Skip to main content

Advertisement

SpringerLink
Log in

The suburban-city divide: an evaluation of emergency department mental health presentations across two centres

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Objective

To evaluate the characteristics of mental health presentations to the emergency department in two different hospital settings.

Methods

This was a retrospective cross-sectional study examining ED referrals to psychiatry in an inner-city and suburban centre. The authors collected data on gender, age, employment, housing, clinical presentation, time of assessment and admissions, over a 1-month period.

Results

The total number referred was 213: inner-city n = 109 and suburban n = 104. The inner-city saw a younger population; 47/109 (43%) were aged between 20 and 29 years, compared with 28/104 (27%) of suburban presenters (P value 0.0134). A higher number of presenters were aged over 60 in the suburban centre n = 13/104 (12.5%) versus the inner-city centre 3/109 (2.8%) (P value 0.0084). In the inner-city, the proportion of homeless presenters was significantly higher at 30/109 (28%) versus 5/104 (4.8%) in the suburban setting (P < 0.0001). Presentations related to substances were highest, a total of 73 (34.3%) across both centres, with no significant difference in clinical presentations across the two centres. The majority were seen in the on-call period, 74/109 (67.9%) in the inner-city centre and 66/104 (63.5%) in the suburban centre. The psychiatric admission rate was significantly different between the two centres, with 33/109 (30.3%) patients admitted in the inner-city centre and 13/104 (12.5%) patients admitted in the suburban centre (P value 0.002).

Conclusions

A large proportion of ED referrals to psychiatry constitute patients with unmet social and addiction needs, who are seen out of hours. This prompts consideration of expanding both ED and community services to comprise a more multidisciplinary-resourced, 24/7 care model.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Data will be made available to interested individuals upon formal request made to authors.

References

  1. Wand A, Wood R, Macfarlane M, Hunt G (2016) Comparison of consultation–liaison psychiatry services for inner-city, district or regional general hospitals using a common tool: does one size fit all? J Psychosom Res 84:13–21

    Article  Google Scholar 

  2. Udoh G, Afif M, MacHale S (2012) The additional impact of liaison psychiatry on the future funding of general hospital services. Ir Med J 105(10):331–332

    CAS  PubMed  Google Scholar 

  3. Lynch B, Browne J, Buckley C et al (2019) An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015. BMJ Open 9(9):e029261

    Article  Google Scholar 

  4. Thomas S, Foley C, Kane B et al (2019) Variation in resource allocation in urgent and emergency Care Systems in Ireland. BMC Health Serv Res 19(1):657

    Article  Google Scholar 

  5. Plunkett P, Byrne D, Breslin T et al (2011) Increasing wait times predict increasing mortality for emergency medical admissions. Eur J Emerg Med 18(4):192–196

    Article  Google Scholar 

  6. Byrne M, Murphy A, Plunkett P et al (2003) Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med 41(3):309–318

    Article  Google Scholar 

  7. Ní Cheallaigh C, Cullivan S, Sears J et al (2017) Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study. BMJ Open 7(11):e016420

    Article  Google Scholar 

  8. Huyse F, Herzog T, Lobo A et al (2001) Consultation-liaison psychiatric service delivery: results from a European study. Gen Hosp Psychiatry 23(3):124–132

    Article  CAS  Google Scholar 

  9. Care Quality Commission (2015) Right Here, Right Now: People’s Experiences Of Help, Care And Support During A Mental Heath Crisis. Care Quality Commission, London

  10. (2020) Mental Health Reform. [Internet]. Mentalhealthreform.ie. [cited 10 December 2020]. Available from: https://www.mentalhealthreform.ie/wp-content/uploads/2019/07/Full-MHR-pre-budget-submission-2020_-FINAL.pdf

  11. Baracaia S, McNulty D, Baldwin S et al (2020) Mental health in hospital emergency departments: cross-sectional analysis of attendances in England 2013/2014. Emerg Med J:emermed-2019-209105. https://doi.org/10.1136/emermed-2019-209105

  12. Lyne J, O'Donoghue B, Bonnar M et al (2010) Reasons for referral and consultation liaison psychiatry diagnoses. Ir J Psychol Med 27(3):123–129

    Article  Google Scholar 

  13. Okorie E, McDonald C, Dineen B (2011) Patients repeatedly attending accident and emergency departments seeking psychiatric care. Psychiatrist 35(2):60–62

    Article  Google Scholar 

  14. Vandyk A, Harrison M, VanDenKerkhof E et al (2013) Frequent emergency department use by individuals seeking mental healthcare: a systematic search and review. Arch Psychiatr Nurs 27(4):171–178

    Article  Google Scholar 

  15. Barratt H, Rojas-García A, Clarke K et al (2016) Epidemiology of mental health attendances at emergency departments: systematic review and meta-analysis. PLoS ONE 11(4):1p.e0154449.A

    Article  Google Scholar 

  16. Haase T (2020) The 2016 Pobal HP Deprivation Index (SA) | Trutz Haase [Internet]. Trutzhaase.eu. [cited 10 December 2020]. Available from: http://trutzhaase.eu/deprivation-index/the-2016-pobal-hp-deprivation-index-for-small-areas/

  17. Health Service Executive (2020) Dublin South City Community Mental Health Services - HSE.ie [Internet]. HSE.ie. [cited 10 December 2020]. Available from: https://www.hse.ie/eng/services/list/4/mental-health-services/dsc/south/

  18. Health Service Executive (2020) Mental Health And Suicide Support Dublin North - HSE.Ie. Www2.hse.ie.

  19. Mental Health Commission (2020) Access to acute mental health beds in Ireland [Internet]. Mhcirl.ie. [cited 10 December 2020]. Available from: https://www.mhcirl.ie/File/Acutebeds_report_Feb2020.pdf

  20. Mcloughlin A, Feeney A, Cooney J (2020) Homelessness, emergency care and mental health. Inner-city emergency department psychiatry referrals: a retrospective descriptive analysis. Ir J Med Sci. https://doi.org/10.1007/s11845-020-02392-3

  21. Ivers J, Zgaga L, O’Donoghue-Hynes B et al (2019) Five-year standardised mortality ratios in a cohort of homeless people in Dublin. BMJ Open 9(1):e023010

    Article  Google Scholar 

  22. Fazel S, Geddes J, Kushel M (2014) The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet 384(9953):1529–1540

    Article  Google Scholar 

  23. Central Statistics Office (2020) Monthly Unemployment March 2019 - CSO - Central Statistics Office [Internet]. Cso.ie. [cited 10 December 2020]. Available from: https://www.cso.ie/en/releasesandpublications/er/mue/monthlyunemploymentmarch2019/

  24. Cassar S, Hodgkiss A, Ramirez A, Williams D (2002) Mental health presentations to an inner-city accident and emergency department. Psychiatr Bull 26(4):134–136

    Article  Google Scholar 

  25. Bidargaddi N, Bastiampillai T, Schrader G et al (2015) Changes in monthly unemployment rates may predict changes in the number of psychiatric presentations to emergency services in South Australia. BMC Emerg Med 15(1)

  26. Blakely T (2003) Unemployment and suicide. Evidence for a causal association? J Epidemiol Community Health 57(8):594–600

    Article  CAS  Google Scholar 

  27. (2016) Health Service Executive, National Clinical Programme For The Assessment And Management Of Patients Presenting To Emergency Departments Following Self-Harm. HSE Clinical Strategy and Programmes Division

  28. (2012) Health Service Executive, The National Emergency Medicine Programme: a strategy to improve safety, quality, access and value in emergency medicine in Ireland. Dublin: Royal College of Surgeons in Ireland

  29. Thomas K, Owino H, Ansari S et al (2018) Patient-centered values and experiences with emergency department and mental health crisis care. Adm Policy Ment Health Ment Health Serv Res 45(4):611–622

    Article  Google Scholar 

  30. Parsonage M, Fossey M, Tutty C (2012) Liaison psychiatry in the modern NHS. Centre for Mental Health, London

    Google Scholar 

  31. Hatfield B, Spurrell M, Perry A (2000) Emergency referrals to an acute psychiatric service: demographic, social and clinical characteristics and comparisons with those receiving continuing services. J Ment Health 9(3):305–317

    Article  Google Scholar 

  32. Kalucy R, Thomas L, King D (2005) Changing demand for mental health services in the emergency department of a public hospital. Aust N Z J Psychiatry 39(1–2):74–80

    Article  Google Scholar 

  33. Ryder S, Aithal G, Holmes M et al (2010) Effectiveness of a nurse-led alcohol liaison service in a secondary care medical unit. Clin Med 10(5):435–440

    Article  CAS  Google Scholar 

  34. Hickey L, Hawton K, Fagg J, Weitzel H (2001) Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment. J Psychosom Res 50(2):87–93

    Article  CAS  Google Scholar 

  35. Morphet J, Griffiths D, Plummer V et al (2014) At the crossroads of violence and aggression in the emergency department: perspectives of Australian emergency nurses. Aust Health Rev 38(2):194–201

    Article  Google Scholar 

  36. (2016) NHS England, the National Collaborating Centre for Mental Health and the National Institute for Health and Care Excellence. Achieving Better Access To 24/7 Urgent And Emergency Mental Health Care – Part 2: Implementing The Evidence-Based Treatment Pathway For Urgent And Emergency Liaison Mental Health Services For Adults And Older Adults – Guidance. NHS England, the National Collaborating Centre for Mental Health and the National Institute for Health and Care Excellence

  37. Chepenik L, Pinker E (2017) The impact of increasing staff resources on patient flow in a psychiatric emergency service. Psychiatr Serv 68(5):470–475

    Article  Google Scholar 

  38. Gibbons P, Lee A, Parkes J, Meaney E (2012) Value for money: a comparison of cost and quality in two models of adult mental health service provision. Dublin, Health Service Executive

    Google Scholar 

  39. (2006) Department of Health and Children "A Vision For Change": Report Of The Expert Group On Mental Health Policy

  40. Cullen, K., McDaid, D., Wynne, R. et al. A wide-angle international review of evidence and developments in mental health policy and practice. Evidence review to inform the parameters for a refresh of A Vision for Change (AVFC) 2017. Retrieved from http://health.gov.ie/

Download references

Author information

Authors and Affiliations

  1. Beaumont Hospital, Dublin 9, Ireland

    Caoimhe McLoughlin, Sudha Jain & Siobhan MacHale

  2. St James’ Hospital, Dublin 8, Ireland

    Aoibheann McLoughlin & John Cooney

  3. Limerick University Hospital Group, Limerick, Ireland

    Ahad Abdalla

Authors
  1. Caoimhe McLoughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aoibheann McLoughlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sudha Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahad Abdalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Cooney
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Siobhan MacHale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caoimhe McLoughlin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical disclosure statement

This was a service evaluation study. No contact was made with patients for the duration of the study. No identifiable patient data was used. Data was obtained via an electronic hospital system and anonymised to ensure patient confidentiality. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation with the Helsinki Declaration of 1975, as revised in 2008. The authors assert that this study was approved as a quality improvement initiative by the Joint Research and Ethics Committee of St. James’s Hospital and Tallaght University Hospital and a service evaluation project by the Clinical Governance, Audit and Service Evaluation Committee in Beaumont Hospital.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McLoughlin, C., McLoughlin, A., Jain, S. et al. The suburban-city divide: an evaluation of emergency department mental health presentations across two centres. Ir J Med Sci 190, 1523–1528 (2021). https://doi.org/10.1007/s11845-020-02496-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-020-02496-w

Keywords

Search

Navigation