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Urgent Outpatient Care Following Mental Health ED Visits: A Population-Based Study
Lucy C Barker1, Nadiya Sunderji1, Paul Kurdyak1
1Department of Psychiatry, Women's College Hospital and Research Institute (Barker, Vigod), Li Ka Shing Knowledge Institute, St. Michael's Hospital (Sunderji), and Centre for Addiction and Mental Health (Kurdyak, Stergiopoulos), all at University of Toronto, Toronto; ICES, Toronto (Barker, Kurdyak, Gonzalez, Kopp, Vigod); Waypoint Centre for Mental Health Care and Research Institute, Penetanguishene, Ontario, Canada (Sunderji); Health Canada, Ottawa (Gonzalez).
Objective:
Follow-up after psychiatric emergency department (ED) contact is key to optimizing outcomes for vulnerable patients. We aimed to quantify the likelihood of receiving outpatient mental health care after psychiatric ED visits in a population-level sample.
Methods:
Among individuals who presented for a psychiatric ED visit in Ontario, Canada (2010-2012) and were not admitted to hospital (N=143,662), the authors estimated the likelihood of outpatient physician mental health care within 14 days post-ED visit and compared this across presenting diagnoses.
Results:
About 40.2% (N=57,797) had a follow-up mental health visit within 14 days post-ED. Follow-up was lower among individuals presenting with substance use disorders (25.2%) than among those presenting with disorders not primarily related to substance use (44.5%) (χ2=3,784.7, df=1, p<0.001). Follow-up differed among those presenting with schizophrenia (46.4%), bipolar disorder (56.1%), and major depressive disorder (51.1%) (χ2=61.7, df=2, p<0.001).
Conclusions:
Post-ED outpatient mental health follow-up is low. Systemwide coordination is needed to connect these high-acuity patients with care, especially those with presentations related to substance use.
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