Characteristics of Individuals With Severe Mental Illness Who Use Emergency Services
Cite this article as: Young, A.S., Chinman, M.J., Cradock-O’Leary, J.A. et al. Community Ment Health J (2005) 41: 159. doi:10.1007/s10597-005-2650-0 Abstract
Emergency services are both a safety net and a locus for acute treatment. While the population with severe, persistent mental illness uses emergency services at a high rate, few studies have systematically examined the causes of this service use. This study examines a random sample of 179 people who were high utilizers of services from the Los Angeles County Department of Mental Health. Interviews were conducted and 5 years of service use data were studied. Greater use of emergency services was associated with male gender, minority race, severe illness, homelessness, and less family support. Efforts to reduce emergency services need to improve access to appropriate community services, particularly for people who are homeless or lack family support.
Keywords adult; emergency services psychiatric mental disorders schizophrenia mental health services health care utilization African Americans needs health services accessibility human United States References
American Psychiatric Association (1987).
Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, Revised. Washington, DC: American Psychiatric Association. Andersen, R. M., Davidson, P. L. 2001 Improving access to care in America: Individual and contextual indicators Andersen, R.M. Rice, T. H. Kominski, G. F. eds. Changing the US Health Care System. Jossey-Bass San Francisco CA 3 30 Google Scholar Arfken, C. L., Zeman, L. L., Yeager, L., Mischel, E., Amirsadri, A. 2002 Frequent visitors to psychiatric emergency services: Staff attitudes and temporal patterns Journal of Behavioral Health Services and Research 29 490 496 PubMed Google Scholar Catalano, R., McConnell, W., Forster, P., McFarland, B., Thornton, D. 2003 Psychiatric Emergency Services and the System of Care Psychiatric Services 54 351 355 CrossRef PubMed Google Scholar Derogatis, L. R., Melisaratos, N. 1983 The Brief Symptom Inventory: An introductory report Psychological Medicine 13 595 605 PubMed CrossRef Google Scholar Doering, S., Muller, E., Kopcke, W., Pietzcker, A., Gaebel, W., Linden, M., Muller, P., Muller-Spahn, F., Tegeler, J., Schussler, G. 1998 Predictors of relapse and rehospitalization in schizophrenia and schizoaffective disorder Schizophrenia Bulletin 24 87 98 PubMed Google Scholar Haywood, T. W., Kravitz, H. M., Grossman, L. S., Cavanaugh, J. L., DavisJ.M. Lewis, D. A. 1995 Predicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders American Journal of Psychiatry 152 856 861 PubMed Google Scholar Kapur, K., Young, A. S., Murata, D., SullivanG. Koegel, P. 1999 The economic impact of capitated care for high utilizers of public mental health services: The Los Angeles PARTNERS program experience Journal of Behavioral Health Services and Research 26 416 429 PubMed Google Scholar Kellermann, A. L., Haley, L., Jr. 2003 Hospital emergency departments: where the doctor is always “in” Medical Care 41 195 197 CrossRef PubMed Google Scholar Koegel, P., Burnam, M. A. 1988 Alcoholism among homeless adults in the inner city of Los Angeles Archives of General Psychiatry 45 1011 1018 PubMed Google Scholar Lehman, A. F. 1988 A quality of life interview for the chronically mentally ill Evaluation and Program Planning 11 51 62 CrossRef Google Scholar Oster, A., Bindman, A. B. 2003 Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations Medical Care 41 198 207 CrossRef PubMed Google Scholar Padgett, D. K., Struening, E. L., Andrews, H., Pittman, J. 1995 Predictors of emergency room use by homeless adults in New York City: the influence of predisposing, enabling and need factors Social Science Medicine 41 547 556 CrossRef PubMed Google Scholar Perlin, L., Schooler, C. 1978 The structure of coping Journal of Health and Social Behavior 19 2 21 PubMed Google Scholar
President’s New Freedom Commission on Mental Health (2003).
Achieving the Promise: Transforming Mental Health Care in America
. Final Report.
. Accessed January 21, 2004.
Robins, L. N., Helzer, J. E., Croughan, J., Ratcliff, K. S. 1981 National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity Archives of General Psychiatry 38 381 389 PubMed Google Scholar Salokangas, R. K. 1997 Living situation, social network and outcome in schizophrenia: a five-year prospective follow-up study Acta Psychiatrica Scandinavica 96 459 468 PubMed Google Scholar Shaner, A., Eckman, T. A., Roberts, L. J., Wilkins, J. N., Tucker, D. E., Tsuang, J. W., Mintz, J. 1995 Disability income, cocaine use, and repeated hospitalization among schizophrenic cocaine abusers–a government-sponsored revolving door? New England Journal of Medicine 333 777 783 CrossRef PubMed Google Scholar Strakowski, S. M., Lonczak, H. S., Sax, K. W., West, S. A., Crist, A., Mehta, R., Thienhaus, O. J. 1995 The effects of race on diagnosis and disposition from a psychiatric emergency service Journal of Clinical Psychiatry 56 101 107 PubMed Google Scholar Sue, S., Fujino, D. C., Hu, L. T., Takeuchi, D. T., Zane, N. W. 1991 Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis Journal of Consulting and Clinical Psychology 59 533 540 CrossRef PubMed Google Scholar Sullivan, G., Young, A. S., Morgenstern, H. 1997 Behaviors as risk factors for rehospitalization: Implications for predicting and preventing admissions among the seriously mentally ill Social Psychiatry and Psychiatric Epidemiology 32 185 190 CrossRef PubMed Google Scholar Sun, B. C., Burstin, H. R., Brennan, T. A. 2003 Predictors and outcomes of frequent emergency department users Academic Emergency Medicine 10 320 328 CrossRef PubMed Google Scholar
Surgeon General (US) (2001).
Mental Health: Culture, Race, and Ethnicity, A Supplement to Mental Health: A Report of the Surgeon General
. Accessed January 21, 2004.
Ware, J. E., Jr., Sherbourne, C. D. 1992 The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection Medical Care 30 473 483 PubMed Google Scholar Young, A. S., Kapur, K., Murata, D. 2001 The time course of treatment costs among patients with severe mental illness Psychiatric Services 52 21 CrossRef PubMed Google Scholar Young, A. S., Sullivan, G., Duan, N. 1999 Patient, provider, and treatment factors associated with poor-quality care for schizophrenia Mental Health Services Research 1 201 211 CrossRef PubMed Google Scholar Young, A. S., Sullivan, G., Murata, D., Sturm, R., Koegel, P. 1998 Implementing publicly funded risk contracts with community mental health organizations Psychiatric Services 49 1579 1584 PubMed Google Scholar