Abstract
Individuals without stable housing experience high rates of mental illness and seek behavioral health care in emergency care settings. Little is known about the effect of homelessness on outpatient follow-up after utilizing emergency or urgent care for behavioral health care. Patient encounters with behavioral health diagnoses among 7 emergency department (ED) or urgent care (UC) locations over 4 years were used to determine the correlation between housing status and outpatient follow-up within 90 days. Of 1,160,386 visits by 269,615 unique patients, 55,738 (23%) encounters included a behavioral health diagnosis. Patients with stable housing were twice as likely to follow up with a primary care provider (PCP) and with an outpatient behavioral health provider than patients without housing (aOR 2.60; aOR 2.00, p < 0.0001). Homelessness is associated with difficulty in accessing follow-up behavioral health care. UCs and EDs may use specific interventions to improve outpatient follow-up.
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Ayano, G., Tsegay, L., Abraha, M., & Yohannes, K. (2019). Suicidal ideation and attempt among homeless people: a systematic review and Meta-analysis. Psychiatric Quarterly, 90(4), 829–842. https://doi.org/10.1007/s11126-019-09667-8.
Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: a national study. American Journal of Public Health, 100(7), 1326–1333. https://doi.org/10.2105/AJPH.2009.180109.
Baxter, A. J., Tweed, E. J., Katikireddi, S. V., & Thomson, H. (2019). Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials. Journal of Epidemiology and Community Health, 73(5), 379–387. https://doi.org/10.1136/jech-2018-210981.
Behavioral Health Services for People Who Are Homeless. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-06-04-003.pdf
Bhui, K., Shanahan, L., & Harding, G. (2006). Homelessness and Mental Illness: A literature review and a qualitative study of perceptions of the adequacy of Care. International Journal of Social Psychiatry, 52(2), 152–165. https://doi.org/10.1177/0020764006062096.
Breslau, J., Cefalu, M., Wong, E. C., Burnam, M. A., Hunter, G. P., Florez, K. R., & Collins, R. L. (2017). Racial/ethnic differences in perception of need for mental health treatment in a US national sample. Social Psychiatry and Psychiatric Epidemiology, 52(8), 929–937. https://doi.org/10.1007/s00127-017-1400-2.
Bruckner, T. A., Singh, P., Chakravarthy, B., Snowden, L., & Yoon, J. (2019). Psychiatric Emergency Department visits after Regional Expansion of Community Health Centers. Psychiatric Services, 70(10), 901–906. https://doi.org/10.1176/appi.ps.201800553.
Butterfield, A. (2018). Telepsychiatric evaluation and Consultation in Emergency Care settings. Child and Adolescent Psychiatric Clinics of North America, 27(3), 467–478. https://doi.org/10.1016/j.chc.2018.03.001.
Chatmon, B. N. (2020). Males and Mental Health Stigma. American Journal of Men’s Health, 14(4), 155798832094932. https://doi.org/10.1177/1557988320949322.
Colorado Department of Health Care Policy and Funding. (n.d.). Health First Colorado Regional Organizations. Retrieved December 16 (2021). from https://www.healthfirstcolorado.com/health-first-colorado-regional-organizations/
Colorado Hospital Transformation Program Measure List. Colorado Healthcare Affordability and Sustainability Enterprise. https://hcpf.colorado.gov/sites/hcpf/files/2020.Nov_.16_HTP_Measure_List.pdf
Dinwiddie, G. Y., Gaskin, D. J., Chan, K. S., Norrington, J., & McCleary, R. (2013). Residential segregation, geographic proximity and type of services used: evidence for racial/ethnic disparities in mental health. Social Science & Medicine, 80, 67–75. https://doi.org/10.1016/j.socscimed.2012.11.024.
Finnegan, J. (2020, February 26). Now more than 9,000 urgent care centers in the U.S., industry report says. Fierce Healthcare. https://www.fiercehealthcare.com/practices/now-more-than-9-000-urgent-care-centers-u-s-industry-report-says
Fontanella, C. A., Warner, L. A., Steelesmith, D. L., Brock, G., Bridge, J. A., & Campo, J. (2020). Association of Timely Outpatient Mental Health Services for Youths after Psychiatric Hospitalization with risk of death by suicide. JAMA Network Open, 3(8), e2012887. https://doi.org/10.1001/jamanetworkopen.2020.12887.
Gambatese, M., Marder, D., Begier, E., Gutkovich, A., Mos, R., Griffin, A., Zimmerman, R., & Madsen, A. (2013). Programmatic impact of 5 years of mortality surveillance of New York City homeless populations. American Journal of Public Health, 103(Suppl 2), S193–S198. https://doi.org/10.2105/AJPH.2012.301196. Suppl 2.
Geissler, K. H., Cooper, M. I., & Zeber, J. E. (2021). Association of Follow-Up after an Emergency Department visit for Mental illness with utilization based outcomes. Administration and Policy in Mental Health and Mental Health Services Research, 48(4), 718–728. https://doi.org/10.1007/s10488-020-01106-2.
Henry, M., de Sousa, T., Roddey, C., Gayen, S., & Bednar, T. J. (2021). The 2020 Annual Homeless Assessment Report (AHAR) to Congress. https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf
How many emergency rooms are in America. (n.d.). Bellaire ER. Retrieved December 29, from https://bellaireer.com/how-many-emergency-rooms-are-in-america/#:~:text=As%20of%202015%2C%20there%20were,by%20the%20National%20Emergency%20Department
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey [Internet]. https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
Kromka, W., & Simpson, S. (2019). A narrative review of predictors of adult Mental Health Emergency Department Return visits and interventions to reduce repeated Use. The Journal of Emergency Medicine, 57(5), 671–682. https://doi.org/10.1016/j.jemermed.2019.08.005.
Kurdyak, P., Gandhi, S., Holder, L., Rashid, M., Saunders, N., Chiu, M., Guttmann, A., & Vigod, S. (2021). Incidence of Access to Ambulatory Mental Health Care Prior to a Psychiatric Emergency Department visit among adults in Ontario, 2010–2018. JAMA Network Open, 4(4), e215902. https://doi.org/10.1001/jamanetworkopen.2021.5902.
Kushel, M. B., Vittinghoff, E., & Haas, J. S. (2001). Factors Associated with the Health Care utilization of homeless persons. Journal Of The American Medical Association, 285(2), 200–206. https://doi.org/10.1001/jama.285.2.200.
Latalova, K., Kamaradova, D., & Prasko, J. (2014). Perspectives on perceived stigma and self-stigma in adult male patients with depression. Neuropsychiatric Disease and Treatment, 1399. https://doi.org/10.2147/NDT.S54081.
Lee, H., Iglewicz, A., Golshan, S., & Zisook, S. (2013). A tale of two veterans: homeless vs domiciled veterans presenting to a psychiatric urgent care clinic. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 25(4), 275–282.
Maura, J., & de Weisman, A. (2017). Mental Health Disparities, Treatment Engagement, and attrition among Racial/Ethnic minorities with severe Mental illness: a review. Journal of Clinical Psychology in Medical Settings, 24(3–4), 187–210. https://doi.org/10.1007/s10880-017-9510-2.
Milstein, R., & Schreyoegg, J. (2016). Pay for performance in the inpatient sector: a review of 34 P4P programs in 14 OECD countries. Health Policy (Amsterdam Netherlands), 120(10), 1125–1140. https://doi.org/10.1016/j.healthpol.2016.08.009.
Morris, D. M., & Gordon, J. A. (2006). The role of the emergency department in the care of homeless and disadvantaged populations. Emergency Medicine Clinics of North America, 24(4), 839–848. https://doi.org/10.1016/j.emc.2006.06.011.
National Guidelines for Behavioral Health Crisis Care – A Best Practice Toolkit. https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf
Okafor, M., Wrenn, G., Ede, V., Wilson, N., Custer, W., Risby, E., Claeys, M., Shelp, F. E., Atallah, H., Mattox, G., & Satcher, D. (2016). Improving quality of Emergency Care through Integration of Mental Health. Community Mental Health Journal, 52(3), 332–342. https://doi.org/10.1007/s10597-015-9978-x.
Peltier, B., Raitt, J. M., Habazi, D., Roaten, K., Pollio, D., & North, C. S. (2021). A longitudinal study of suicidality in a Homeless Population Sample. Archives of Suicide Research, 1–12. https://doi.org/10.1080/13811118.2021.1950588.
Rafal, G., Gatto, A., & DeBate, R. (2018). Mental health literacy, stigma, and help-seeking behaviors among male college students. Journal of American College Health, 66(4), 284–291. https://doi.org/10.1080/07448481.2018.1434780.
Schmidt, M. (2018). Frequent visitors at the psychiatric emergency room – A literature review. Psychiatric Quarterly, 89(1), 11–32. https://doi.org/10.1007/s11126-017-9509-8.
Stergiopoulos, V., Gozdzik, A., Misir, V., Skosireva, A., Connelly, J., Sarang, A., Whisler, A., Hwang, S. W., O’Campo, P., & McKenzie, K. (2015). Effectiveness of Housing First with Intensive Case Management in an ethnically diverse sample of homeless adults with Mental illness: a Randomized Controlled Trial. PLOS ONE, 10(7), e0130281. https://doi.org/10.1371/journal.pone.0130281.
Vandyk, A. D., Kaluzienski, M., Goldie, C., Stokes, Y., Ross-White, A., Kronick, J., Gilmour, M., MacPhee, C., & Graham, I. D. (2019). Interventions to improve emergency department use for mental health reasons: protocol for a mixed-methods systematic review. Systematic Reviews, 8(1), 84. https://doi.org/10.1186/s13643-019-1008-6.
Weinstein, L. C., LaNoue, M. D., Plumb, J. D., King, H., Stein, B., & Tsemberis, S. (2013). A primary care-public Health Partnership addressing homelessness, Serious Mental Illness, and Health Disparities. The Journal of the American Board of Family Medicine, 26(3), 279–287. https://doi.org/10.3122/jabfm.2013.03.120239.
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Appendix A. ICD-10 codes for inclusion
Appendix B. Outpatient medications
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Bonfiglio, G., Loh, R., Simpson, S.A. et al. Housing Status as a Predictor for Outpatient Care Following an Emergency or Urgent Care Encounter with a Behavioral Health Diagnosis: A Multivariable Analysis. Community Ment Health J 59, 826–833 (2023). https://doi.org/10.1007/s10597-022-01063-0
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DOI: https://doi.org/10.1007/s10597-022-01063-0