title: Disordered lives: Life circumstances and clinical characteristics of very frequent users of emergency departments for primary mental health complaints.
abstract: This study explored the life circumstances and clinical characteristics of very frequent users of emergency departments (EDs) presenting with a primary mental health complaint. Patients with 10 or more EDs visits in 2012 with a primary psychiatric diagnosis in a Canadian regional health authority were identified from electronic administrative files. The hospital charts for these patients were thoroughly reviewed for a three-year period, from 2011 to 2013. A retrospective thematic analysis was undertaken. Very frequent users of EDs were generally young to early middle aged, unemployed, living in transient accommodations, having substance abuse diagnoses, and self-referred to EDs for a variety of psychiatric and health symptoms and/or unmet needs. Four themes were identified: 1) substance abuse and associated health and social problems; 2) common mental disorders, which may include suicidality; 3) social and personal stressors with additional common mental disorders and somatic complaints; 4) cognitive impairment with concurrent psychiatric disorders. Traditional mental health services are ineffective in dealing with patients with complex psychiatric and social problems/needs. Efforts should focus on early detection, intervention, reducing mental and behavior problems, and developing appropriate case management and treatment options. Personalized care models are needed to meet their diverse needs.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada. Electronic address: xiangfei.meng@mcgill.ca.
authors.forename: Xiangfei
authors.initials: X
authors.lastname: Meng
authors.affiliation: Mental Health and Addition Services, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada.
authors.forename: Tracy
authors.initials: T
authors.lastname: Muggli
authors.affiliation: Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Baetz
authors.affiliation: Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Carl
authors.initials: C
authors.lastname: D'Arcy
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000523:psychology; D019966:Substance-Related Disorders / Q000523:psychology
keywords: Complex psychiatric patients; Frequent users; Psychiatric emergency; Unmet needs