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Caregivers of youth in psychiatric crisis often seek treatment from hospital emergency departments (EDs) as their first point of entry into the mental health system. Emergency departments have struggled over the last decade with growing numbers and now, because of the pandemic, have experienced a deluge of mental health crises. As one approach to divert unnecessary ED admissions, pediatric emergency psychiatric telephone triage services have been created. This study aimed to define the characteristics and utilization of a pediatric triage service and to examine clinician documentation of calls to identify the assessment of risk and disposition.This study included 517 youth (2-18 years; mean, 12.42 years; SD, 3.40 years) who received triage services in the winter of 2 consecutive years. Triage calls were received from caregivers (75%), schools (17.0%), and providers (6.6%) regarding concerns, including suicidal ideation (28.6%), school issues (28.6%), and physical aggression (23.4%).Dispositions were for acute, same-day evaluation (9.7%), direct care service (28.8%), further evaluation (within 48-72 hours, 40.0%), and resource/service update information (21.5%). Findings revealed that most clinical concerns were referred for further evaluation. Both adolescent females and males were referred for emergency evaluations at high rates.A dearth of information on pediatric crisis telephone triage services exists; thus, developing an evidence base is an important area for future work. This information assists not only in our understanding of which, why, and how many youths are diverted from the ED but allows us to extrapolate significant costs that have been saved because of the utilization of the triage service.

In der Abteilung für Psychiatrie und Psychotherapie des Kinder- und Jugendalters des ZfP (Zentrum für Psychiatrie) Südwürttemberg Ravensburg, Standort Weissenau, wurden aus der elektronischen Patientenakte retrospektiv die Daten der stationären Aufnahmen der Jahre 2010, 2011, 2013, 2015, 2017 und 2018 gesichtet. Daraus wurden verschiedene Fragestellungen zur Entwicklung der stationären Notaufnahmen untersucht. Als Notaufnahme wurde eine akute Aufnahme ohne ambulante Vorplanung definiert. Es wurden in den untersuchten Jahren Daten zur Dauer der Notaufnahmen, Anzahl der Notaufnahmen und zum psychosozialen Lebensumfeld von Notaufnahmen erhoben. Die erhobenen Daten wurden dann auf Zusammenhänge zwischen Notaufnahme, Alter, Geschlecht, Jahreszeit, zu Hause und Freiwilligkeit der Aufnahme untersucht. Zusätzlich wurde eine Definition des Kinder- und Jugendpsychiatrischen Notfalls mit einer Empfehlung zum Umgang mit Patient*innen nach Notaufnahme erarbeitet. In SPSS (IBM SPSS Statistics 27) wurde zur deskriptiven Datenanalyse der Chi-Quadrat-Test für Häufigkeitstabellen angewendet, um den Zusammenhang zwischen zwei kategorialen Merkmalen einzuschätzen. Die einfaktorielle Varianzanalyse (ANOVA) wurde verwendet, um Mittelwertsunterschiede über den gesamten Untersuchungszeitraum zu analysieren. Für die Zeitreihenanalyse wurde eine Trendlinie berechnet. Folgende Ergebnisse konnten gefunden werden: 1. Der Anteil der Notaufnahmen zu den Regelaufnahmen (2010 bis 2018) schwankte im Beobachtungszeitraum zwischen 40 % und 53 %. Bei gleicher Bettenzahl (n = 10) gab es in den Jahren 2017 und 2018 pro Station deutlich mehr Notaufnahmen. Um dem erhöhten Patient*innenaufkommen zu begegnen ist im Gegenzug die Verweildauer im Median gesunken. 2. Notaufnahmen fanden etwas häufiger in der kalten Jahreszeit statt. Im August (Zeit der Schulferien) sanken die Notaufnahmezahlen. 3. Insgesamt stellten sich signifikant häufiger Jungen als Notaufnahmepatient*innen vor. Bis auf die Jahre 2011 und 2015 waren die Geschlechterverhältnisse annähernd ausgeglichen. Bezüglich der Anfangsdiagnosen zeigte sich teilweise eine deutliche Verschiebung zugunsten eines Geschlechts. Internalisierende Störungen zeigten eine weibliche Prädominanz, externalisierende Störungen eine männliche Prädominanz. 4. Der Großteil (80 %) der Notaufnahmepatient*innen war zwischen 13 und 18 Jahre alt, mit einem Peak um das 16. Lebensjahr. 5. Klinikaufenthalte nach Notaufnahme dauerten mit im Median einem Tag deutlich kürzer als die der Regelaufnahmepatient*innen mit 33 Tagen. 6. Im Beobachtungszeitraum gab es eine deutliche Steigerung der Übernachtungen der Notaufnahmepatient*innen von 975 (2011) auf 2513 Übernachtungen (2018) bei unveränderten Kapazitäten der Stationen. 7. Über den gesamten Beobachtungszeitraum kamen etwas mehr (52 %) Notaufnahmepatient*innen von zu Hause als aus Einrichtungen der Jugendhilfe mit steigender Tendenz in den Jahren 2013, 2015 und 2018. 8. Die Aufnahme der deutlichen Mehrzahl der Notaufnahmepatient*innen (87 %) erfolgte freiwillig. Nur 13 % wurden nach genehmigter freiheitsentziehender Unterbringung nach § 1631b BGB (Bürgerliches Gesetzbuch) aufgenommen. 9. Eine mögliche Definition des Kinder- und Jugendpsychiatrischen Notfalls könnte sein, dass sich der Notfall durch eine (lebens-)bedrohliche Situation oder eine akute Bedrohung für die/den Patient*in oder andere auszeichnet, während die/der Patient*in in der Krise zwar eine dringende Versorgung benötigt, ihre/seine Situation aber nicht lebensbedrohlich ist. Durch die Zunahme der Gesamt- sowie der Notaufnahmepatient*innenzahl sind die Stationen deutlich mehr belastet und kommen an Ihre Kapazitätsgrenzen. Es ließ sich eine deutliche Verschiebung der Bettenbelegung zugunsten der Notaufnahmepatient*innen und zulasten der Regelpatient*innen darstellen. Bei einem derart hohen Notaufnahmeaufkommen besteht die Gefahr, dass geplante Regelaufnahmen verschoben werden müssen. Hier sind neue Konzepte notwendig – ambulant, stationsäquivalent oder zeitlich strukturierte Notfallaufnahmen mit ggf. geplanten Wiederaufnahmen – um der Verdichtung des Notaufnahmeaufkommens zu begegnen.

Psychiatric Emergency Services (PES) at Connecticut Department of Veterans Affairs (VACT) began offering the COVID-19 vaccine to eligible veterans in February 2021. From February 10 to March 17, 2021 there were 110 encounters where a veteran was offered the vaccine (96 unique veterans). Of those 96 veterans, 39 (40.6%) were interested in receiving the vaccine. Of those, 23 (60.0%) veterans received the first dose of the Pfizer-BioNTech vaccine and among those, 21 (91.3%) eventually received the second dose. Sixteen veterans were interested but unable to receive the vaccine due to PES-related obstacles. Common themes regarding vaccine hesitancy among this population include vaccine mistrust and concerns about side effects. Offering the vaccine to PES patients allowed VACT to reach a vulnerable subset of veterans who may be at higher risk of contracting the virus and experience worse disease outcomes.

Background During the COVID-19 pandemic, there have been an increasing number of emergency department visits for behavioral health reasons, even as overall emergency department volumes have decreased. The impact of the pandemic and related public health interventions on specialized psychiatric emergency services has not been described. These services provide high-intensity care for severely ill patients who are likely to be homeless and underserved. Objective We describe the change in total volume and psychiatric hospitalization rates among three psychiatric emergency services across the United States. Methods Changes in volumes and hospitalization were assessed for statistical significance using a seasonal autoregressive integrated moving average with exogenous factors model from January 2018 to December 2020. Results The pandemic's impact on volumes and hospitalization varied by site. In Denver (CO), there was a statistically significant 9% decrease in overall volumes, although an 18% increase in hospitalizations was not significant. In New York City (NY), there was a significant 7% decrease in volumes as well as a significant 6% decrease in hospitalizations. In Portland (OR), volumes decreased by 4% and hospitalizations increased by 6% although differences did not reach statistical significance. Conclusions There has been a decrease in volume at these services after the pandemic, but there are substantial variations in the magnitude of change and demand for hospitalization by region. These findings suggest a need to understand where patients in crisis are seeking care and how systems of care must adapt to changing utilization in the pandemic era.

Background and objectives Lack of mental health resources, such as inpatient psychiatric beds, has increased frequency and duration of boarding for mental health patients presenting to U.S. emergency departments (EDs). The purpose of this study is to describe characteristics of mental health patients with an ED length of stay of one week or longer and to identify barriers to their disposition. Methods This study was conducted in an academic ED in which emergency psychiatric evaluations and care are provided by a Psychiatric Emergency Services (PES) team contained within the Department of Emergency Medicine. Prolonged boarding was defined as an ED length of stay of 7 days or more. Pediatric, adult, and geriatric mental health patients with prolonged ED boarding from January 1 to August 31, 2019 were included. This study includes prospective data collection of the boarding group and retrospective identification and data collection of a comparison group of non-barding patients over the same 8-month period to compare patient characteristics and outcomes for each group. Results Between January 1 and August 31, 2019, the PES team completed 2,745 new assessments of mental health patients, of whom 39 met criteria for prolonged ED boarding. The following characteristics were associated with boarding: child (8%), male (64%), having Medicaid (49%) or both Medicaid and Medicare (18%), and having either a neurodevelopmental (15%) or neurocognitive disorder (15%) with a median stay of 18 days. Barriers to discharge included being declined from all state inpatient psychiatric hospitals (69%), declined from community living environments (21%), or declined from both (10%). The most common ED non-boarding patients were: Caucasian (64%), have a diagnosis of unspecified mental disorder (including suicidal ideation) or other specified mental disorder (59%) and have private insurance (42%) with a median stay of 1 day. Conclusion In this study of mental health patients with prolonged ED stays, the primary barrier to disposition was the lack of patient acceptance to inpatient psychiatric hospitals, community settings, or other housing. Early identification of potential prolonged boarding, quality treatment and care for those patients, and effective case management, may resolve the ongoing challenges of boarding within the ED.

Background: Although de-institutionalisation has been underway for decades, admission to hospital followed by low-intensity outpatient care remains the usual treatment for patients with an acute psychiatric crisis. Intensive home treatment has been developed for patients in a severe psychiatric crisis as an alternative to inpatient care. This study aimed to evaluate the potential of intensive home treatment to reduce bed-days and its clinical effectiveness compared with treatment as usual. Methods: We did a two-armed, two-centre, open-label, Zelen, double-consent, pragmatic randomised controlled trial. Patients aged 18–65 years were recruited at the psychiatric emergency service and psychiatric emergency wards of the two major mental health institutions (Arkin and GGZ inGeest) in Amsterdam, the Netherlands. Patients diagnosed with at least one DSM-IV-TR or DSM-5 disorder and in a psychiatric crisis and for whom psychiatrists had indicated or completed a clinical admission could be included. Trained psychiatric emergency service and hospital professionals did the automated web-based pre-randomisation procedure upon first contact with the patient. A seeded pseudo-random number generator allocated patients (2:1) to intensive home treatment or treatment as usual. Informed consent was obtained after randomisation as soon as the patient was mentally capable within 14 days. Due to the nature of this study, patients and professionals were not masked to treatment. Intensive home treatment was tailored to the nature of the crisis and goals of patients and relatives, and developed in collaboration with them and a multidisciplinary professional team. All main analyses were intention-to-treat, and the primary outcome was the total number of admission days 12 months after randomisation. To investigate the effect of treatment conditions on the outcome measures, linear mixed modelling analyses using restricted maximum likelihood estimation were done. This trial was prospectively registered with Trialregister.nl, NL-6020 (NTR-6151). Findings: Between Nov 15, 2016, and Oct 15, 2018, 246 patients were included in the study (183 patients with intensive home treatment vs 63 patients with treatment as usual). 135 women (55%) and 111 men (45%) were included, with a mean age of 41·01 years (range 18–65; SD 12·68). 114 participants (46%) were born in the Netherlands and 85 (35%) elsewhere (missing data on 47 [19%] participants). Ethnicity data were not available. After 12 months, the mean number of admission days in the intensive home treatment condition was 42·47 (SD 53·92) versus 67·02 (SD 79·03) for treatment as usual, a reduction of 24·55 days (SD 10·73) or 36·6% (p=0·033). 26 adverse events were registered, 23 (89%) of which were suicide attempts. The number of patients with a reported adverse event did not differ significantly between the groups (15 [8%] in the intensive home treatment group vs five [8%] in the treatment as usual group; p=0·950). Five patients died by suicide (three [2%] in the intensive home treatment group vs two [3%] in the treatment as usual group; p=0·610). No treatment-related deaths occurred. Interpretation: Intensive home treatment is a safe and effective partial substitute for conventional psychiatric crisis care that led to a reduction in admission days, causing patients to stay longer in their social environment, with similar clinical effects, patient satisfaction and adverse events. Funding: De Stichting tot Steun Vereniging voor Christelijke Verzorging van Geestes-en Zenuwzieken.

Background Suicide is a painful consequence of many psychiatric disorders and one of the most frequent psychiatric emergencies. Generally, pre-hospital technician is the first person in the treatment chain who attends the situation; hence, his/her sound clinical judgment and professional behavior can play an important role in preventing or stopping the suicide process. We tried to develop a concise, evidence-based, and step-by-step guide for dealing with a suicidal patient, which could be quickly reviewed by technicians before confronting a suicide situation. Method We reviewed the literature for suicide management plans and protocols, to extract the evidence-based interventions and instructions for dealing with a suicide situation. Then, we discussed the extracted material in an expert panel, and developed the initial version of the protocol considering the local socio-cultural issues and available facilities. Subsequently, we reviewed the protocol in a meeting with pre-hospital technicians and emergency physicians, to receive their feedback and address any possible executive problems. Finally, we revised the protocol to its final version considering the feedbacks. Results The basic principles of dealing with a suicidal patient are similar to other psychiatric emergencies and include: Patient Safety; Patient evaluation and diagnosis; and Patient (behavioral and pharmacological) management. However, specific considerations should be taken into account and special arrangements are necessary for suicidal patients. Whether the patient has attempted suicide or not, would guide the management to one of the two major paths. In addition, the needs of the family should be considered. Conclusion A locally adapted protocol considering existing facilities in the emergency system and cultural issues in Iranian society is provided for pre-hospital emergency technicians.

The coronavirus pandemic and related social distancing measures have brought about dramatic changes in people's lives. In particular, health workers have been forced to change their activities both for the different needs of patients and for preventive measures against the spread of the virus. This study is aimed at comparing the urgent psychiatric consultations (UPC) performed at the outpatient Mental Health Center (MHC) of Modena during the coronavirus outbreak period, from 1 March to 31 August 2020, with the same period in 2019. We retrospectively collected in a database the demographic and clinical characteristics of patients who required UPC in the MHC during the 6-month observation periods in both 2019 and 2020. Data were statistically analyzed. We analyzed 656 urgent psychiatric consultations in 2019 and 811 in 2020, requested by 425 patients in 2019 and 488 in 2020, respectively. In the pandemic period, we observed an increase in the total and daily number of UPC which were more frequently required by patients in care at local outpatient services in comparison with the previous period. During 2020, an increased number of UPC was carried out remotely and the outcome was more frequently represented by discharge at home, avoiding hospitalization as much as possible. In the course of the coronavirus pandemic, MHC had to face an increased demand for clinical activity especially from the most clinically and socially vulnerable patients, who more frequently required UPC in outpatient psychiatric services.

Introduction: France has been impacted by the COVID-19 pandemic. Anxiety, depression, burn out and the high proportion of post-traumatic stress disorder proved to be the most expected troubles caused by this pandemic and the confinement. Medico-psychological emergency units (CUMP) have been solicited at the very early stage of the pandemic because CUMP units are very well known by the French government and systematically associated to emergency plans. Methods: In this article we describe the process which has been developed to cope with the psychological needs in the general population. At a first level, platforms of volunteers specialised into listening were available. Then those platforms could directly mobilise the CUMP in case of psychiatric disorders. It ran over the whole first wave and it has been reactivated because of the second confinement in France. Results: During the first wave, approximately 1% of all the calls made on the national Covid number required to be redirected to the listening platforms. Of this group, 4% were related to reactive pathology or a psychiatric decompensating that required adapted and specialised care. Conclusion: The high rates of psychological distress detected in the general population in recent scientific literature seem discrepant with our findings of relatively low reorientation towards the CUMP. Nevertheless, our study highlights that the response of the CUMP network in France during the first wave was supportive. The second wave displays its adaptability to the public health policies.

Individuals with intellectual and developmental disabilities disproportionately use emergency psychiatric services compared with their neurotypical peers, suggesting that such individuals and their supports are at increased risk for crisis events. This prospective study examined the timing, outcomes, and predictors of mental health crises for this population.The data came from Systemic, Therapeutic, Assessment, Resources, and Treatment (START), a national model that provides mental health crisis services for those with intellectual and developmental disabilities in the United States. The study included 1,188 individuals from four U.S. regions enrolled between 2018 and 2019. The outcome was urgent crisis contacts with the START program. Baseline and clinical predictors were examined with multivariate regression analyses.More than a quarter had at least one crisis contact, and 9% had three or more. Contacts increased within the initial 3 months of START enrollment, followed by a steep drop-off thereafter; few contacts happened after 1 year. Almost 45% of the contacts occurred after hours, and 30% involved police. Clinical factors predicted crisis contact most robustly, followed by lack of occupational supports. After START crisis intervention, 73% of individuals remained in their primary setting.For individuals with intellectual and developmental disabilities and mental health needs, crisis stabilization resources are needed, including after hours. Results clearly identify times and risk factors for mental health crisis contacts, including frequent involvement with emergency responders. Importantly, gainful employment conveyed benefits for community stabilization. Findings may be leveraged to develop effective mental health crisis intervention services and supports for this underserved group.

The Public Health Agency of Canada is funding a new Canada Suicide Prevention Service (CSPS), timely both in recognition of the need for a public health approach to suicide prevention, and also in the context of the COVID-19 pandemic, which is causing concern about the potential for increases in suicide. This editorial reviews priorities for suicide prevention in Canada, in relation to the evidence for crisis line services, and current international best practices in the implementation of crisis lines; in particular, the CSPS recognizes the importance of being guided by existing evidence as well as the opportunity to contribute to evidence, to lead innovation in suicide prevention, and to involve communities and people with lived experience in suicide prevention efforts.

OBJECTIVES Children visiting emergency departments (EDs) are disproportionately affected by mental health disorders. Integrated behavioral health models hold promise for improving care among ED patients. We implemented and evaluated a novel behavioral health service integrated psychology trainees in a safety net hospital's pediatric ED and urgent care. METHODS Consultations and interventions provided were identified from the service's patient registry. Patients treated by the service were matched based on age, sex, day, and month of presentation to control patients who received a brief assessment by a specialized psychiatric nurse or patients receiving comprehensive management in a psychiatric emergency service. Rates of ED return visits were obtained from local hospital records, and insurance claims were used to identify rates of psychiatric hospitalization and outpatient follow-up care. RESULTS The most commonly provided interventions among 71 intervention patients were assistance with connection to follow-up behavioral health treatment (65%), relaxation training (41%), and motivational interviewing (31%). These patients were matched with 142 comparison patients. There was no difference among groups in return rates within 90 days among intervention versus nurse assessment or psychiatric emergency service patients (25% vs 23% vs 13%, P = 0.14). Insurance claims data were available for 115 patients (54%): within 90 days, integrated care patients were less likely to have at least 1 outpatient claim (52% vs 78% vs 84%, P < 0.01), and there was no difference in rates of psychiatric hospital admission (18% vs 20% vs 24%, P = 0.83). CONCLUSIONS Although this psychology-led integrated behavioral health service delivered a range of brief psychotherapeutic interventions, its impact on outpatient, inpatient, and emergency care was mixed. This lower follow-up rate among intervention patients may reflect the success of active psychological treatment in the ED, lower acuity among intervention patients, or implications of the study's safety net setting. The authors discuss this model's potential for enhancing mental health care in pediatric EDs.

Emergency departments (ED) provide psychiatric assessments to approximately 4000 youth annually. While most are discharged home, they are not without risk. To improve safety, this study examined the distribution of medication lock bags (MLB) to caregivers of youth discharged following an emergency evaluation.The objective was to evaluate caregiver attitudes and behaviors related to the bag and perceptions of whether the MLB enhanced their youth's safety. MLB distribution was limited to patients who had presented with recent or current non-suicidal self-injurious behavior, suicidal ideation, or a suicide attempt.Caregivers were contacted for a phone survey and asked components of their MLB experience. Of the 119 caregivers offered the MLB, 114 accepted and 5 declined. Results indicate that caregivers found the most positive aspects of the bag to include the "Bag is Secure" (39%) and "Safety of Child and Family" (31%). Parents found the most negative aspects of using the bag to be "Nothing" (30%) and "Size" (21%).These results suggest most caregivers will accept and use MLBs when it is provided during a psychiatric ED evaluation. Further, data suggests caregivers find the bag to be easy to use and that it provides them with a sense of safety/security.

Objective Little information is available on young children (age 4-12 years) with mental health problems who are seen by the psychiatric emergency services. We therefore described this population to identify (1) variables that differentiated children from those aged 13 to 18 years who had been referred for psychiatric emergency consultation; and (2) to describe sex differences. Method We extracted data for a 9-year period from the records of the mobile psychiatric emergency services in 2 urban areas in the Netherlands. In this period, 79 children aged 4 to 12 years (37.2% girls) and 1695 children aged 12 to 18 years (62.2% girls) had been referred for psychiatric emergency consultation. Demographic and process factors were recorded. Clinical characteristics included diagnostic and statistical manual of mental disorders, 4th edition classifications and the Severity of Psychiatric Illness scale. Logistic regression analyses were used to examine differences between the girls and boys in the 2 age groups. Results Young children aged 4 to 12 years had been involved in 4.5% of all consultations of minors. In contrast with adolescents, a higher percentage of young children seen for emergency consultation were boys, and a lower percentage was admitted to a psychiatric hospital (7.7%). In boys and girls alike, a DSM classification of behavioral disorder was associated with younger age. Conclusions The young group of children referred for psychiatric emergency consultation comprised relatively more children with behavioral disorders. Decisions to refer them for urgent psychiatric consultation seemed to be influenced by the suspicion of psychotic symptoms or of danger to themselves or others.

The medical-psychological emergency units (CUMP) have the specific mission of taking care of people suffering from psychological trauma following a collective catastrophic event. Their functioning and the techniques they use are discussed after a review of their history.

Highlights • A retrospective analysis was performed of all patients admitted to the Psychiatric Emergency Service 90 days before and after March 14th, 2020, the first day of lockdown in Spain due to COVID-19. • During the lockdown the number of admissions decreased by 37.9% while a significant increase in the percentage of patients requiring acute psychiatric hospitalization was observed. • Anxiety spectrum disorders accumulated the greatest decrease in admission rates compared to the three months before lockdown. • A statistically significant increase in admissions rates was found in patients with dementia-like cognitive impairments, autism spectrum, and substance use disorders during the lockdown., Background During the COVID-19 pandemic, a structural reorganization was imposed on public health systems. Psychiatry services were also affected with the imposed reduction of non-urgent consultations. We aim to explore the effect of these changes on a Psychiatry Emergency Service during COVID-19 lockdown in Spain. Methods A retrospective analysis was performed on all patients admitted to our Psychiatric Emergency Service 90 days before and after March 14th, 2020, the first day of lockdown in Spain. Extracted data were compared between the two periods. Poisson regression analysis was performed to analyze changes in admission rates. Results 1,958 psychiatric emergency admissions were analyzed. Although the number of admissions decreased by 37.9%, we observed a significant increase in the percentage of acute psychiatric hospitalization during the lockdown. Anxiety spectrum disorders accumulated the greatest significant decrease in admission rates during the lockdown. On the other hand, a significant increase in admissions rates was found in patients with dementia, autism spectrum disorders, and substance use disorders during the lockdown. Limitations This study was conducted in a single psychiatric emergency service, preventing a generalization of our results. The comparison time period might have biased our results due to the influence of external factors. Conclusion Mental health consequences of COVID-19 are becoming apparent. A reduction of admission rates for anxiety disorders might be related telepsychiatry implementation during the lockdown. Other conditions particularly vulnerable to the routine changes and lack of social support have suffered the most, and efforts should be placed to treat these situations.

In 2013, China's first Mental Health Law (MHL) took effect, with the goal of better protecting patients' rights. Under the law the police, with appropriate training, rather than family members, employers or medical staff sent from a hospital, are the ones who bring persons in behavioral crises to medical facilities for psychiatric assessment for possible involuntary hospitalization. We examined the proportion and distinctive characteristics of persons brought to psychiatric emergency services (PES) by the police since the implementation of MHL. We used medical records to document demographic and clinical characteristics of all persons evaluated at the PES of the Guangzhou Psychiatric Hospital, the largest psychiatric hospital in China's fourth largest city, from April 2017 to August 2017. Bivariate and multivariate statistical analyses were performed to identify characteristics of patients brought to the PES by the police. Among 1515 PES visits, 166 (11.0%) were brought by the police as compared to virtually none in the years before the law took effect. Compared to non-police referrals, police referrals were associated with male gender, age greater than 30, more documented violent behavior, greater likelihood of having been restrained, and higher rates of hospital admission after assessment. Assessed risk of suicidality and diagnoses of substance use disorder were not significantly associated with police referral. A modest but increased and noteworthy proportion of patients evaluated at the PES after implementations of China's MHL were brought by the police, especially those with violent behavior requiring restraint and hospitalization resulting from mental illness.

The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

Objective: Given increases in mental health utilization among college and university students, this study examines clinical and socio-demographic characteristics in students presenting to psychiatr...

The receipt of telemedicine for the management of mental illness, also known as telepsychiatry, is being adopted in emergency departments (EDs), but little is known about this approach. This study investigated the prevalence and applications of telepsychiatry in general EDs in the United States.All 5,375 U.S. EDs were surveyed to characterize emergency care in 2016. From the EDs that reported receiving telepsychiatry services, a 15% random sample was selected for a second survey that confirmed telepsychiatry use in 2017 and collected data on emergency psychiatric services and applications of telepsychiatry in each ED.The 2016 national survey (4,507 of 5,375; 84% response) showed that 885 (20%) EDs reported receiving telepsychiatry. Characteristics associated with higher likelihood of ED telepsychiatry receipt included higher annual total visit volumes, rural location, and Critical Access Hospital designation. Characteristics associated with lower likelihood of telepsychiatry receipt included being an autonomous freestanding ED. In the second survey (105 of 130; 81% response), 95 (90%) EDs confirmed telepsychiatry use. Most (59%) of these reported telepsychiatry as their ED's only form of emergency psychiatric services, and 25% received services at least once a day. The most common applications of telepsychiatry were in admission or discharge decisions (80%) and transfer coordination (76%).In 2016, 20% of EDs received telepsychiatry services, and most receiving telepsychiatry had no other emergency psychiatric services. The latter finding suggests that telepsychiatry is used to fill a critical need. Further studies are warranted to investigate barriers to implementing telepsychiatry in EDs without access to emergency psychiatric services.

International audience; OBJECTIVES:Compared to the general population, psychiatric patients are more exposed to physical illness but have reduced access to care.METHODS:We conducted a descriptive study in Montpellier between November 2011, 2nd and December 2012, 21st. Every Wednesday and Friday, the last two inpatients admitted in the psychiatric post-emergency unit of the University Hospital of Montpellier were assessed by a general practitioner and included in the study. This unit takes care of suicidal patients suffering from mood and/or personality disorders. The general practitioner assessed lifetime somatic history, current somatic comorbidities and medical follow-up for non-psychiatric issues.RESULTS:One hundred patients were included. The sample consisted of 81% women with a mean age of 43 years (18-79 years). The majority of patients had a lifetime history of somatic disease (96%) and was followed by a general practitioner (99%). Six patients had no met general practitioner for at least one year. Dyslipidemia was reported in 32 patients, among those only one patient was on lipid-lowering drug (96.88%). Among patients with impaired dental condition, 29 (55.77%) had not met a dentist for at least one year. Among those with impaired near visual acuity and/or impaired distance visual acuity, 19 (65.52%) had not met an ophthalmologist for at least one year.CONCLUSION:Although detected, somatic comorbidities seem outsourced in psychiatric patients. Greater awareness among different health professionals about the medical care of such patients could improve healthcare management and life expectancy

Objective: We explored the feasibility of developing, running and evaluating a simulation-based medical education (SBME) workshop to improve the knowledge, skills and attitudes of emergency department (ED) doctors when called on to assess patients in psychiatric crisis. Method: We designed a four-hour workshop incorporating SBME and a blend of pre-reading, short didactic elements and multiple-choice questions (MCQs). Emergency department nurses (operating as SBME faculty) used prepared scripts to portray patients presenting in psychiatric crisis. They were interviewed in front of, and by, ED doctors. We collected structured course evaluations, Debriefing Assessment for Simulation in Healthcare (DASH) scores, and pre- and post-course MCQs. Results: The pilot workshop was delivered to 12 ED registrars using only existing resources of the Psychiatry and Emergency Departments. Participants highly valued both ‘level of appropriateness’ (Likert rating μ = 4.8/5.0) and ‘overall usefulness’ ( μ = 4.7/5.0) of the programme. They reported an improved understanding of the mental state and of relevant legal issues and rated the debriefings highly (participant DASH rating: n = 193; score μ = 6.3/7.0). Median MCQ scores improved non-significantly pre- and post-course (7.5/12 vs 10/12, p = 0.261). Conclusion: An SBME workshop with these aims could be delivered and evaluated using the existing resources of the Psychiatry and Emergency Departments.

This exploratory retrospective study assessed demographic and hospital utilization characteristics of patients presenting with methamphetamine use to an urban psychiatric emergency service in New Mexico. De-identified data from patients presenting to PES from 2011 to 2015 were extracted from our health system. Descriptive statistics were used to characterize the study population. We employed bivariate analyses to assess the relationship between methamphetamine use and patient demographics. Methamphetamine use increased faster than any other drug tested during the study’s time period. Compared to non-methamphetamine patients, methamphetamine use was associated with a shorter PES stay when the patient was in the PES more than 12 h. Patients with methamphetamine use are increasingly seeking emergency psychiatric evaluations. Methamphetamine use may impact certain racial, ethnic, and socioeconomic classes disproportionately. Further health service delivery studies are needed to develop clear, evidence-based interventions and policy recommendations to address the methamphetamine crisis in the United States.

Objectives: Individuals with psychotic symptoms presenting to emergency psychiatry often have comorbid symptoms, such as substance misuse, depression, and anxiety. Many will also have symptoms link...

Objective: We aimed to describe patterns of substance use among patients admitted to an emergency psychiatric unit for non-fatal suicidal behaviour (NFSB) or another psychiatric reason and establis...

In Canada, more than 64 000 children are growing up with 1 or both parents in the military. We compared mental health service use by children and youth in military families versus the general population, to understand potential mental health service gaps.This was a matched retrospective cohort study of children and youth (aged20 yr) of members of the Canadian Armed Forces posted to Ontario between Apr. 1, 2008, and Mar. 31, 2013, with follow-up to Mar. 31, 2017, using provincial administrative health data at ICES. We created a comparison group of children and youth in the general population, matched 4:1 by age, sex and geography. We compared the use and frequency of mental health-related physician visits, emergency department visits and hospital admissions, and the time to first service use, using regression models.This study included 5478 children and youth in military families and a matched cohort of 21 912 children and youth in the general population. For visits and admissions for mental health reasons, children and youth in military families were more likely to see a family physician (adjusted relative risk [RR] 1.25, 95% confidence interval [CI] 1.17 to 1.34), less likely to see a pediatrician (adjusted RR 0.87, 95% CI 0.79 to 0.96), equally likely to see a psychiatrist, and as likely to visit an emergency department or be admitted to hospital as the matched cohort. Children and youth in military families had the same frequency of use of outpatient mental health services. The time to first visit for mental health reasons was shorter to see a family physician (adjusted days difference [DD] -57, 95% CI -80 to -33) and longer to see a psychiatrist (adjusted DD 103, 95% CI 43 to 163) for children and youth in military families.Children and youth in military families use mental health services differently from those in the general population. Provincial policies aimed at increasing access to mental health specialists for children and youth in military families, alongside targeted federal services and programming through military organizations, are needed.

Crisis Resolution Teams (CRT) for rapid assessment and short-term treatment of mental health problems have increasingly been implemented internationally over the last decades. Among the Nordic countries, the CRT model has been particularly influential in Norway, where ‘Ambulante akutteam (AAT)’ is a widespread psychiatric emergency service for adult patients. However, the clinical practice of these teams varies significantly. To aid further development of the service and guide future research efforts, we carried out a scoping review to provide an up-to-date overview of research available in primary studies focusing on phenomena related to CRTs in English and Scandinavian literature. A systematic literature search was conducted in the bibliometric databases MEDLINE, Embase, PsychINFO, Scopus, and SveMed+. Included studies were thematically analyzed using a qualitative method. The search identified 1516 unique references, of which 129 were included in the overview. Thematic analysis showed that the studies could be assigned to: (1) Characteristics of CRTs (k = 45), which described key principles or specific interventions; (2) Implementation of CRTs (k = 54), which were descriptive about implementation in different teams, or normative about what clinical practice should include; and (3) Effect of CRTs (k = 38). The international research literature on CRTs or equivalent teams is extensive. Many sub-themes have been studied with various research methodologies. Recent studies provide a better evidence base for how to organize services and to select therapeutic interventions, but there is still a need for more controlled studies in the field.

SUMMARY OBJECTIVES: This study aimed to identify the infrastructure (e.g., availability, resources, and staff), basic metrics, and problems (e.g., network, overcrowding, resources, and infrastructure) of the psychiatric emergency services in Brazil. METHODS: This is a cross-sectional study assessing psychiatric services (n=29) listed by the Brazilian Psychiatric Association in 2019. RESULTS: Almost all the units reported 24 h/7-day availability having psychiatrists, nurses, and social workers, with 8.8 (SE=2.2) and 2.8 (SE=0.3) consultations and hospitalizations per day, respectively. Separated room for contention was reported by the minority of the services (38%). The most commonly reported problems were insufficient structure for child/adolescent care (83%), increasing patient demand (72%), housing referral for homeless (72%), excessive prescription demand (69%), short-term room overcrowding (59%), court orders for inpatient treatment (59%), lack of vacancies for inpatients hospitalization (59%), and referral to primary care (56%). CONCLUSIONS: Similar to the United States, the Brazilian psychiatric emergency units are decreasing and encompass the shortcomings of the Brazilian mental health care network.

The pre-hospital care process of a patient presenting a psychiatric emergency involves many pre-hospital and hospital personnel. Identifying such high-risk situations, allowing an initial approach that is adjusted and authorises care are often very delicate moments. An adapted management, concerted within a network, allows the safety of the patient, his entourage and the interveners. These situations are characterised by their polymorphism with major constants: training, anticipation and knowledge of organisations.

Objective: This study examined the effects of electroconvulsive therapy (ECT) on suicidal ideation, suicide attempt, and emergency department use among homeless veterans receiving services in the Veterans Affairs (VA) health care system. Methods: National VA administrative data from 2001 to 2017 were analyzed using propensity score matching to compare 1,524 homeless veterans who received ECT and 3,025 homeless veterans discharged from psychiatric inpatient units serving as matched controls. Results: Homeless veterans who received ECT were significantly less likely to have used any ED services 30 and 90 days after their first ECT session compared to homeless veterans who did not receive ECT (OR = 0.65, 95% CI = 0.60-0.71; OR = 0.86, 95% CI = 0.81-0.93, respectively). Homeless veterans who received ECT showed reductions in suicidal ideation and suicide attempts after ECT, but these reductions were significantly less than homeless veterans who did not receive ECT 30 days, 90 days, and 1 year later (OR = 1.48-2.00). Conclusions: ECT has the potential to reduce ED use among homeless veterans with ECT-responsive psychiatric conditions. Further study is needed on whether the treatment engagement required of ECT participants indirectly reduces use of acute services in this population.