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Mental health in hospital emergency departments: cross-sectional analysis of attendances in England 2013/2014
  1. Simona Baracaia1,
  2. David McNulty2,
  3. Simon Baldwin2,
  4. Jemma Mytton2,
  5. Felicity Evison2,
  6. Rosalind Raine1,
  7. Domenico Giacco3,4,
  8. Andrew Hutchings5,
  9. Helen Barratt1
  1. 1 Department of Applied Health Research, University College London, London, UK
  2. 2 University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
  3. 3 Unit for Social and Community Psychiatry, Queen Mary University of London, London, London, UK
  4. 4 Department of Health Sciences, University of Warwick Faculty of Science, Coventry, Coventry, UK
  5. 5 London School of Hygiene and Tropical Medicine, London, London, UK
  1. Correspondence to Dr Helen Barratt, Department of Applied Health Research, University College London, London WC1E 6BT, UK; h.barratt{at}ucl.ac.uk

Abstract

Objective To describe the population of patients who attend emergency departments (ED) in England for mental health reasons.

Methods Cross-sectional observational study of 6 262 602 ED attendances at NHS (National Health Service) hospitals in England between 1 April 2013 and 31 March 2014. We assessed the proportion of attendances due to psychiatric conditions. We compared patient sociodemographic and attendance characteristics for mental health and non-mental health attendances using logistic regression.

Results 4.2% of ED attendances were attributable to mental health conditions (median 3.2%, IQR 2.6% to 4.1%). Those attending for mental health reasons were typically younger (76.3% were aged less than 50 years), of White British ethnicity (73.2% White British), and resident in more deprived areas (59.9% from the two most deprived Index of Multiple Deprivation quintiles (4 and 5)). Mental health attendances were more likely to occur ‘out of hours’ (68.0%) and at the weekend (31.3%). Almost two-thirds were brought in by ambulance. A third required admission, but around a half were discharged home.

Conclusions This is the first national study of mental health attendances at EDs in England. We provide information for those planning and providing care, to ensure that clinical resources meet the needs of this patient group, who comprise 4.2% of attendances. In particular, we highlight the need to strengthen the availability of hospital and community care ‘out of hours.’

  • emergency care systems
  • emergency departments
  • emergency department
  • mental health
  • psychiatry
  • research
  • epidemiology
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Footnotes

  • Handling editor Simon Carley

  • Contributors SBar, DMN, AH and HB contributed to study conception, data analysis and data interpretation. SBal, JM and FE contributed to data analysis and data interpretation. RR and DG contributed to study conception and data interpretation. SBar and HB drafted the manuscript, which was critically revised for important intellectual content by DMN, SBal, JM, FE, DG, RR, and AH. All co-authors read and approved the final draft.

  • Funding This research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust (NIHR CLAHRC North Thames). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Not required because data obtained from secondary sources (Hospital Episode Statistics).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement In line with the data sharing agreement between NHS Digital and University Hospitals Birmingham NHS Foundation Trust, aggregate small number suppressed outputs for the study period (1 April 2013 and 31 March 2014) are available on request from the corresponding author, Dr Helen Barratt (h.barratt@ucl.ac.uk).

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