Emergency department utilization for substance use disorders and mental health conditions during COVID-19

Background As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. Methods We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. Findings While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. Conclusions We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.

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Emergency department utilization for mental health conditions before and after the COVID-19 outbreak

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.03.084 ◽

2021 ◽

Vol 47 ◽

pp. 164-168

Author(s):

Stephanie Stroever ◽

Chelsea Brett ◽

Katherine Michael ◽

Joann Petrini

Keyword(s):

Mental Health ◽

Emergency Department ◽

Health Conditions ◽

Emergency Department Utilization ◽

Mental Health Conditions ◽

Before And After

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The Role of Suffering in Relation to Suicide in Persons Experiencing Co-occurring Substance Use Disorders and Mental Health Conditions: A Brief Perspective

Alcoholism Treatment Quarterly ◽

10.1080/07347324.2021.1891846 ◽

2021 ◽

pp. 1-7

Author(s):

Nicole D. Hune ◽

Thomas G. Kimball

Keyword(s):

Mental Health ◽

Substance Use ◽

Substance Use Disorders ◽

Health Conditions ◽

Mental Health Conditions

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Effects of High-Deductible Health Plans on Enrollees With Mental Health Conditions With and Without Substance Use Disorders

Psychiatric Services ◽

10.1176/appi.ps.202000914 ◽

2021 ◽

Author(s):

Cameron J. Schilling ◽

Matthew D. Eisenberg ◽

Alene Kennedy-Hendricks ◽

Alisa B. Busch ◽

Haiden A. Huskamp ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Substance Use Disorders ◽

Health Conditions ◽

Health Plans ◽

Mental Health Conditions

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Lifetime Doctor-Diagnosed Mental Health Conditions and Current Substance Use Among Gay and Bisexual Men Living in Vancouver, Canada

Substance Use & Misuse ◽

10.1080/10826084.2016.1264965 ◽

2017 ◽

Vol 52 (6) ◽

pp. 785-797 ◽

Cited By ~ 10

Author(s):

Nathan J. Lachowsky ◽

Joshun J. S. Dulai ◽

Zishan Cui ◽

Paul Sereda ◽

Ashleigh Rich ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Gay And Bisexual Men ◽

Health Conditions ◽

Bisexual Men ◽

Mental Health Conditions ◽

And Bisexual

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LO84: Experiences of youth and family presenting to the emergency department for addiction and mental health

CJEM ◽

10.1017/cem.2018.146 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S36-S37

Author(s):

H. Hair ◽

M. Bercov ◽

S. Hastings

Keyword(s):

Mental Health ◽

Emergency Department ◽

Substance Use ◽

Family Involvement ◽

Online Survey ◽

Wait Times ◽

Youth Survey ◽

The Family ◽

Social Media Platforms ◽

Ed Visits

Introduction: The Canadian Institute for Health Information reports the rate of child and youth emergency department (ED) visits for mental health complaints increased by 50% between 2007 and 2015. Improving care for these patients is a major priority of Alberta Health Services (AHS). As part of a multi-phased approach to improving care, the Emergency and the Addiction and Mental Health Strategic Clinical Networks (SCNs) surveyed youth who had presented to an ED for mental health or substance use concerns and their families/caregivers. Methods: The online survey contained closed- and open-ended questions on reasons for ED visits, expectations about and experiences during their visits, and areas for improvement. An ethics approved survey was conducted for 4 weeks. Participants were recruited across the province using an extensive array of social media platforms. For each survey, we randomly selected a sample of open-ended responses to thematically analyze to the point of informational redundancy. Results: The Youth survey received 992 responses and the Family survey received 553. A small number of overarching themes emerged. For both surveys, the major themes were 1) Wait times and access: participants were disappointed with lengthy wait times and services in the community. Youth said this made them question their decision to seek help and left them feeling hopeless. 2) Care provider training: participants were unhappy with the quality of care provided (e.g., lack of compassion, minimizing symptoms). They felt better training would improve care and attitudes towards mental health patients. 3) Environment: participants were uncomfortable with the lack of privacy for discussing sensitive topics; youth also requested items such as pens/paper and phone chargers to make the stay more comfortable and provide distractions. An additional theme emerged in the Youth survey regarding family involvement; participants wanted to decide how much/what information is shared with their families. Youth noted they were less likely to be honest with family present. Communication and navigation were mentioned frequently in the Family survey; participants noted the complexity of the mental health care system and felt frustrated by the lack of information to help them access additional resources. Conclusion: There are a number of areas in need of improvement to provide high-quality, patient-centred care to youth with mental health or substance use concerns that present to the Emergency Department. Phase II of this project will involve a review of the themes and determine priorities and strategies to address the themes that could be implemented into the workflow.

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Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization

Western Journal of Emergency Medicine ◽

10.5811/westjem.2018.9.38954 ◽

2018 ◽

Vol 19 (6) ◽

pp. 902-906 ◽

Cited By ~ 12

Author(s):

Aimee Moulin ◽

Ethan Evans ◽

Guido Xing ◽

Joy Melnikow

Keyword(s):

Mental Health ◽

Mental Illness ◽

Substance Use ◽

Health Planning ◽

Private Insurance ◽

Mental Healthcare ◽

Emergency Department Utilization ◽

Public Healthcare ◽

Frequent Users ◽

Ed Visits

Introduction: Frequent users of emergency departments (ED) account for 21–28% of all ED visits nationwide. The objective of our study was to identify characteristics unique to patients with psychiatric illness who are frequent ED users for mental health care. Understanding unique features of this population could lead to better care and lower healthcare costs. Methods: This retrospective analysis of adult ED visits for mental healthcare from all acute care hospitals in California from 2009–2014 used patient-level data from California’s Office of Statewide Health Planning and Development. We calculated patient demographic and visit characteristics for patients with a primary diagnosis of a mental health disorder as a percentage of total adult ED visits. Frequent ED users were defined as patients with more than four visits in a 12-month period. We calculated adjusted rate ratios (aRR) to assess the association between classification as an ED frequent user and patient age, sex, payer, homelessness, and substance use disorder. Results: In the study period, 846,867 ED visits for mental healthcare occurred including 238,892 (28.2%) visits by frequent users. Patients with a primary mental health diagnosis and a co-occurring substance use diagnosis in the prior 12 months (77% vs. 37%, aRR [4.02], 95% confidence interval [CI] [3.92-4.12]), homelessness (2.9% vs 1.1%, odds ratio [1.35], 95% [CI] [1.27-1.43]) were more likely to be frequent users. Those covered by Medicare (aRR [3.37], 95% CI [3.20-3.55]) or the state’s Medicaid program Medi-Cal (aRR [3.10], 95% CI [2.94-3.25]) were also more likely to be frequent users compared with those with private insurance coverage. Conclusion: Patients with substance use disorders, homelessness and public healthcare coverage are more likely to be frequent users of EDs for mental illness. Substance use and housing needs are important factors to address in this population.

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