scholarly journals LO84: Experiences of youth and family presenting to the emergency department for addiction and mental health

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S36-S37
Author(s):  
H. Hair ◽  
M. Bercov ◽  
S. Hastings
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Substance Use ◽  
Family Involvement ◽  
Online Survey ◽  
Wait Times ◽  
Youth Survey ◽  
The Family ◽  
Social Media Platforms ◽  
Ed Visits

Introduction: The Canadian Institute for Health Information reports the rate of child and youth emergency department (ED) visits for mental health complaints increased by 50% between 2007 and 2015. Improving care for these patients is a major priority of Alberta Health Services (AHS). As part of a multi-phased approach to improving care, the Emergency and the Addiction and Mental Health Strategic Clinical Networks (SCNs) surveyed youth who had presented to an ED for mental health or substance use concerns and their families/caregivers. Methods: The online survey contained closed- and open-ended questions on reasons for ED visits, expectations about and experiences during their visits, and areas for improvement. An ethics approved survey was conducted for 4 weeks. Participants were recruited across the province using an extensive array of social media platforms. For each survey, we randomly selected a sample of open-ended responses to thematically analyze to the point of informational redundancy. Results: The Youth survey received 992 responses and the Family survey received 553. A small number of overarching themes emerged. For both surveys, the major themes were 1) Wait times and access: participants were disappointed with lengthy wait times and services in the community. Youth said this made them question their decision to seek help and left them feeling hopeless. 2) Care provider training: participants were unhappy with the quality of care provided (e.g., lack of compassion, minimizing symptoms). They felt better training would improve care and attitudes towards mental health patients. 3) Environment: participants were uncomfortable with the lack of privacy for discussing sensitive topics; youth also requested items such as pens/paper and phone chargers to make the stay more comfortable and provide distractions. An additional theme emerged in the Youth survey regarding family involvement; participants wanted to decide how much/what information is shared with their families. Youth noted they were less likely to be honest with family present. Communication and navigation were mentioned frequently in the Family survey; participants noted the complexity of the mental health care system and felt frustrated by the lack of information to help them access additional resources. Conclusion: There are a number of areas in need of improvement to provide high-quality, patient-centred care to youth with mental health or substance use concerns that present to the Emergency Department. Phase II of this project will involve a review of the themes and determine priorities and strategies to address the themes that could be implemented into the workflow.

scholarly journals Emergency department utilization for substance use disorders and mental health conditions during COVID-19

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262136
Author(s):  
Arjun K. Venkatesh ◽  
Alexander T. Janke ◽  
Jeremy Kinsman ◽  
Craig Rothenberg ◽  
Pawan Goyal ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Substance Use ◽  
Safety Net ◽  
Health Conditions ◽  
Emergency Department Utilization ◽  
Mental Health Conditions ◽  
Ed Visits ◽  
National Emergency

Background As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. Methods We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. Findings While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. Conclusions We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.

Lack of associations of substance use and mental health with self-reported pain scores among emergency department patients

2019 ◽  
Vol 37 (9) ◽  
pp. 1790-1792
Author(s):  
Catherine A. Marco ◽  
Dennis Mann ◽  
Christian Daahir ◽  
Harry Savarese ◽  
John Paul Detherage ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Substance Use ◽  
Pain Scores ◽  
Emergency Department Patients

scholarly journals 1A Nationwide Analysis of U.S. Racial/Ethnic Disparities in Emergency Department Patients with Mental Health and Substance Use Disorders

2021 ◽  
Author(s):  
Joanne Weinreb ◽  
Penina Gavrilova ◽  
Jonathan Avery ◽  
Sean M. Murphy ◽  
Jyotishman Pathak
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Wait Time ◽  
Wait Times ◽  
Hispanic Patients ◽  
Racial Ethnic ◽  
Triage Level ◽  
Hispanic White ◽  
White Patients

Abstract BackgroundRacial and ethnic health disparities have been linked with inequalities in access to health care and outcomes. The present study considers whether inequalities persist between racial/ethnic groups among patients with mental health or substance use disorders who visit the emergency department (ED). MethodsWe analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012-2018, assessing health disparities among patients diagnosed with mental health or substance use disorders by observing whether significant differences exist in ED wait time and length of visit (LOV) for patients of different races/ethnicities. Stratified models were performed to further understand the impact of regions across the U.S., year, and triage level on the association analysis. ResultsFrom 2012-2018, non-Hispanic Black and Hispanic patients experienced significantly longer ED wait times and LOV as compared to White patients. Patients with private insurance experienced significantly shorter wait times compared to patients with self-pay, and shorter LOV than those with Medicaid/ Children’s Health Insurance Program, or Medicare. Male patients had significantly longer LOV compared to female patients. We observed year by year differences in wait times of non-Hispanic Black patients with improvement appearing between the years 2013 to 2016, while LOV remained consistently longer. We observed both regional and triage level differences, with the U.S. Northeast presenting with the most disparities. Additionally, we noted a general upward trend of SUD diagnoses. Conclusion Our analysis suggests that while there has been an overall improvement in median ED wait time through the years, non-Hispanic Black and Hispanic patients experience significantly longer ED wait time compared to non-Hispanic White patients. Additionally, non-Hispanic Black and Hispanic patients have a significantly longer ED LOV compared to non-Hispanic White patients.

A conceptual review of family involvement in acute mental health treatment: Methodology and personal reflections

2018 ◽  
Vol 2 (2) ◽  
pp. 257-266 ◽  
Author(s):  
Aysegul Dirik ◽  
Katherine Shea Barrett ◽  
Gerry Bennison ◽  
Sue Collinson ◽  
Sima Sandhu
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Family Involvement ◽  
Mental Health Treatment ◽  
Research Knowledge ◽  
Health Treatment ◽  
Patient Voice ◽  
Review Team ◽  
The Family ◽  
Personal Reflections

This paper describes a process developed in order to work collaboratively on a conceptual review of some of the family involvement models that are used in acute mental health treatment. The members of the review team consisted of clinicians, academics and people with lived experience of mental illness and mental health services. This combination of backgrounds had the potential to present many challenges to the dynamics of the group. There were varying levels of research knowledge and experience within the group, as well as a lack of literature describing how to actualize their potential to best effect. Financial resources were minimal, which meant that the number of meetings had to be limited. Most importantly, however, there was the strong potential for a power imbalance within the group during the review process. Senior academics and clinicians were being expected to help to create a research environment in which the patient voice carried as much weight as theirs. In this paper, we discuss how we overcame these challenges and ended up with a process that was coherent, equable and enjoyable.

scholarly journals Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization

2018 ◽  
Vol 19 (6) ◽  
pp. 902-906 ◽  
Author(s):  
Aimee Moulin ◽  
Ethan Evans ◽  
Guido Xing ◽  
Joy Melnikow
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Health Planning ◽  
Private Insurance ◽  
Mental Healthcare ◽  
Emergency Department Utilization ◽  
Public Healthcare ◽  
Frequent Users ◽  
Ed Visits

Introduction: Frequent users of emergency departments (ED) account for 21–28% of all ED visits nationwide. The objective of our study was to identify characteristics unique to patients with psychiatric illness who are frequent ED users for mental health care. Understanding unique features of this population could lead to better care and lower healthcare costs. Methods: This retrospective analysis of adult ED visits for mental healthcare from all acute care hospitals in California from 2009–2014 used patient-level data from California’s Office of Statewide Health Planning and Development. We calculated patient demographic and visit characteristics for patients with a primary diagnosis of a mental health disorder as a percentage of total adult ED visits. Frequent ED users were defined as patients with more than four visits in a 12-month period. We calculated adjusted rate ratios (aRR) to assess the association between classification as an ED frequent user and patient age, sex, payer, homelessness, and substance use disorder. Results: In the study period, 846,867 ED visits for mental healthcare occurred including 238,892 (28.2%) visits by frequent users. Patients with a primary mental health diagnosis and a co-occurring substance use diagnosis in the prior 12 months (77% vs. 37%, aRR [4.02], 95% confidence interval [CI] [3.92-4.12]), homelessness (2.9% vs 1.1%, odds ratio [1.35], 95% [CI] [1.27-1.43]) were more likely to be frequent users. Those covered by Medicare (aRR [3.37], 95% CI [3.20-3.55]) or the state’s Medicaid program Medi-Cal (aRR [3.10], 95% CI [2.94-3.25]) were also more likely to be frequent users compared with those with private insurance coverage. Conclusion: Patients with substance use disorders, homelessness and public healthcare coverage are more likely to be frequent users of EDs for mental illness. Substance use and housing needs are important factors to address in this population.

scholarly journals Investigating the impact of COVID-19 on performance and image enhancing drug use

2021 ◽  
Author(s):  
Matthew Dunn ◽  
Timothy Piatkowski
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Online Survey ◽  
High Dose ◽  
Convenience Sample ◽  
Health Concerns ◽  
Exercise Habits ◽  
Mental Health Concerns ◽  
Image Enhancing ◽  
The Impact

Abstract Background Emerging research has suggested that the COVID-19 pandemic has had some impact on substance use patterns. The aim of the study was to conduct a rapid survey to assess the impact of COVID-19 on performance and image enhancing drug (PIED) use and training, and any subsequent negative physical or mental health outcomes. Methods During 2020, a convenience sample of 60 PIED consumers (mean age = 26.69; 68.3% located outside Australia) completed a quantitative anonymous online survey exploring how the coronavirus pandemic impacted patterns of PIED use and associated exercise habits. The survey was administered via the Qualtrics platform and distributed online through PIED forums as well as through the investigator's networks. Participants were asked about their PIED use and exercise habits prior to and during restricted movement ‘lockdowns’. Results Pre-COVID, the majority of the sample opted to ‘blast-cruise’ (an initial high dose, followed by a lower maintenance dose; 71.7%, n = 43). During lockdown, (45%, n = 27) reported a change in PIED use as a result of the restrictions. In light of health concerns during COVID-19, a majority of men (60%, n = 36) did not take any extra precautions relating to their PIED use. A subgroup of men ceased using PIEDs completely (16.7%, n = 10) with the majority (80%, n = 8) of that subgroup following post-cycle therapy (PCT) of some kind. Conclusions This study contributes to the emerging literature of the impact of the COVID-19 pandemic on substance use, specifically PIED use among men. The results suggest that the pandemic did influence the choice of PIEDs that participants consumed, although there was little disruption to patterns of exercise, an important aspect of PIED use. Of the men who did cease use completely, the majority reported little issue with PCT access; those who reported difficulty accessing PCT compounds indicated experience some mental health concerns related to ceasing their PIED use. Clinicians and those who come into contact with this group should be alert for any negative physical or mental health concerns resulting from disrupted or ceased PIED use.

scholarly journals Young People's Use of Digital Tools to Support Their Mental Health During Covid-19 Restrictions

2021 ◽  
Vol 3 ◽  
Author(s):  
Claudette Pretorius ◽  
David Coyle
Keyword(s):  
Mental Health ◽  
Social Media ◽  
Young People ◽  
Support Groups ◽  
Online Survey ◽  
Online Resources ◽  
Sensitive Period ◽  
Social Media Platforms ◽  
Mental Health Support ◽  
Google Search

Young adulthood represents a sensitive period for young people's mental health. The lockdown restrictions associated with the COVID-19 pandemic have reduced young people's access to traditional sources of mental health support. This exploratory study aimed to investigate the online resources young people were using to support their mental health during the first lockdown period in Ireland. It made use of an anonymous online survey targeted at young people aged 18–25. Participants were recruited using ads on social media including Facebook, Twitter, Instagram, and SnapChat. A total of 393 respondents completed the survey. Many of the respondents indicated that they were using social media (51.4%, 202/393) and mental health apps (32.6%, 128/393) as sources of support. Fewer were making use of formal online resources such as charities (26%, 102/393) or professional counseling services (13.2%, 52/393). Different social media platforms were used for different purposes; Facebook was used for support groups whilst Instagram was used to engage with influencers who focused on mental health issues. Google search, recommendations from peers and prior knowledge of services played a role in how resources were located. Findings from this survey indicate that digital technologies and online resources have an important role to play in supporting young people's mental health. The COVID-19 pandemic has highlighted these digital tool's potential as well as how they can be improved to better meet young people's needs.

scholarly journals LO67: Alcohol-related emergency department visits by youth aged 12-24: demographics and resource utilization at Kingston Health Sciences Centre

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S32-S32
Author(s):  
H. Murray ◽  
L. Erlikhman ◽  
T. Graham ◽  
M. Walker
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Resource Use ◽  
Standard Form ◽  
Emergency Department Visits ◽  
Acute Intoxication ◽  
Mental Health Issue ◽  
Male Predominance ◽  
Ed Visits ◽  
The Impact

Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visits among youth. We sought to quantify the impact of ED visits (type and frequency, patient characteristics and resource use) related to alcohol in our centre. Methods: This was a chart review of patients aged 12-24 with alcohol-related ED visits between Sept 2013-Aug 2017. The National Ambulatory Care Reporting System (NACRS) database was searched for visits alcohol related ICD-10 codes. The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) database was also searched using the keyword alcohol. Duplicate visits were removed. Visits were excluded if patients had a history of psychosis, were held in the ED for psychiatric assessment, were homeless, were inmates from a correctional institute, if alcohol use was not mentioned and for complaints of sexual assault/intimate partner violence. Data was abstracted by two reviewers using a standard form with predetermined variables. Differences were resolved with third party adjudication. Interrater reliability of the reviewers was assessed with Kappa scores through duplicate review of 10% of randomly selected charts. A further 10% were assessed by a 3rd reviewer for extraction accuracy. Results: 3,256 ED visits were identified with 777 removed via predefined exclusion criteria. 2,479 visits were reviewed with a male predominance (54.3%). More than half of all patients (50.9%) arrived via ambulance. Assigned CTAS levels were Resuscitation: 1% Emergent: 9.9% Urgent: 48.2% Less Urgent: 35.7% Non-Urgent: 4.2% (missing 1%). The median LOS was 2.9 hrs (IQR 1.8-4.6). All visits were subclassified into mutually exclusive categories: injury (51.8%), acute intoxication (45.1%) and mental health issue (3.2%). Males were more likely to present with injury (62.4% vs 42.6%, p < 0.01). Females were more likely to present with acute intoxication (53.3% vs 46.7%, p <0.01) and mental health issues (59.5% vs 40.5%, P = 0.01). ED resource use was notable: 483 (19.4%) had imaging tests and 1216 (49.1%) had some medical intervention (blood test, fluids or medication). 57 (2.3%) patients were admitted and there was one death from an alcohol related MVC. Conclusion: Alcohol-related ED visits by youth are common in our centre and utilize substantial prehospital and in-hospital resources. Identification of effective harm reduction strategies should be a research priority.

Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study

2019 ◽  
Vol 73 (6) ◽  
pp. 557-563 ◽  
Author(s):  
Monika Mitra ◽  
Ilhom Akobirshoev ◽  
Susan L Parish ◽  
Anne Valentine ◽  
Karen M Clements ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Emergency Department ◽  
Developmental Disabilities ◽  
Postpartum Period ◽  
Post Partum ◽  
Population Based ◽  
Intellectual And Developmental Disabilities ◽  
Healthcare Needs ◽  
Ed Visits

BackgroundAn emerging body of evidence underscores the often-intensive perinatal healthcare needs of women with intellectual and developmental disabilities (IDD). However, population-based research examining postpartum experiences of US women with IDD is sparse. We examined emergency department (ED) use in the postpartum period among Massachusetts mothers with IDD.MethodsWe analysed 2002–2010 Massachusetts Pregnancy to Early Life Longitudinal data to compare any and ≥2 ED visits between mothers with and without IDD: within 1–42 days post partum, 1–90 days post partum and 1–365 days post partum. We also determined whether or not such ED use was non-urgent or primary-care sensitive.ResultsWe identified 776 births in women with IDD and 595 688 births in women without IDD. Across all three postpartum periods, women with IDD were vastly more likely to have any postpartum ED use, to have ≥2 ED visits and to have ED visits for mental health reasons. These findings persisted after controlling for numerous sociodemographic and clinical characteristics. Women with IDD were less likely to have non-urgent ED visits during the three postpartum periods and they were less likely to have primary-care sensitive ED visits during the postpartum period.ConclusionThese findings contribute to the emerging research on perinatal health and healthcare use among women with IDD. Further research examining potential mechanisms behind the observed ED visit use is warranted. High ED use for mental health reasons among women with IDD suggests that their mental health needs are not being adequately met.

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