Le Centre de recherche Douglas

This study explored the life circumstances and clinical characteristics of very frequent users of emergency departments (EDs) presenting with a primary mental health complaint. Patients with 10 or more EDs visits in 2012 with a primary psychiatric diagnosis in a Canadian regional health authority were identified from electronic administrative files. The hospital charts for these patients were thoroughly reviewed for a three-year period, from 2011 to 2013. A retrospective thematic analysis was undertaken. Very frequent users of EDs were generally young to early middle aged, unemployed, living in transient accommodations, having substance abuse diagnoses, and self-referred to EDs for a variety of psychiatric and health symptoms and/or unmet needs. Four themes were identified: 1) substance abuse and associated health and social problems; 2) common mental disorders, which may include suicidality; 3) social and personal stressors with additional common mental disorders and somatic complaints; 4) cognitive impairment with concurrent psychiatric disorders. Traditional mental health services are ineffective in dealing with patients with complex psychiatric and social problems/needs. Efforts should focus on early detection, intervention, reducing mental and behavior problems, and developing appropriate case management and treatment options. Personalized care models are needed to meet their diverse needs.