Acute psychiatric problems in an A&E Department

A study of patients with psychiatric problems attending the Accident & Emergency Department at the Western Infirmary, Glasgow was performed over a four month period. Those requiring admission to other specialties for treatment were excluded (e.g. overdoses). Forty-seven patients presented during the study period and all were self-referred. Seventy-seven per cent had a past history of psychiatric illness. Sixty-six per cent of cases presented with self harm. Eighty-one per cent of cases presented after normal working hours. Alcohol intoxication was a contributing factor in only one quarter of patients presenting. Of all cases seen, 62% were referred to a duty psychiatrist. In this group 38% were admitted and 45% were discharged with psychiatric follow-up, three absconded and two were referred back to their general practitioners. Results indicated that the majority of patients referred to the psychiatric services from Accident & Emergency needed some form of psychiatric input. In the self harm group results showed a correlation between known risk factors for suicide and a need for admission or follow up. Due to local psychiatric referral policies, patients were referred to four different psychiatric hospitals in the area. After initial assessment by the duty psychiatrist, 52% of these patients were subsequently discharged with or without psychiatric follow up. Availability of an on site psychiatrist would alleviate many of the present delays in obtaining definitive management.