Health Care Service Use Outcomes of a Community Mental Health Program for Frequent Emergency Department Users

Supporting frequent emergency department users' psychosocial needs while reducing strain on hospital resources is a growing area of mental health policy concern. This study thus aimed to investigate health care service use outcomes of a novel community mental health program for frequent emergency department users presenting with mental illness or addiction. The program offered stepped-care system navigation and intensive case management supports. A quasi-experimental, pre-test/post-test, nonequivalent groups design evaluated the interaction effects of group (stepped-care intervention and three treatment as usual comparisons) and time (baseline and two follow-up years) on health care service use (emergency department visits, hospital admissions, days in hospital, general practice outpatient visits, and psychiatric outpatient visits). Retrospective longitudinal participant data were obtained from population-level public health care records and analyzed using generalized estimating equations methods. Results replicated past research findings demonstrating that a targeted intervention did not reduce emergency department visits and hospital admissions among frequent emergency department users beyond what others experienced with treatment as usual. However, this study also identified benefits of the stepped-care intervention, notably for increasing access to psychiatric outpatient services.