Psychiatric Emergency Service Use Trends: Adults Experiencing Homelessness in Massachusetts from 2005-2020

Area of Science:

• Psychiatry
• Public Health
• Health Services Research

Background:

• Adults experiencing homelessness (AEH) exhibit high rates of psychiatric conditions.
• AEH face significant barriers to accessing consistent psychiatric care.
• Emergency departments are often ill-equipped to manage the complex needs of AEH.

Purpose of the Study:

• To analyze time trends in psychiatric emergency services (PES) utilization by AEH.
• To identify high-frequency utilization patterns among AEH in a PES program.
• To assess changes in the demographic profile of AEH utilizing PES.

Main Methods:

• Retrospective review of electronic health records from an urban PES program (2005-2020).
• Analysis of 227,553 total PES encounters, with a focus on 75,127 encounters involving AEH.
• Statistical analysis of time trends, demographic shifts, and high-frequency utilization (10+ visits/year).

Main Results:

• The proportion of PES encounters involving AEH nearly doubled, increasing from 23.3% in 2005 to 41.6% in 2020.
• The percentage of PES users aged 55 and older among AEH more than tripled (4.2% to 15.4%).
• AEH were over six times more likely than housed adults to be high-frequency PES users.

Conclusions:

• PES are increasingly utilized by AEH, indicating a growing need for specialized interventions.
• The aging demographic among AEH utilizing PES suggests evolving population needs.
• Findings strongly support the integration of housing access interventions within PES to address complex care requirements.