Characteristics of Psychiatric Patient's Use of One Emergency Department and Crisis Services and Comparison of Models of Care for Patients with Borderline Personality Disorder in the Frequency of Use of Emergency Services

Background: The cost of urgent mental health care services is high, both to the system as well as the individual and strategies that prevent these visits are paramount. Frequent users of the emergency department (ED) are a small percentage of ED patients but account for a large percent of visits. In particular, studies show that those patients with borderline personality disorder commonly present to urgent care. Given the rising number of ED visits and the corresponding cost to the health care system, it is important to explore strategies for avoidable or preventable visits to the ED, coupled with directing resources that ensure access to appropriate quality care. Methods: This research was a prospective chart review of the population of frequent users diagnosed with psychiatric illness in the (ED) and crisis (CRI) services at one hospital. Detailed analysis revealed characteristics of the patients who presented to the ED and CRI with a mental health diagnosis. Additional analysis of the subgroup of these patients with borderline personality disorder and/or self-harming behaviour was completed to determine the impact of the model of psychiatric care on subsequent crisis or ED visits in the year after the index visit. Results: The majority of patients presenting for mental health issues did so once. The mean number of subsequent presentations to the ED was 5.00 demonstrating that a small number of patients presented many times. Male patients were trending toward significance for number of ED and CRI visits. Patients with borderline personality disorder and/or self-harming behaviours in a model of care that offered increased access to services were less likely to visit the ED and CRI. Conclusions: Unstable or complex patients with psychiatric issues often present at the ED and CRI. Accessibility to community care services has the potential to reduce the number of ED and CRI visits and is a critical factor when considering this less stable group.