Abstract
Intoxicated persons showing challenging behavior (IPCBs) under influence of alcohol and/or drugs frequently have trouble finding appropriate acute care. Often IPCBs are stigmatized being unwilling or unable to accept help. Separated physical and mental healthcare systems hamper integrated acute care for IPCBs. This pilot aimed to substantiate the physical, psychiatric, and social health needs of IPCBs visiting the emergency room (ER) during a 3-month period. All ER visits were screened. After triage by the ER physician, indicated IPCBs were additionally assessed by the consultation–liaison–psychiatry physician. If needed, IPCBs were admitted to a complexity intervention unit for further examinations to provide integrated treatments and appropriate follow-up care. The INTERMED and Health of the Nation Outcome Scale (HoNOS) questionnaires were used to substantiate the complexity and needs. Field-relevant stakeholders were interviewed about this approach for acute integrated care. Alongside substance abuse, almost half of identified IPCBs suffered from comorbid psychiatric disturbances and one third showed substantial physical conditions requiring immediate medical intervention. Almost all IPCBs (96%) accepted the acute medical care voluntarily. IPCBs showed high mean initial scores of INTERMED (27.8 ± 10.0) and HoNOS (20.8 ± 6.9). At discharge from the complexity intervention unit, the mean HoNOS score decreased significantly (13.4 ± 8.6; P < 0.001). Field-relevant stakeholders strongly supported the interdisciplinary approach and ER-facility for IPCBs and acknowledged their unmet health needs. A biopsychosocial assessment at the ER, followed by a short admission if necessary, is effective in IPCBs. This approach helps to merge separated healthcare systems and may reduce stigmatization of IPCBs needing help.
Highlights
Worldwide, intoxicated persons showing challenging behavior (IPCBs) under the influence of alcohol and/or drugs frequently experience trouble finding the most appropriate acute care [1, 2]
A total of 142 IPCBs were included during the study period
25 (18%) IPCBs were consecutively admitted to the complexity intervention unit
Summary
Worldwide, intoxicated persons showing challenging behavior (IPCBs) under the influence of alcohol and/or drugs frequently experience trouble finding the most appropriate acute care [1, 2]. Like in the Netherlands, the healthcare system is separated into organizations for physical (e.g., general hospitals) and mental health (e.g., mental healthcare facilities). This hampers the interdisciplinary emergency healthcare that these patients usually require. A negative attitude towards psychiatric patients in the ER is a well-known problem [10, 11], and may hamper appropriate acute care
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