What reduces the need for frequent visits to psychiatric emergency services in a large urban centre? A convergent mixed methods study

Background: Frequent psychiatric emergency service users eventually cease their frequent use. However, less is known about the events that lead to reduced use. The current project seeks to determine what events happen in the lives of frequent users to reduce their patterns of frequent psychiatric ES use. Methods: This convergent mixed methods study had retrospective and prospective components. It was conducted at Singapore’s only tertiary mental health hospital and its emergency services. It focuses on a group of 327 frequent service users who made 5 or more visits over the index year to the hospital’s emergency service. They made 6,746 individual visits over the 7-year observation period. Administrative data from June 2010 to June 2015 was used to reconstruct historic trends, June 2015 to June 2016 was the index year, and data from June 2016 to June 2017 was used to explore the pattern of use after the index year. Qualitative interviews were done with a subset of 44 frequent service users after the index year. Three interviews were conducted over a year to determine if and why they reduced their frequent use. Results: Over the 12 months following a 12-month period of frequent use, 76% (235/309) of people no longer met the criteria for frequent use. People had positive (recovery, right siting) or negative (disengagement, poor satisfaction) reasons for reducing their use of psychiatric emergency services. Administrative data could not differentiate those who ceased their frequent use for negative reasons from those that ceased their use due to positive reasons. Qualitative differences exist between the narratives of those who ceased their frequent use compared with those who continued their patterns of service use in the subsequent year. Conclusion: The majority of frequent psychiatric emergency service users are frequent users only within the index year. Very few people have sustained frequent use for more than a year. Recovery is not the sole reason service users cease their patterns of frequent use and negative experiences with services lead to disengagement, even if there are very few sources of psychiatric care.