title: The Impact of Integrating Crisis Teams into Community Mental Health Services on Emergency Department and Inpatient Demand.
abstract: This investigation focused on the impact of integrating crisis team members into community mental health services on emergency department and adult mental health inpatient unit demand within an Australian public health service. Mixed methods were used including (a) the comparison of service use data with that of two other comparable services (both of which had community-based crisis teams), (b) surveys of (i) patients and carers and (ii) staff, and (c) focus groups with staff. The numbers of emergency department presentations with mental health conditions and adult mental health inpatient separations increased 13.9 and 5.7 %, respectively, from FY2006/07 to FY2012/13. Between the three services, there were minimal differences in the percentages of presentations with mental health conditions, the distribution of mental health presentations across a 24-h period, and the triage categories assigned to these patients. Survey participants reported that patients used the emergency department due to the urgency of situations, perceptions that gaining access to mental health services would take less time, and the unavailability of mental health services when help is needed. Staff identified several issues (e.g. inappropriate referrals) that may be unnecessary in increasing emergency department demand. The integration of crisis team members into community mental health services does not seem to have produced an increase in emergency department admissions or inpatient separations beyond what might be expected from population growth. The potential may exist, however, to reduce emergency department admissions through addressing the issue of inappropriate referrals.
authors.affiliation: Peninsula Health, 2 Hastings Road, PO Box 52, Frankston, VIC, 3199, Australia.|Central and Eastern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, 3800, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Jespersen
authors.affiliation: Peninsula Health, 2 Hastings Road, PO Box 52, Frankston, VIC, 3199, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Lawman
authors.affiliation: Peninsula Health, 2 Hastings Road, PO Box 52, Frankston, VIC, 3199, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Reed
authors.affiliation: Peninsula Health, 2 Hastings Road, PO Box 52, Frankston, VIC, 3199, Australia.
authors.forename: Kari
authors.initials: K
authors.lastname: Hawke
authors.affiliation: Peninsula Health, 2 Hastings Road, PO Box 52, Frankston, VIC, 3199, Australia. virginia.plummer@monash.edu.|Monash University, Peninsula Campus, McMahons Road, Frankston, VIC, 3199, Australia. virginia.plummer@monash.edu.
authors.forename: Virginia
authors.identifier: 0000-0003-3214-6904
authors.initials: V
authors.lastname: Plummer
authors.affiliation: Gaskin Research, Ashwood, Australia.
authors.forename: Cadeyrn J
authors.initials: CJ
authors.lastname: Gaskin
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003156:Community Mental Health Services / Q000458:organization & administration*; D003419:Crisis Intervention / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014739:Victoria
keywords: Admission; Community; Crisis teams; Emergency department; Mental health