142nd APHA Annual Meeting and Exposition

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306741
Characteristics and Outcomes among Adult Psychiatric Emergency Services Patients in a Large Urban Safety Net Health System

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 2:50 PM - 3:10 PM

Toktam Sadralodabai, PhD , Office of Planning and Data Analytics, Los Angeles County Department of Health Services, Los Angeles, CA
Kristen Ochoa, MD, MPH , Olive View Medical Center, Sylmar, CA
Vichuda Matthews, DrPH , Office of Planning and Data Analytics, Los Angeles County Dept. of Health Services (LACDHS), Los Angeles, CA
Irene Dyer, MPH, MS , Office of Planning and Data Analytics, Los Angeles County Department of Health Services, Los Angeles, CA
Anish Mahajan, MD, MPH , Los Angeles County Dept. of Health Services, Los Angeles, CA
Audio (mp3) recording Recorded Presentation (mp4)
Background: To better understand the characteristics and outcomes among persons with mental illness seen by Psychiatric Emergency Services (PES) staff at three Los Angeles County (LAC) hospitals, we identified adult patients (n=25,427) who were admitted through an involuntary 72-hour psychiatric hold status (due to risk of harming themselves or others) during 2008-2010. The first PES encounter during this period was defined as their “Index” encounter and data from 12 months post-index encounter was analyzed. Sources included administrative data from LAC public and private hospitals, LAC Sheriff’s Department, and California mortality records.

Population Characteristics:  60% of PES patients were male and 67% fell between the ages of 18-44; 63% were brought in by law enforcement, 66% were uninsured, and 9% were homeless.  After PES evaluation, 52% of patients were hospitalized (public or private), 41% were discharged to home/family, and 7% were discharged to other venues (shelter, jail, etc.).

Post-Index Encounter Outcomes: 5,564 (22%) of patients made 9,501 PES visits; 4,726 had 10,881 psychiatric inpatient admissions within this period. Furthermore, within a 30-day period, 1,027 (4%) patients had made 1,823 subsequent PES ED visits and 1,330 (5%) patients had 3,853 subsequent psychiatric inpatient admissions. Additionally, in the year following their index visits, 1,558 patients (6%) had arrest records, and 573 (2%) died within one year, including 84 (0.3%) due to either homicide or suicide.

Conclusion:  This pattern of high utilization and poor outcomes emphasizes the need for follow-up mental health care after discharge for PES patients arriving on involuntary holds.

Learning Areas:

Social and behavioral sciences

Learning Objectives:
Discuss the importance of studying patients with mental illnesses who are in danger of harming themselves or others

Keyword(s): Emergency Medical Services, Mental Health Treatment &Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a Ph.D. in Experimental Psychology and oversee the Analytical Services in the Office of Planning and Data Analytics for Department of Health Services (DHS)in Los Angeles County. In that capacity, I am responsible for understanding the pattern of utilization and outcomes for persons with mental illnesses who receive psychiatric emergency services through an involuntary hold at our 3 hospitals.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4349.0: Emergency Departments and Mental Health: Utilization, Outcomes and Service Design