title: Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre.
abstract: OBJECTIVE
  This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention.
  
  
  METHODS
  We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care.
  
  
  RESULTS
  Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers.
  
  
  CONCLUSIONS
  Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kahan
authors.affiliation: Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.|Institute of Mental Health, Singapore.
authors.forename: Daniel
authors.initials: D
authors.lastname: Poremski
authors.affiliation: Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Wise-Harris
authors.affiliation: Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pauly
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Molyn
authors.initials: M
authors.lastname: Leszcz
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Donald
authors.initials: D
authors.lastname: Wasylenki
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.|Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.|Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Stergiopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D016739:Behavior, Addictive / Q000523:psychology; D019090:Case Management; D004636:Emergency Service, Hospital; D017144:Focus Groups; D006786:Hospitals, Urban; D006801:Humans; D007407:Interviews as Topic; D008603:Mental Health; D008875:Middle Aged; D010465:Perception; D012934:Social Isolation; D057545:Social Stigma; D012944:Social Support; D055815:Young Adult