Profile of psychiatric emergency patients

From this mass of data, one can assemble a statistical composite profile of the psychiatric emergency patient. This patient is young, unmarried, female, living near the emergency department, poor, diagnosed as psychotic, exhibiting some acutely disruptive or life-threatening behavior, having a history of prior contact with the psychiatric system, arriving at night by herself, and at risk for medical illness or substance abuse. Such a composite profile is misleading, however, for it is unlikely that there is a homogeneous population seeking help in psychiatric emergency services. Rather it seems likely that the composite data conceals a number of demographic and clinical subgroups: the young unmarried borderline woman, the chronically psychotic deinstitutionalized single young male, the middle-aged alcoholic, and the other depressed and organically-impaired patient are examples of such subgroups. When these groups are lumped together in overall figures, salient features and differences are obscured. Studies of these subgroups are needed. Secondly, there is substantial variation between the different studies reported above. Thus, while this summary can give some general guidance for clinical and administrative planning, it is crucial for every psychiatric emergency service to monitor its own utilization statistics. Where the profile of emergency service users does not match that of the underlying census data or that of those persons most at risk for serious psychiatric illness, administrators must raise the question of over- or under-utilization. Finally, there is a need for further studies to build on this preliminary data. Such studies must use uniform diagnostic criteria such as DSM III, prospective blind design, and better coding of the data to facilitate retrieval and processing of relevant information.