[The position of the emergency ward within the emergency psychiatric services]

In the Netherlands, acute care for psychiatric emergencies is primarily provided at mental health crisis centres. In cases where there is insufficient capacity or when an evaluation of acute physical symptoms by first responders deems it necessary, patients are directed to the emergency ward. However, information on the role of the emergency ward is required to organize an efficient care chain.

To better understand the role of the emergency ward within the emergency psychiatric services, a quantitative analysis of data recorded on psychiatric emergencies from 2018 to 2020 at the largest emergency ward in Amsterdam was conducted, along with a qualitative study on the experiences of healthcare professionals.

On average, 53 patients were admitted monthly to the emergency ward, with 44% (n = 131) displaying both acute psychiatric and physical comorbidity. Within this group, 69% (n = 90) exhibited self-injurious behaviour. Additionally, 9% (n = 26) of patients were admitted due to insufficient capacity at mental health crisis centres. Detailed analysis revealed that this group included cases of drug-induced psychosis (12%; n = 3) and substance-use related psychiatric emergencies (23%; n = 6). Interviews conducted for the qualitative analysis indicated that a prolonged length of stay in the emergency ward and limited admission capacity were viewed as significant factors affecting the efficiency of emergency psychiatric services.

The findings suggest that the actual function of the emergency ward differs from its presumed primary role as a facility for acute physical care within the psychiatric services. A possible solution to reduce patient movements and the risk of overlooking somatic needs in psychiatric patients, is to centralize both the mental health crisis centre and the hospital emergency ward in one location.