1. In this cohort study, almost half of the psychiatric presentations to the emergency department (ED) had not received outpatient mental health care in the previous 2 years.
2. Male patients who presented with substance use disorder from rural communities were less likely to have previously received psychiatric outpatient care.
Evidence Rating Level: 2 (Good)
Despite the increase in Psychiatric ED visits, emergent care may not be appropriate for all presentations. Outpatient settings, for instance, are both better suited for patients who require long-term follow-up and have connections to key support services. Additionally, proper outpatient support may prevent acute psychiatric events requiring emergent care.
This cohort study analyzed psychiatric ED visits in Ontario, Canada to investigate how many patients over the age of 16 had received outpatient psychiatric care in the preceding 2 years. Patients 16 years or older who presented to the ED for the first time with mental health complaints between 2010 and 2018 were included. Non-Ontario residents and those without Ontario health insurance plan (OHIP) eligibility were excluded. The primary outcome was a first-contact ED visit without visiting outpatient care in the previous two years. Additionally, sociodemographic and admission data were used to identify factors associated with lack of previous outpatient care.
Among the 659,084 patients included in this study, 45.4% had not received psychiatric outpatient care preceding their ED visit. Patients who were male, from a rural community (<10,000 residents), immigrants, not followed by a primary care physician, and who presented with substance use disorder were more likely to present without 2-year history of outpatient care. One limitation of this study was that there were no controls for external mental health programs that patients could have accessed previously, such as privately funded programs or utilization of social workers. Nonetheless, this study’s results are significant and reinforce that improved outpatient care and mental health screening may reduce progression of mental illness, number of psychiatric ED visits, and outcomes for disproportionately impacted populations.
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