A Qualitative Assessment of Reasons for Frequent Emergency Department Utilization Among Patients With Serious Mental Illness
Objective: Characterize drivers of frequent emergency department use and barriers to mental and primary healthcare among individuals diagnosed with serious mental illness at a large, urban hospital in Northern California.
Methods: Using purposive sampling, we conducted 6 semi-structured interviews with adult patients who were identified as frequent emergency department utilizers, and had a serious mental illness diagnosis. Data was analyzed thematically using deductive and inductive techniques and themes were organized into high utilization drivers, primary and mental health care barriers.
Results: The average age of participants was 39, half were female, and half self-identified as Black. Most participants reported substance use issues. Drivers of emergency department use included a variety of unmet mental healthcare and social needs. Participants shared positive experiences related to quality of care received, which in part, contributed to their frequent emergency department utilization. The emergency department was perceived as the most convenient way to access care, while accessing primary care was problematic (ex. long waits, limited appointment availability). Barriers to mental healthcare access included lack of awareness of resources, lack of proper referrals, long waiting lists and denials from healthcare facilities. Insurance coverage was another important reason for seeking emergency department healthcare, and served as a barrier to seeking both non-emergency primary and mental health services.
Conclusions: The study highlights the complexities associated with unmet health and psychosocial needs among frequent emergency department users with serious mental illness. Given the challenges to engage this population, this study adds a crucial perspective on high emergency department utilization.
This poster was presented at the 32nd annual Psych Congress, held Oct. 3-6, 2019, in San Diego, California.
