title: Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study.
abstract: Study objectives were to: (1) provide an estimate of the prevalence of repeat emergency department (ED) use for mental health reasons among individuals enrolled in intensive case management programs; and (2) to identify socio-demographic, diagnostic, and service need characteristics associated with repeat ED visits among this service population.
  
  
  
  The study utilized administrative health data from community mental health organizations in Toronto, Canada on a sample of 2274 individuals enrolled in intensive case management programs. Patients with 2+ ED visits for mental health reasons within the prior 6 months were compared with individuals who had no ED visits or one visit on the basis of demographic, diagnostic and service need characteristics.
  
  
  
  Approximately 6 % of intensive case management clients had two or more ED visits over a 6-month period. Membership in the repeat ED user group was associated with younger age (OR 0.98), a mood disorder (OR 1.58), being in service less than 1 year (OR 1.94) and unmet needs related to psychotic symptoms (OR 2.19), substance use (OR 2.27), and safety to self/others (OR 3.42).
  
  
  
  The repeat ED user group within case management may have distinct need profiles that require different treatment responses. Moreover, clinical needs rather than psychosocial needs have the greatest relationship with repeat psychiatric ED utilization. These unmet needs suggest areas for future interventions aimed at reducing the use of ED services for mental health reasons and improving care for patients who repeatedly present at the ED.
authors.affiliation: Canadian Mental Health Association, Toronto Branch, 700 Lawrence Ave West, Ste 480, Toronto, ON, M6A 3B4, Canada. fsirotich@cmha-toronto.net.|Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada. fsirotich@cmha-toronto.net.
authors.forename: Frank
authors.initials: F
authors.lastname: Sirotich
authors.affiliation: Canadian Mental Health Association, Toronto Branch, 700 Lawrence Ave West, Ste 480, Toronto, ON, M6A 3B4, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Durbin
authors.affiliation: Provincial System Support Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Durbin
mesh_terms: D000328:Adult; D019090:Case Management / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003617:Dangerous Behavior; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology; D009864:Ontario; D011618:Psychotic Disorders / Q000453:epidemiology; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology
keywords: Camberwell assessment of need; Case management; Frequent ED presenters; Repeated emergency department visits