Emergency psychiatric service (EPS) is one of the five essential services defined in the 1963 Community Mental Health Centers Act. Since that time, utilization of EPS has soared, constraining system resources and hampering effective care. To address this problem, we conducted a case-control study of frequent utilizers in a large EPS (10,000+ admissions per year) serving as the primary screening center for an urban disadvantaged population. The cases (n=74, 6+visits in 12 months) did not differ from the controls (n=74, <6 visits in 12 months) on age, education, prior military service, current symptoms or diagnosis. They were more likely to be male, minority, higher functioning (as measured by the GAF), homeless, hospitalized in past year, and have ingested alcohol (but not drugs) the two days prior to admission. They were also more likely to report they came to the EPS for the following reasons: convenient location, no appointment needed, need shelter and need medication. They were, however, less likely to name a person who knows them well, derive income from a partner, or arrive by police/ambulance. In multivariate analysis, independent risk factors for frequent utilization of EPS were being homeless, hospitalized in past year, needing medication and not naming a person who knows them well. These results suggest that people who frequently utilize the EPS, and thereby incur EPS charges averaging $11,000+/year, have basic social needs defying short-term crisis interventions.
Learning Objectives: At the conclusion of the session, the participant will be able to list risk factors for frequent emergency psychiatric service utilization in an urban setting and discuss potential interventions to reduce the burden to healthcare systems and consumers.
Keywords: Homeless, Mental Health Services
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.