Abstract
Psychiatric emergencies occur frequently in the community setting, e.g. the patient’s home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical records of consultations classified as psychiatric emergencies of a 24/7 service of community-based emergency physicians. Information on sociodemographic, clinical and situational factors was extracted. The observation period was 6 months in 2017. Binary logistic regression was used to examine predictors for involuntary admissions. Most emergency consultations (64.5%) took place at the patient’s home, followed by police stations (31.0%), public places (3.2%), and somatic hospitals (1.3%). Patient characteristics and reasons for consultation varied considerably between the locations. The first involved person was commonly a relative. Of all consultations, 38.4% resulted in involuntary admissions, mainly in patients with psychosis, suicidality, aggression, refusal of necessary treatment and previous involuntary admissions. Situation-related factors and the involvement of relatives were no significant predictors of the outcome. Psychiatric emergencies occur in different places and in patients with a variety of psychiatric symptoms. Although half of the emergency situations were resolved in the community, the rate of involuntary admissions was still high. For additional reduction, the further development of quickly available alternatives to psychiatric inpatient treatment is required. These should be specifically geared towards acute situations in patients with the described risk factors. Additionally, the role of relatives during psychiatric emergencies should be further studied.
Highlights
Psychiatric emergencies (PE), such as acute exacerbations of psychotic or manic illness, suicidal behavior and other acute crises often arise in the community
In addition to previous studies on PE which described mostly patients who were referred to a hospital, our study focused on a group of non-psychiatric emergency physicians who provide emergency consultations in the community, such as the patient’s home
Emergency physicians were shown to be responsible for a relevant number of psychiatric emergency consultations in the canton of Zurich (Kieber-Ospelt et al 2016) and PE account for about a fifth of their clinical consultations, which is a relevant amount and comparable to other non-psychiatric emergency care settings (Downey et al 2012; Fulbrook & Lawrence 2015; Lally et al 2015; Rotvold & Wynn 2015)
Summary
Psychiatric emergencies (PE), such as acute exacerbations of psychotic or manic illness, suicidal behavior and other acute crises often arise in the community (e.g. at home, in public, at work). These situations require a fast assessment, but a specialized mental healthcare worker (e.g. psychiatrist) is not always available. More intensive treatment is needed, and patients are immediately referred to inpatient services At best, this happens on a voluntary basis, but in some cases, if no less intrusive options are available, patients are admitted involuntarily (Marty et al 2018; Rotvold & Wynn 2015). Structural and cultural factors, as well as different legal regulations have been discussed in attempts to understand the variance in IA rates between and within countries (Fiorillo et al 2011; Lauber & Roessler 2007)
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