Psychiatric Emergency Service Research Articles

Emergency care carried out during the pandemic due to substance abuse in a Spanish province.

During periods of isolation, people with substance use disorders may reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices that they have abused. The objective of this study was to evaluate the impact of the pandemic on emergency care and continuity of care for patients with substance use disorders. Study carried out in the only psychiatric emergency service in the province at the Hospital Universitario Santa María de Lérida, which cares for 431,183 people. Sociodemographic, clinical and evolutionary variables were collected from all the patients treated during a period prior to lockdown (January 13, 2020, until March 14, 2020) and during the first (March 15, 2020 until June 20, 2020) and second states of emergency (from October 25, 2020 to May 9, 2021). 908 patients attended with substance use disorder, representing 23.8% of all visits. During the first state of emergency, visits increased (p < 0,001) with a decrease in the average age (p = 0.0023). During the second state of emergency, there was an increase in the use of alcohol with respect to the rest of toxic substances (p < 0,001) and an increase in the visits of patients without prior follow-up (p = 0.005). Substance use disorder consultations increased in the first state of emergency, with patients being younger and attending for reasons related to outpatient discontinuity, while in the second state of emergency, alcohol use increased in people without prior follow-up and with small social networks. Admissions in the first state of emergency were shorter, with no subsequent link to other detoxification treatment centers and with an earlier return to the emergency room, especially in female users.

Adoption of Best Practices in Behavioral Health Crisis Care by Mental Health Treatment Facilities.

The authors aimed to examine adoption of behavioral health crisis care (BHCC) services included in the Substance Abuse and Mental Health Services Administration's (SAMHSA's) best practices guidelines. Secondary data from SAMHSA's Behavioral Health Treatment Services Locator in 2022 were used. BHCC best practices were measured on a summated scale capturing whether a mental health treatment facility (N=9,385) adopted BHCC best practices, including provision of these services to all age groups: emergency psychiatric walk-in services, crisis intervention teams, onsite stabilization, mobile or offsite crisis responses, suicide prevention, and peer support. Descriptive statistics were used to examine organizational characteristics (such as facility operation, type, geographic area, license, and payment methods) of mental health treatment facilities nationwide, and a map was created to show locations of best practices BHCC facilities. Logistic regressions were performed to identify facilities' organizational characteristics associated with adopting BHCC best practices. Only 6.0% (N=564) of mental health treatment facilities fully adopted BHCC best practices. Suicide prevention was the most common BHCC service, offered by 69.8% (N=6,554) of the facilities. A mobile or offsite crisis response service was the least common, adopted by 22.4% (N=2,101). Higher odds of adopting BHCC best practices were significantly associated with public ownership (adjusted OR [AOR]=1.95), accepting self-pay (AOR=3.18), accepting Medicare (AOR=2.68), and receiving any grant funding (AOR=2.45). Despite SAMHSA guidelines recommending comprehensive BHCC services, a fraction of facilities have fully adopted BHCC best practices. Efforts are needed to facilitate widespread uptake of BHCC best practices nationwide.

The evaluation of IMR in crisis resolution home treatment, a mixed methods study protocol

IntroductionIn the past years, recovery has become a central concept in psychiatric treatment (Sowers et al. Acad Psychiatry 2016; 40 461-467). However, in acute mental health care the concept of recovery is lacking attention (Rabenschlag et al. Psychiatry Q 2014; 85 225-239; Jaeger et al. Nord J Psychiatry 2015; 69 188-195; Luigi et al. Can. Med. Educ. J. 2010; 11 62-73). In 2021 a short version of Illness Management and Recovery (IMR) was implemented at the Psychiatric Emergency Service Amsterdam-Amstelland (SPAA). IMR is an evidence based group intervention for patients with severe mental illness, based on cognitive-behavioral, psychoeducational and motivational components. The aim of IMR is to support participants to manage their mental illness (Mueser et al. Schizophr Bull 2006; 32 32-43). To our knowledge this the first time that IMR is implemented within an acute mental health care setting Therefore the effects of IMR program on recovery in the acute phase of psychiatric illness are unknown.ObjectivesInsight in effects of IMR in acute mental health care.MethodsWe will carry out a mixed method study. In phase 1 the intervention will be carried out. 25 patients who are admitted to acute mental health care and diagnosed with a severe mental illness (SMI) will take part in the shortened version of IMR. Effects will be measured by the client version of the IMR-scale (Salyers et al. Community Ment. Health J. 2007; 43 459-480).Phase 2 includes qualitative interviews with a subsample from phase 1 (using maximum variety in diagnosis and demographic characteristics) to gain insight in the mechanisms and impact of the program.ResultsThe proposed study will investigate the effects of an adjusted evidenced-based treatment within a population of people who receive treatment in a Psychiatric Emergency Service. The original intervention is shortened in time and topics, to match the needs of people in the acute phase of psychiatric illness. The question that arises is if an existing treatment can be translated to a different group of patients.ConclusionsThe proposed project has some important limitations that we feel deserve mentioning. It is questionable if a person can profit from a recovery program during a phase of acute crisis. Also, can we expect the same effects if the new program is a shortened version of the original evidence based intervention?Disclosure of InterestNone Declared

Two-year experience of the implementation of a psychiatric home hospitalization care service for acute mental illness

IntroductionPsychiatric home hospitalisation is a service aiming to support people with mental illnesses in their acute stage at their own home. This care model has been recently implemented in our territory with the main objective of avoiding hospital admissions.ObjectivesOur goal is to describe a cohort of patients followed up over 2-years in the context of a pilot mental health program within a community-based model (Mutua Terrassa University Hospital).MethodsWe conducted a prospective longitudinal study including 125 patients attended from 01/11/2020 to 09/11/2022 in our reference area of 250,000 inhabitants. The team was formed by 1 psychiatrist and 1 mental health nurse. DSM-5 diagnoses, socio-demographic variables, mean stay and care trajectories were collected.ResultsOne-hundred twenty-five patients were attended (women: 70). Mean age at consultation: 38.3 years-old. Mean stay: 24 days. The most frequent diagnoses: non-affective psychotic disorders (58%), affective disorders (30%), followed by anxiety and personality disorders. Referrals from Community Mental Health Outpatient Services (CMHS) (72%), Acute Inpatient Unit (25%), and Psychiatric Emergency Service (3%). Referrals after discharge: CMHS (83%), Adult Acute Inpatient Unit (13%), others (4%). Individualized mental health plans were carried out in all cases, in coordination with community mental health services. Follow-up adherence after discharge was about 95%. Patients with first-episode of psychosis showed the highest degree of satisfaction (N=46).ConclusionsPatients with emerging psychosis were the profile of users who showed the highest benefit of our service. Women showed higher adherence, and loss to follow-up was lower than we expected.Disclosure of InterestNone Declared

Compulsory admission: are there differences between migrants and natives? Data from a psychiatric emergency service of an Italian metropolitan area

BackgroundAs compared to natives, higher rates of involuntary admission were found among migrants in most European countries. A possible strategy to reduce this phenomenon is to develop preventive strategies targeting risk and protective factors of compulsory admission specific to the migrant population. AimsThe first aim of the present study was to evaluate compulsory admission rates in the migrant population as compared to natives admitted for an acute mental disorder. The second aim was investigate whether sociodemographic, clinical, and care-related variables associated with compulsory admission differed between migrants and natives. Moreover, in the whole sample we assessed whether migrant status affected the risk of compulsory admission. MethodsRetrospective single-center study on patients hospitalized in the period between January 1, 2018 and December 31, 2020 in a large metropolitan academic hospital. We compared sociodemographic, clinical, and care-related variables between migrants and natives, voluntary or compulsory admitted. We investigated the association between compulsory admission and the variables collected in the whole sample and in the migrants' and natives’ groups with a correlation analysis followed by hierarchical logistic regression models. ResultsThe sample included 185 migrant patients and 933 native patients. The prevalence of compulsory admission was significantly higher in the migrants' group. Male gender, lower education, non-comprehension of the local language, a diagnosis of a schizophrenia spectrum disorder, and aggressive behavior were associated with compulsory admission in the migrants’ sample, partially differing from the natives. ConclusionOur study highlighted how migrant status is associated with a higher risk for compulsory admission. Inclusion policies or the presence of cultural mediators in emergency settings might be preventive strategies in this context.

Analysis of the factors that influence caregiver burden in adolescents with dual diagnosis

IntroductionSerious mental illness in adolescence that not only has a significant impact on the patient but also on other contexts such as their family. Caregivers assume almost all of the care. This responsibility exposes caregivers to intense overload with negative consequences.ObjectivesTo evaluate and quantify the overload of the primary caregiver in children and adolescents with severe mental disorders.MethodsA prospective study was designed using structured interviews in caregivers of patients between 11 and 18 years of age with severe mental disorders and substance use who were evaluated in the psychiatric emergency service for 2 months. The Zarit Caregiver Burden Scale was used for quantitative assessment. Diagnosis, main caregiver, socio-health resources were recorded.ResultsOf a total of 35 patients with serious mental illness between 11 and 16 years of age, the following was observed: intense caregiver burden in 42.2% of cases, moderate in 21%. Being the main caregiver the mother. 27.5% had adequate use of socio-health resources, while 42.7% had not requested them. The greatest need detected was economic and rehabilitation.ConclusionsSerious mental disorder present since adolescence leads families to significant destabilization of the family nucleus and comorbidity of psychiatric disorders in caregivers. Good orientation and evaluation of individual cases are necessary to guide families about the resources available in the social and health network, thus avoiding a high overload of caregivers and improving the quality of life of families.Disclosure of InterestNone Declared

Effectiveness of a targeted brief intervention for recent suicide attempt survivors: a randomised controlled trial protocol

IntroductionEffective, brief, low-cost interventions for suicide attempt survivors are essential to saving lives and achieving the goals of the National Strategy for Suicide Prevention and Zero Suicide. This study aims...

Prevalence and factors associated with non-suicidal self-Injury and suicidality in children and adolescent attending Emergency department in Oman

IntroductionNon-suicidal self-Injury (NSSI) and suicidality are common reasons for emergency presentations in child and adolescent psychiatry (1). NSSI is defined as intentional destruction of one’s body tissue without suicidal intent and has a prevalence rate in adolescents of approximately 30–40% in clinical samples (2). Suicide prevalence is around 24–33% (3).There are many factors leading to suicidal or self-harming behavior. A prior history of self-injurious behavior is one of the strongest predictors of future suicidal behavior, both cross-sectionally and longitudinally (6) . Additionally, longitudinal studies have found that a previous suicide attempt increases the risk of a future suicide attempt threefold.Suicide and NSSI have a significant impact on families and communities. Hence, considerable required clinical attention is warranted to develop preventive strategies.ObjectivesThe aim of this study is to investigate the prevalence of non-suicidal self-Injury (NSSI) and suicidality among children and adolescents presenting in emergency department of the tertiary psychiatric services and to study their demographic and clinical characteristics.MethodsThis is a retrospective cross-sectional analytical study included all children and adolescent patients attended the emergency department at Sultan Qaboos University Hospital between June 2021 to March 2016. The data was collected using the hospital´s electronic database to retrieve the medical records of children and adolescents who visited the emergency department. Patients who were 18 years of the age or younger were included in the study. The included patients must had been evaluated by psychiatrist during their presentations in the emergency department.ResultsDuring the 63 months of observation, 114 patients attended the emergency department and required psychiatric evaluation, 44.7%(n=51) of patients presented with NSSI and/or SA. The mean age was 15.7. 80.4%(n=41) were females while 19.6%(n=10) were males. 37.3% had a primary diagnosis of major depressive disorder (MDD) and 21.5% had comorbid medical illness. 44% of suicidal attempts were with drug overdose, mostly paracetamol overdose, while the most used method for NSSI was cutting the body with a razor, 57%.19 patients had a primary diagnosis of major depressive disorder, 17 patients had no clear diagnosis at presentation.22% of the patients had other medical comorbidities, 5 patients with epilepsy. 51% of the patients had positive family history of mental illness.ConclusionsConsidering that NSSI and suicidality were found to be the main reasons for presenting to a child and adolescent emergency psychiatric service, it seems crucial for physicians at PEDs to provide proper crisis intervention and referral to mental health services when appropriate. Early identification of risk factors is highly recommended.Disclosure of InterestNone Declared

Psychiatric emergencies among urban youth during COVID-19: Volume and acuity in a multi-channel program for the publicly insured

This study sought to characterize changes in the utilization of psychiatric emergency services among children and adolescents during distinct phases of 2020, as compared with prior years. We conducted a retrospective review of electronic health records from January 2018 through December 2020 that included all encounters made by patients under age 21. We then analyzed data for the 15,045 youth psychiatric encounters during the study period. Encounter volume in 2020 was significantly lower than prior years in March through May (IRR, 0.44; 95% CI, 0.40–0.49), May through July (IRR, 0.63; 95% CI, 0.56–0.71), and October through December (IRR, 0.76; 95% CI, 0.70–0.83). Encounters for youth with primary psychotic disorders remained at typical levels throughout 2020. Among older adolescents and youth with anxiety disorders, pervasive developmental disorders, and substance use disorders, encounter volume was significantly lower than prior years only during the initial lockdown period. There were significantly more encounters than normal conducted by mobile crisis units, including via telehealth, in July through October (IRR, 1.31; 95% CI, 1.06–1.62) and October through December (IRR, 1.28; 95% CI, 1.05–1.55) of 2020. Differences in patterns of encounter volume based on sociodemographic and clinical characteristics highlight subgroups of youth who may have been particularly vulnerable to acute mental health problems during periods of social distancing and isolation. Proactive efforts to engage vulnerable youth in outpatient treatment during periods of increased infectivity may help prevent increasing symptoms from reaching the point of crisis.

The rapid stabilization pathway: impact of a brief inpatient intervention on the length of stay and readmissions among psychiatrically hospitalized adolescents.

Suicide is the second leading cause of death among adolescents in the United States (Centers for Disease Control and Prevention [CDC], 2017, Death rates due to suicide and homicide among persons age 10-24: United States, 2000-2017) constituting a significant public health crisis. The demand for psychiatric emergency services and inpatient beds is increasing, while the number of beds available decreases or remains static (National Association of State Mental Health Program Directors, 2017, Trend in psychiatric inpatient capacity, United States and Each State, 1970-2014. www.nasmhpd.org/sites/default/files/TACPaper.2.Psychiatric-Inpatient-Capacity_508C.pdf) leading to delays in treatment and exacerbation of symptoms for some adolescents awaiting care. This pilot project describes the development, feasibility, and acceptability of a creative, values-based safety planning intervention for adolescents hospitalized on an acute inpatient psychiatric unit and the impact of this intervention on length of stay and readmissions to acute psychiatric care. Thirty patients experiencing a suicidal crisis participated in the Rapid Stabilization Pathway (RSP) during their inpatient psychiatric admission. Results indicate that, compared to patients who underwent inpatient treatment as usual (TAU), RSP patients were discharged after a significantly shorter length of stay (4 vs. 6.1 weekdays respectively, p< .001). Further, there was no significant difference in readmission to the inpatient unit or to the psychiatric emergency room among RSP and TAU patients at 30, 60, and 90 days postdischarge. These findings have significant implications for acute inpatient programming. The RSP intervention treated patients in a shorter amount of time without any increase in re-admissions. Further, the shortened length of stay allowed for more patients to be treated on the inpatient unit and a significant cost savings. Future directions for programming and outcome research are discussed.

Locked down or locked out? Trends in psychiatric emergency services utilization during the COVID-19 pandemic.

To estimate changes in Boston Emergency Services Team (BEST) psychiatric emergency services (PES) encounter volume (total and by care team) and inpatient disposition during the first 8months of the COVID-19 pandemic. Data on 30,657 PES encounters was extracted from the four-county, BEST reporting system. The study period consisted of the first 34weeks of 2019 and 2020. This period corresponded to the first five stages of Massachusetts's COVID-19 public health restrictions: pre-lockdown, lockdown, Phase I, II and III reopenings. Descriptive and regression analyses were performed to estimate changes in encounter volume by care team and disposition. Compared to the same period in 2019, covariate-adjusted, weekly PES encounters decreased by 39% (β = -0.40, 95% Confidence Interval (CI) = [-0.51, -0.28], p < 0.00) during the lockdown. PES volume remained significantly lower during Phase I reopening compared to the previous year but returned to 2019 levels during Phase II. The covariate-adjusted proportion of weekly encounters that led to inpatient admission significantly increased by 16% (CI = [0.11, 0.21], p < 0.00) for mobile crisis teams (MCTs) and significantly declined by 13% (CI = [-0.19, -0.07], p < 0.00) for BEST-designated emergency departments during the lockdown period compared to the prior year. The overall drop in PES utilization and the rise in inpatient admissions for MCT encounters suggests that during the early phases of the pandemic, patients delayed psychiatric care until they had a psychiatric crisis. Public health messaging about the lockdowns and absent equivalent messaging about the availability of telehealth services may have made patients more reluctant to seek psychiatric care.

(51) Brief Educational and Process Change Quality Improvement Intervention Increases HIV, Hepatitis C, and Syphilis Screening in Psychiatric Inpatients Admitted from a Psychiatric Emergency Service

(51) Brief Educational and Process Change Quality Improvement Intervention Increases HIV, Hepatitis C, and Syphilis Screening in Psychiatric Inpatients Admitted from a Psychiatric Emergency Service

The Effect of Pharmacy-Led Medication Reconciliation on Odds of Psychiatric Relapse at a Community Hospital

Purpose: Individuals with psychiatric disorders are at increased risk for treatment non-adherence and related complications, especially during transitions of care. Medication reconciliation is now a standard process during hospital admissions that is uniformly recommended by international organizations to aid in safe and effective care transitions. Pharmacy-led medication reconciliation (PMR) practices are poised to represent a standardized method of reconciliation attempt within this underserved population with complex medication histories. Methods: A retrospective cross-sectional study using medical chart review was conducted for all adults admitted to the inpatient psychiatric service at a community hospital in Buffalo, NY, during 2 months in 2018. Outcomes were 30- and 180-day psychiatric readmission rates, 30- and 180-day visit rates to the outpatient comprehensive psychiatric emergency program (CPEP), and composite 30- and 180-day relapse. Receipt of pharmacy-led medication reconciliation was identified from pharmacy documentation in the electronic medical record. Results: 78% of patient’s medication lists on admission were reconciled, with 49% of reconciliations made by the inpatient pharmacy. Presence of a PMR did not alter the odds of inpatient readmission alone, however patients without a PMR were found to have 2.13 times higher odds of visiting the hospital’s outpatient CPEP within 30-days (P = .012) and 1.9 times higher odds of any composite psychiatric relapse within 30-days (P = .024). Conclusions: Implementation of hospital-wide pharmacy-led medication reconciliation on admission may help reduce psychiatric relapse across multiple care settings.

Factors Associated With Police Bringing Children to a Psychiatric Emergency Room.

Sensational headlines describing police entanglements with young children have prompted questions about how often these incidents occur and why. The authors of this cross-sectional study examined the factors associated with police versus nonpolice arrivals to the psychiatric emergency room and those predicting subsequent police arrivals. Electronic medical records of children ages 5.0-12.9 years brought to a comprehensive psychiatric emergency program (CPEP) at a university hospital were reviewed to determine whether a child was brought by police ("police arrival") in response to a 911 call by school personnel, a mental health or other medical professional, or a caregiver. Extracted data included the child's age, sex, race-ethnicity, family makeup, insurance status, arrival status, referral source, diagnosis, disposition, treatment, number of CPEP and police encounters, and occurrences of aggression and suicidality. Multilevel and ordinary logistic regression models were used to identify factors associated with a first and subsequent police arrival. Of 339 children with CPEP encounters from September 2017 to April 2018, 103 (30%) had had at least one police arrival. Children brought by police were more likely than peers brought by caregivers to be Black or Latinx, have Medicaid, come from families without two parents, and have aggressive outbursts or suicidal behavior. Results from multilevel logistic regression indicated that aggressive outbursts and suicidality were most significantly and consistently associated with experiencing both a first and subsequent police arrival. Clinical and sociodemographic differences in police arrivals highlight the need for a comprehensive systems approach for children, especially marginalized youths, who need psychiatric emergency care.

Provision of Mental Health Services in the Veterans Health Administration: A Nationwide Comparison With Other Providers.

Public interest in developing a national health care system has grown in the United States, but so have concerns that a large system would provide poor care. The Veterans Health Administration (VHA) is the largest national U.S. health care system, and several of its performance measures have been compared with those of non-VHA organizations. However, few studies have compared VHA's overall provision of mental health care services, and this study aimed to fill this gap. Using 2018 National Mental Health Services Survey data, the authors examined the differences in provision of 45 treatment modalities, specialized services, and dedicated programs between self-identified VHA facilities (N=459), non-VHA facilities that serve only adults (N=3,671), and non-VHA facilities that serve all ages (N=6,378). Self-identified VHA facilities offered more services (including more treatment modalities, specialized services, and dedicated programs) (mean±SD=24.2±8.9 services) than both non-VHA adult-only facilities (15.4±6.8; Cohen's d=1.11, p<0.001) and non-VHA all-ages facilities (17.1±6.6; Cohen's d=0.90, p<0.001). Notably, VHA facilities were more likely to offer electroconvulsive therapy and telemedicine. VHA facilities were more likely to offer integrated primary care, chronic illness management, supportive housing, vocational rehabilitation, and psychiatric emergency services, among others. Last, VHA facilities were more likely to offer dedicated treatment programs for patients identifying as lesbian, gay, bisexual, or transgender, as well as for patients with posttraumatic stress disorder, traumatic brain injury, or dementia. VHA facilities offer no fewer and possibly more comprehensive mental health services per facility than do non-VHA facilities, possibly because VHA represents an integrated and centralized health system.

Multifamily therapy in the community mental health network: A pragmatic randomized and controlled study.

Multifamily therapy (MFT) is a psychotherapeutic group intervention for patients with severe mental disorders (SMDs) and their families. The present study is a multicenter, randomized, and controlled trial that analyzes the benefit of MFT during outpatient treatment. The recruited patients were randomly assigned to the experimental group (n = 26), which received 24 MFT sessions in addition to their treatment as usual (TAU), or to the control group (n = 29), which received only TAU (individual and family sessions). Six months after the inclusion in the MFT, the experimental group showed a significant decrease in number of visits to the psychiatric emergency services, number of psychiatric admissions, and the days of admission. The need for hospital care 6 months after recruitment was also lower in the experimental group compared to the control group. These results suggest that the implementation of MFT during outpatient treatment facilitates community management of people diagnosed with mental health problems.

Treatment Motivation and Burden of Stress among Parents of Adolescents with Non-Suicidal Self-Injury Presenting to a Child and Adolescent Psychiatric Emergency Service

Introduction: The successful treatment of adolescents almost always requires parents’ involvement in the treatment process. Thus, parental involvement will impact further treatment, especially concerning the acute management of self-harming behavior of their children. Parental burden or low parental motivation for treatment can significantly affect the success of the intervention. Therefore, this study aimed at investigating how especially motivational factors of the adolescents and parents, as well as stressors of the parents, affect the course of non-suicidal self-injury (NSSI) after an acute psychiatric emergency presentation. Methods: Ninety-six adolescents aged 11–18 years who have been presented to an emergency service at a child and adolescent psychiatry clinic for suicidal and/or NSSI behavior were recruited together with their accompanying parents within the framework of a specified diagnostic procedure. This included detailed questionnaire and interview procedures for psychiatric assessment. The extent of parental stress and parents’ motivation for treatment and its relations to adolescents’ NSSI and own treatment motivation have been investigated in a follow-up examination in the aftermath of the acute presentation. We predicted adolescents’ NSSI at follow-up based on their own motivation and parental motivation and stress. Results: Data analysis demonstrated that higher adolescents’ treatment motivation was associated with higher parental stress. Also, higher parental treatment motivation was correlated with a higher degree of parental distress. Furthermore, parents showed lower treatment motivation when their children engaged in NSSI for a longer duration. Finally, lower adolescents’ motivation and lower parental stress due to own parental concerns were predictive for higher adolescents’ NSSI frequency at follow-up investigation. Discussion/Conclusion: Patients as well as their parents who present for an emergency service are especially likely to be exposed to increased stress and strain factors. During treatment, additional focus should be placed on parental stress and parental and adolescents’ treatment motivation. Identifying and addressing deficits in motivation, increases in parental stress, as well as offering support could favorably impact future NSSI behavior.

1.100 Effects of the COVID-19 Pandemic on Substance Use in New York Inner City Child and Adolescent Comprehensive Psychiatric Emergency Program (CPEP) Patients

Recent studies report a possible increase in youth substance use rates during the pandemic, although results are conflicting. We examined rates of substance use in youth seen at a New York inner city Comprehensive Psychiatric Emergency Program (CPEP) before and during the COVID-19 pandemic, hypothesizing an increase in use.

2.109 Impact of COVID-19 on Suicidal Ideation and Behavior in Youth Presenting to a New York City Comprehensive Psychiatric Emergency Program

Investigators have demonstrated fewer youth presenting to the psychiatric emergency room during the COVID-19 pandemic. Some studies have found no significant elevation of suicide rates compared to 2019, whereas others found increased rates, especially among females and youth who identify as Black or from other minoritized groups. We examined rates of suicidal ideation and behavior in youth presenting to the Comprehensive Psychiatric Emergency Program (CPEP), comparing rates from before COVID-19 (pre–COVID-19) to during the first year of the COVID-19 pandemic (COVID-19).

Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team.

Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005–2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.