated with intense use, and a negative binomial regression was used to identify factors associated with frequent attendance.
  
  
  RESULTS
  People with certain characteristics were more likely to make 'intense' use of mental health emergency services, which we define as shorter time to reattendance and a higher number of visits over 5 years. The people more likely to make intense use are more likely to have certain clinical diagnoses such as substance misuse, stress disorder, personality disorder and learning disability, to have certain social characteristics such as not being in a relationship, or living alone, and to have healthcare issues such as having been detained under the Mental Health Act and having a greater number of care coordinators over 5 years.
  
  
  CONCLUSIONS
  Individuals with certain clinical and social characteristics were significantly more likely to reattend EDs and have referral to MHLS rapidly and frequently (i.e. intensely).
authors.affiliation: aDepartment of Psychology and Psychotherapy, Maudsley Hospital bDepartment of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience cDepartment of Psychological Medicine, Kings College Hospital, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Beck
authors.forename: Emma
authors.initials: E
authors.lastname: Sanchez-Walker
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Evans
authors.forename: Victoria
authors.initials: V
authors.lastname: Harris
authors.forename: Ruth
authors.initials: R
authors.lastname: Pegler
authors.forename: Sean
authors.initials: S
authors.lastname: Cross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007859:Learning Disabilities / Q000628:therapy; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010554:Personality Disorders / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000628:therapy; D019966:Substance-Related Disorders / Q000628:therapy; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult