Acute Psychiatric Services Research Articles

Hospitalization trends among immigrants and natives in an acute psychiatric service: a descriptive study from Italy

Acute psychiatric services are crucial for immigrants who face barriers in accessing outpatient mental healthcare due to socio-economic, cultural, and linguistic challenges. This study compared psychiatric hospitalization characteristics between immigrants and native Italians at the University of Foggia from 2004 to 2019. A total of 536 inpatients, equally divided between immigrants and natives, were analysed for sociodemographic and clinical variables. Findings revealed that immigrants were hospitalized through emergency departments for severe psychiatric disorders such as psychosis, while natives were more often admitted for mood disorders. Immigrants showed a higher incidence of substance abuse and suicidal attempts and a lower number of prior hospitalizations compared to natives, with higher incidence of first episodes of mental illness. Despite presenting with severe psychopathology, natives exhibited better clinical outcomes, longer hospitalizations and higher functioning improvements. We also found that natives received more psychotropic medications but experienced fewer adverse effects compared to immigrants. Differences in pharmacological treatments and hospital outcomes suggested that culturally tailored interventions could improve the effectiveness of psychiatric care for migrants. These findings emphasized the necessity for systemic changes in mental health services to address disparities and improve care for migrant populations.

A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety.

Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context. This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr's use would be associated with improved patient agitation and distress. Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction. The most frequent modules assigned were Comfort and Skills (98% of users; n=942) and lethal means assessment (90% of patient users; n=870). Patient task completion rates for all modules ranged from 51% to 79%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8% (n=325) and 84% (n=90) of patients recommending the app to others. Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments.

Improving Women's Sexual and Reproductive Health in Acute Inpatient Psychiatric Services – A Quality Improvement Project

Improving Women's Sexual and Reproductive Health in Acute Inpatient Psychiatric Services – A Quality Improvement Project

Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access

There have been notable increases in pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement in psychiatric treatment programs. We aimed to evaluate the outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis. Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement. Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October-December 2021 and one year later (October-December 2022). Inclusion criteria were patients ≤17 years who presented with mental health-related emergencies during the study period. Exclusion criteria were patients ≥18 years and/or patients with >100 days of admission awaiting long-term placement. Primary outcome was mean length of boarding (LOB). Secondary outcome was mean length of stay (LOS) at the hospital's acute psychiatry units. One year after full intervention implementation (October-December 2022), mean LOB decreased by 53% (4.3 vs 9.1 days, P < 0.0001) for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to October-December 2021. Additionally, mean LOS at all the 24-hour acute psychiatry treatment programs was reduced by 27% (20.0 vs 14.6 days, P= 0.0002), and more patients were able to access such programs (265/54.2% vs 221/41.9%, P < 0.0001). Across both years, youth with aggressive behaviors had 193% longer LOB (2.93± 1.15, 95% CI [2.23, 3.87]) than those without aggression, and youth with previous psychiatric admissions had 88% longer LOB than those without (1.88± 1.11, 95% CI [1.54, 2.30]). The current study shows decreased LOB and improved access for youth requiring acute psychiatric treatment after comprehensive interventions and highlights challenges with placement for youth with aggressive behaviors. We recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.

Psychotherapy unchained: The Comprehend, Cope and Connect approach

The role of the Comprehend, Cope and Connect model in embedding a psychotherapeutic approach throughout a team, and making such an approach available to those with severe mental health problems, is outlined. The model is explained: its starting point in felt sense; its distributed model of the self, and its co-produced, trauma informed formulation that leads to new ways of coping with the internal state, which can be supported by a wider team. The way in which this makes a psychotherapeutic approach, with emphasis on the power of relationship, available to acute psychiatric and other services providing for those with severe mental health problems, is outlined. The inclusion of spirituality and its applicability to diverse populations is also covered, along with its, so far limited, research base.

Predictors of high intensity use of acute psychiatric inpatient services

ABSTRACT Objective High Intensity Users (HIUs) represent a small group of individuals accounting for a large proportion of inpatient resources. The paper aims to identify risk factors for becoming a High Intensity User of acute inpatient services and to understand the impact of different operationalisations of HIU. Method Participants were eligible admissions from 2016 to 2022 in an outer London NHS Trust. Retrospective case files were accessed to retrieve data. Regression models were used to identify predictors of HIU, operationalised using three binary and one continuous measure (3+ admissions in one year; 4+ in 5 years; 3+ ever; and percentage of adulthood in hospital). Results Being of Black ethnicity or younger when first admitted was associated with greater high intensity use, however defined. Risk of 3+ admissions in a year increased with age and was higher for those with personality disorders, previous admissions, those who had been placed in care during childhood, and those with historical cannabis use. Individuals whose first admission was due to a suicide attempt were at lower risk. Different operationalisations of HIU altered the factors that predicted risk. Discussion The study highlights the need for a consensus HIU definition to help progress the research and clinical efforts to support this group. Identifying and targeting support for those at greater risk for frequent readmission is needed to help reduce readmission and improve outcomes.

Integrating a virtual reality relaxation clinic within acute psychiatric services: A pilot study

People with acute psychiatric conditions experience heightened stress, which is associated with worsened symptoms and increased violence on psychiatric wards. Traditional stress management techniques can be challenging for patients. Virtual reality (VR) relaxation appears promising to reduce stress; however, research on VR for psychiatric wards is limited. This mixed-methods study investigated feasibility and acceptability of integrating a VR relaxation clinic within acute psychiatric services. The study evaluated a VR relaxation session for inpatients and outpatients with acute psychiatric conditions (N = 42) and therapists’ (N = 6) experience facilitating VR sessions for patients. Self-report assessments of psychological wellbeing were completed by patients pre- and post-VR. Patients and therapists provided qualitative feedback. The number of violent incidents and restrictive practices on the wards in the 12 weeks before VR implementation was compared to the first 12 weeks of VR. Post-VR, there were statistically significant increases in patients’ relaxation, happiness, and connectedness to nature, and decreases in stress, anxiety, and sadness. Qualitative findings indicate patients found sessions enjoyable, relaxing, and helpful. Therapists provided positive feedback but highlighted practical challenges. Violent incidents and restrictive practices halved during VR implementation. VR relaxation appears feasible and acceptable in acute services. Larger studies should evaluate potential impact on psychiatric wards.

Minor tranquillizers for short-term treatment of newly onset symptoms of anxiety and distress: a systematic review with network meta-analysis of randomized trials

Unspecific symptoms of anxiety and distress are frequently encountered in patients in both general practice and acute psychiatric services. Minor tranquillizers may be a treatment option when non-pharmacological interventions are insufficient or unavailable. We conducted a systematic review with network meta-analysis of the evidence for short-term (1–4 weeks) pharmacological treatment of newly onset symptoms of anxiety and distress. We searched the PsycInfo, MEDLINE, EMBASE and Cochrane Library databases and extracted data following a predefined hierarchy of outcomes. We assessed risk of bias using the Cochrane Risk of Bias tool and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). We included 34 randomized trials comprising a total of 7044 patients with adjustment disorders or anxiety spectrum disorders. The network meta-analysis showed that regarding the critical outcome symptoms of anxiety within 1–4 weeks benzodiazepines (SMD − 0.58, 95% CI − 0.77 to − 0.40), quetiapine (SMD − 0.51, 95% CI − 0.90 to − 0.13) and pregabalin (SMD − 0.58, 95% CI − 0.87 to − 0.28) all performed better than placebo with no statistically significant difference between the drugs. Data on other important outcomes were inconsistently reported. Adverse effects varied, but overall, it was uncertain whether adverse effects differed between interventions. The evidence regarding the risk of dependence was uncertain, but dependence may be a concern in susceptible individuals even with short-term treatment. Overall, the certainty of the evidence according to GRADE was rated as low to very low across outcomes. Despite the limitations in the evidence, the results of this review can inform treatment guidelines, supporting clinicians in the choice of minor tranquillizer in this prevalent and help-seeking, clinically heterogeneous population.

Review of Psychiatric Patient Transfer Times in an Emergency Department with Limited Psychiatric Services

Introduction:The National Ambulance Service (NAS) must transport patients with acute psychiatric needs to their nearest emergency department for assessment. Wexford General Hospital (WGH) does not have on-site medical psychiatric services after hours, in-patient psychiatric beds, or dedicated psychiatric doctors. Patients requiring formal acute psychiatric assessment and/or admission after ED review need to be transferred 60-80 km to other healthcare facilities.Aimed to assess average ED stays of psychiatric patients and determine what degree transfer time contributed to their total time would help to determine what delay there was to providing acute psychiatric care due to the lack of after hours/on-site services.Method:Data was collected from the iPMS system. A total of 125 patients presented with primary psychiatric complaints between January 1, 2021 and December 31, 2021 and required onward transfer for acute psychiatric assessment or admission. Patients were excluded if less than 18 years or had been admitted to another WGH service before transfer. There are no existing guidelines in the National Clinical Program for Psychiatry or NICE guidelines for acute psychiatric patient transfer times or ED stays.Results:The average WGH ED attendance time was 15h 27min (range 0h08min and 19h22min). The longest interval contributing to overall time was Transfer Booked to Transfer Time (average 3h 27min). The time from Psychiatric Referral to Transfer accounted for 30% (on average) of patients’ attendance time.Conclusion:There are significant delays in accessing acute psychiatric care due to the absence of Ambulance Service Bypass Protocols to transport patients to the most appropriate rather than the nearest ED. Proposed Trauma bypass system changes offer unique opportunities to review such inequity of access to acute psychiatric services.

The perils of boarding: A call to achieve parity in the delivery of acute psychiatric services for children with COVID-19.

Boarding across pediatric healthcare systems is on the rise during the pandemic. Children with positive COVID-19 test results awaiting psychiatric placements in the emergency department or medical unit settings are at increased risk for decompensation with unmet psychiatric needs during a time of crisis marked by vulnerability. There is scant literature unveiling best practices on delivery of care for these patients to achieve acute crisis stabilization. Recent studies have uncovered substantial increases in mental health disorders among children during the pandemic compared to previous incidence and prevalence rates prior to the pandemic. From the published literature, two healthcare systems have initiated long-term planning, development, and implementation of biodome psychiatric units for patients with COVID-19 in need of acute crisis stabilization services. We sampled 100 acute inpatient child and adolescent psychiatric programs to discern their post-COVID positive clearance policies for admission. Findings were mixed among days of quarantine required, symptomology, covid-designated spaces vs. self-isolated rooms for psychiatric treatment, number of COVID negative retests, and additional considerations. We also review a range of considerations and recommendations for clinical practice and the health system in achieving parity in mental health care for these patients which in turn could contribute towards mitigating the rising global mental health crisis. Furthermore, increasing access to acute psychiatric services for these patients will also contribute towards the larger goal of the World Health Organization, Sustainable Developmental Goals of the United Nations, and Healthy People 2030 in increasing accessibility, quality and equity of mental health care for individuals on both global and national frontiers.

Post-discharge suicide among high-risk psychiatric inpatients: Risk factors and warnings signs

The present study explored the predictive value of a novel suicide risk assessment with regard to suicide deaths within three years of discharge from an acute inpatient unit. The contributions of the different components of the assessment to overall determination of suicide risk were also explored. A total of 380 acute psychiatric inpatients were analysed in a 3- year prospective study. At admission, the physician on duty performed a suicide risk assessment based on national guidelines and clinical state variables. A dichotomous variable reflecting high/low suicide risk level was determined by the clinician and recorded in the chart. Information on the number and causes of deaths was obtained from the Norwegian Cause of Death Registry. Eleven (2.9%) patients died by suicide within three years after discharge, eight high-risk patients and three low risk patients (OR = 8.7, 95% CI: 2.2–33, p = 0.002). In multivariable analysis, recent suicidal ideation (SI) (OR = 3.6, 95% CI: 1.5–8.7, p = 0.004), and affective disturbance (OR = 4.3, 95% CI: 1.5–12.6, p = 0.008) were significantly associated with rating of high suicide risk. The sample size was rather small, which in conjunction with the low base rate of suicide, reduces power and limits generalizability of the findings. We found that a novel suicide risk assessment at admission to an acute psychiatric service was a powerful predictor of suicide post-discharge. The components of the risk assessment that were statistically significant with high suicide risk were affective disturbance and recent SI.

The effect of wearable technology on psychomotor agitation in patients with diagnostic patients with schizophrenia expansion and psychosis

IntroductionDue to the exacerbation of psychotic processes in acute psychiatric services, patients may exhibit risky behaviors for themselves and others. Especially, psycho-motor agitation seen in schizophrenia may result in some harmful behaviors towards him/her self or other individuals in patient. Physical restrain, or chemical restrain with psychotropic drugs can be used for ensuring the safety of the patient with a tendency toward violent behavior and to prevent harm to himself and others. These restrain methods are usually applied when they showed aggressive or violent behaviors, that is after the observed warning signs or real violent behaviors.There is no system that can evaluate and notice agitation or tendency of violence before the obvious behaviors. By using a wearable sensor system to be able to measure some biological change and to evaluate of the sensors’ ability to obtain quantitative and objective data may help the health professionals to prevent the damage in advance.ObjectivesThe aim of this pilot study was to evaluate the changes in measurements of the four wearable sensors which applied to persons with schizophrenia.MethodsTen patients who restrained in the observation room, selected for this pilot study. On the first day (13:00), which meets the criteria for inclusion in the study and the end of the insulation process (the COVID test result is negative), the first measurement was before the noon treatment. The patients’ second measurements were taken on the day they switched from parenteral to oral treatment. For measurement, the sensor circuits developed at the Physiological Analysis and Wearable Systems Research Laboratory of Koç University were connected to various parts of the body to collect the non-invasive data detailed below. In addition, including the clinical status of the patient in the experimentation process, and a positive-negative syndrome scale was also used. The data from the patient was obtained under the supervision of the clinical chief nurse for 10 minutes. Sensors were electrocardiogram (ECG) photoplethysmogram (PPG), seismocardiography (SCG), body temperature.ResultsSince some recording errors observed in two patients’ records, the data of eight patients were evaluated. Aside from one of the eight patients evaluated, the signal deviation and strength of other patients’ data increased in general. This result imply that signal deviations and strengths may be reduced during the psychomotor agitation. These deviations may suggest that this sensor system is capable to evaluate some biological changes in patients.ConclusionsConsidering the results of the pilot study, it is planned to carry out future studies with a larger sample size and longer records. With these studies, it is thought that psychomotor agitation in patients can be determined in an objective and measurable way without risk.Disclosure of InterestNone Declared

Effectiveness of Paliperidone Palmitate in Reducing Acute Psychiatric Service Use for Patients Suffering from Psychosis-A Retrospective Mirror-Image Study.

Poor adherence to antipsychotic treatment is a leading cause of relapse for patients suffering from psychotic disorders and the use of long-acting injectable antipsychotics (LAI) may lead to improved clinical outcomes. This was a 1-year mirror-image study examining the clinical outcomes after monthly administration of paliperidone palmitate (PP1M). The primary outcome measure was the total days of psychiatric hospitalization in the 1-year before and 1-year after initiation of PP1M. Data from 158 patients were included in the study. Most of the patients suffered from schizophrenia. In the year after initiation of PP1M, the mean number of hospitalization days fell from 106.53 to 19.10 (p < 0.001). There were significant reductions in the mean number of hospitalizations and emergency room visits. The use of paliperidone palmitate is associated with significant reduction in both the number of admissions and days of psychiatric hospitalization.

What Are the Sociodemographic and Clinical Characteristics and Needs of Mothers Who Access Acute Postpartum Psychiatric Care and Have Children’s Social Care Involvement?

Mothers with severe postpartum psychiatric diagnoses are more likely to have children’s social care involvement with their infants, but little is known about the needs or experiences of this group of women. With input from a lived experience advisory group, we carried out secondary analysis of data collected from 278 mother-infant dyads where the mother accessed acute psychiatric care in England or Wales postnatally. We explored the characteristics, needs, and service use experiences of mother-infant dyads with (n = 99) and without (n = 179) children’s social care involvement. We found that mothers with social care involvement were often experiencing wider adversity and inequity across multiple areas of their lives. These mothers were also less satisfied with their mental health care and had more unmet needs after discharge from acute services. We built multivariable logistic regression models to examine factors associated with children’s social care involvement during the acute admission and one year later. We found that having social care involvement during an acute postpartum admission was associated with being deprived, reporting a maternal history of childhood trauma, experiencing domestic abuse, having a diagnosis of personality disorder or schizophrenia, and having a history of previous psychiatric admissions. At one-year follow-up, factors associated with children’s social care involvement included deprivation, experiencing childhood trauma, having been single at the time of the postpartum admission, and having been readmitted to acute psychiatric services following the postpartum admission. Our findings suggest that mothers with children’s social services involvement in the context of an acute postpartum psychiatric diagnosis may have high levels of support needs, but services may struggle to meet their needs fully. We argue that an increased focus on supporting mothers with histories of trauma, adversity, and deprivation, along with greater collaboration between mental health, children’s social care, and third sector services may help improve experiences and outcomes.

Perceptions of racism in a children's psychiatric inpatient unit: A qualitative study of entrenching and uprooting factors.

We describe a systematic and orderly way to identify factors that contribute to entrenching racism as the status quo or that help to uproot it. By incorporating a racial equity lens, we can better understand daily racism and inform the optimal antiracist actions most relevant to an inpatient psychiatric setting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our two-domain/six-theme model may serve as a rubric for individuals to engage in structured self-reflection, for organizations in auditing or programmatic evaluation, or as scaffolding for difficult but frequently elided conversations. The unique strengths of a mental health environment can be harnessed toward the elimination of racism and racist practices in clinical care and in the workplace ABSTRACT: INTRODUCTION: It is well documented that racism plays a role in health care access and outcomes. However, discussions about racism in the inpatient psychiatric workplace are generally avoided. To address this gap, we incorporated a racial equity perspective into a qualitative study to better understand daily racism, its impact on patients and staff, and to inform optimal antiracist actions most relevant to inpatient psychiatric settings. We sought to identify factors that may contribute to or deter from racism to inform interventions to sustain a psychologically supportive environment for patients and staff. We conducted semistructured interviews using a purposive sample of 22 individuals in an acute child psychiatric inpatient service. We analysed transcripts using thematic analysis guided by a constructivist grounded theory conceptual framework. We identified two countervailing processes: (1) Entrenching-factors that sustain or increase racism: Predisposing, Precipitating, and Perpetuating and (2) Uprooting-factors that rectify or reduce racism: Preventing, Punctuating, and Prohibiting. We organized each of the elements into a '6P' model along a temporal sequence around sentinel racist events. For each of the six components we describe: Contributing Factors, Emotional Reactions, and Behavioural Responses as reported by participants. Identifying factors that entrench or uproot racism can inform specific steps to improve the care of all children and families on an inpatient child psychiatry unit. The two-domain/six-theme model we developed can serve as a rubric for individuals or milieu-based inpatient settings serving patients of any age to engage in structured self-reflection, auditing, program evaluation, or as scaffolding for difficult but frequently elided conversations.

Psychiatrist and trainee moral injury during the organisational long COVID of Australian acute psychiatric inpatient services.

This paper provides a commentary on the risk of moral injury amongst psychiatrists and trainees working in the acute psychiatric hospital sector, during the third winter of the COVID-19 pandemic. Moral injuries arise from observing, causing or failing to prevent adverse outcomes that transgress core ethical and moral values. Potentially, morally injurious events (PMIEs) are more prevalent and potent while demand on acute hospitals is heightened with the emergence of highly infectious SARS-CoV-2-Omicron subvariants (BA.4 and BA.5). Acute hospital inpatient services were already facing extraordinary stresses in the context of increasingly depleted infrastructure and staffing related to the pandemic. These stresses have a high potential to be morally injurious. It is essential to immediately fund additional staff and resources and address workplace health and safety, to seek to arrest a spiral of moral injury and burnout amongst psychiatrists and trainees. We discuss recommended support strategies.

Suicide Patterns in Malta: pathways for prevention

Abstract Background Suicidal behaviour is the result of several risk factors, such as acute stress, severe depression, violence, sexual abuse, etc. A mental public health approach to suicide prevention needs to look beyond the demographic characteristics of deaths by suicide and to take into account specific country determinants. Available clinical information can help identify and quantify risk, analyse patterns of behaviour, explore links between risk and behaviour and generate possible suicide prevention pathways. Methods 162 deaths by suicide for the period January 2015 - June 2021 in Malta are analysed against available clinical information. Major sources of detailed clinical information include obligatory notifications to the Commissioner for Mental Health of all cases of persons involuntarily admitted to acute psychiatric services and other medical records held within the Maltese public mental health system. Results 81% of 162 deaths by suicide for the period under study were males, two-thirds of them between 25 and 54 years. The preliminary findings have confirmed that less than 50% of these deaths had previous contact with the public health system. The two main diagnostic criteria among deaths with recent psychiatric admission/s were acute stress reaction to personal life events and very severe mood disturbances, particularly depression. There seems to be increased risk among migrants and foreign workers residing and working in Malta. The frequency of prior admissions, age-related issues, the time-event relationships, and relevance of elicited clinical findings are still being evaluated and will be presented in more detail in the workshop. Conclusions Exploring risk factors within the history of cases of suicide through available clinical information can contribute to the development of suicide prevention pathways, relevant to the specific context of local communities.

Established Outpatient Care and Follow-Up After Acute Psychiatric Service Use Among Youths and Young Adults.

This study explored follow-up after hospitalization and emergency room (ER) use for mental health among youths and young adults with private insurance. The IBM MarketScan commercial database (2013-2018) was used to identify people ages 12-27 with a mental health hospitalization (N=95,153) or ER use (N=108,576). Factors associated with outpatient mental health follow-up within 7 and 30 days of discharge were determined via logistic models with generalized estimating equations that accounted for state variation. Of those hospitalized, 42.7% received follow-up within 7 days (67.4% within 30 days). Of those with ER use, 28.6% received follow-up within 7 days (46.4% within 30 days). Type of established outpatient care predicted follow-up after hospitalization and ER use. Compared with people with no established care, the likelihood of receiving follow-up within 7 days was highest among those with mental health and primary care (hospitalization, adjusted odds ratio [AOR]=2.81, 95% confidence interval [CI]=2.68-2.94; ER use, AOR=4.06, 95% CI=3.72-4.42), followed by those with mental health care only (hospitalization, AOR=2.57, 95% CI=2.45-2.70; ER use, AOR=3.48, 95% CI=3.17-3.82) and those with primary care only (hospitalization, AOR=1.20, 95% CI=1.15-1.26; ER use, AOR=1.22, 95% CI=1.16-1.28). Similar trends were observed within 30 days of discharge. Follow-up rates after acute mental health service use among youths and young adults were suboptimal. Having established mental health care more strongly predicted receiving follow-up than did having established primary care. Improving engagement with outpatient mental health care providers may increase follow-up rates.

Associations between violence, self-harm and acute psychiatric service use: Implications for inpatient care.

For some service users, behaving violently may be a response to previous trauma and an expression of distress. It is therefore important that mental health nurses are supported by their employers to work with service users in a trauma-informed manner. Nurses employed across a range of psychiatric settings could benefit from direct interventions such as comprehensive trauma-informed care training and psychological debrief spaces, or systemic interventions to address staff shortages and improve ward conditions. INTRODUCTION: Instances of violence in acute psychiatric settings are frequent, can be devastating for service users and staff, and are costly. Such settings would benefit from a greater understanding of violence. We analysed the association between current and historical variables and rates of inpatient violence. To address gaps in current research, we included instances of self-harm and being the target of violence. We also included seldom used service metrics. Data were extracted on admissions to acute adult wards and PICUs 2017-2020 within South London and Maudsley NHS Foundation Trust. A zero-inflated negative binomial regression mixed model was used to analyse the impact of variables on rates of violence. Variables associated with an increased rate of violence were as follows: an increased number of violent incidents in the year before admission, being admitted on MHA section, being admitted to PICU, instances of self-harm, being the target of violence and referral to a Psychiatric Liaison Team. The novel associations found between enacting violence, self-harm and being the target of violence indicate trauma-informed care is crucial to reduce violent presentations of distress. System level interventions are crucial to ensure mental health nurses are supported to provide trauma-informed care.

Factors associated with re-admission in the year after acute postpartum psychiatric treatment

PurposeTo examine factors associated with being re-admitted in the year after discharge from acute postpartum psychiatric treatment.MethodsSecondary data analysis of information collected from mothers who were admitted to acute psychiatric services in the year after childbirth between 2013 and 2017. We carried out univariable analyses and multivariable hierarchical logistic regression to examine risk factors for women’s re-admission to acute psychiatric care (inpatient or community crisis care) in the year following discharge.ResultsSixty-seven (24.1%) of 278 women were re-admitted in the year after discharge from acute care; the median number of days to re-admission was 86 (IQR 35–214), and women who were re-admitted accessed a median of two further acute services (IQR 1–3). In adjusted analyses, reporting a history of childhood trauma (aOR 1.02; 95% CI 1.00- 1.03, p = 0.036), a higher level of difficulties in the mother–infant bond (aOR 1.03; 95% CI 1.01–1.06, p = 0.009) and younger age (aOR 0.95; 95% CI 0.90–1.00, p = 0.066) were associated with re-admission.ConclusionThis study confirms that the role of childhood adverse experiences on mental health is relevant for outcomes in women experiencing acute postpartum psychiatric episodes. Ongoing parent–infant bonding difficulties are also independently associated with re-admission. Perinatal mental health services therefore need to offer evidence-based interventions to address histories of trauma and to support parent–infant bonding to optimise mental health in women following discharge from acute psychiatric services. However, further research is needed to explore what other factors, not measured in our study, are also influential to re-admission.