Concern for mental health 'usual suspects'

A study of people with mental health disorders who frequently attended a South Australian emergency department has found that while they only represented less than half a per cent of patients they accounted for 4.5% of attendances. It also found that the documented management of these patients, defined as those people who attended the emergency department (ED) an average of once a month, with mental disorders “appeared to be less than optimal”. The study examined nearly 11600 people attending the Queen Elizabeth Hospital (QEH) emergency department in South Australia, and found that 54 of them (0.47%) had mental disorders and were also were frequent visitors to the ED. They attended the hospital emergency department 735 times, and other Adelaide hospital emergency departments 410 times, during the 8 and a half month study period. One patient in particular had attended the QEH ED 63 times and had a total of 139 visits to EDs across Adelaide. Furthermore, 25 of his QEH attendances were by ambulance. The study’s authors estimated that this person’s ambulance costs alone would have totalled around $27 000. The most common diagnosis was depression and/or anxiety (29.6% of patients), followed by psychosis (27.8%), personality disorder (22.2%), substance abuse or dependence disorder (16.7%) and somatoform disorder (3.7%). The study found that 7% and 10% of the patients’ presentations at the QED and other emergency departments respectively were related to suicidality, a finding that the authors said was “somewhat unexpected”. Only 43% of the patients had specific mental health care plans and only two-thirds of them had been assigned to a mental health team. The authors said that it “is of concern’ that less than half of the patients with depression and/or anxiety had access to a mental health care plan. “It is of even greater concern that none of the substance-related frequent attenders had such a plan,” they said. Emergency Medicine Australasia 2009; 21:191 - 195...