Emergency department visits by patients with mental health disorders--North Carolina, 2008-2010

Abstract

Patients with mental health disorders (MHDs) use the emergency department (ED) for acute psychiatric emergencies, for injuries and illnesses complicated by or related to their MHD, or when psychiatric or primary-care options are inaccessible or unavailable. An estimated 5% of ambulatory-care visits in the United States during 2007-2008 were made by patients with primary mental health diagnoses. To measure the incidence of ED visits in North Carolina with MHD diagnostic codes (MHD-DCs), the Carolina Center for Health Informatics (University of North Carolina at Chapel Hill) analyzed ED visits occurring during the period 2008-2010 captured by the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). This report describes the results of that analysis, which indicated that nearly 10% of ED visits had one or more MHD-DCs assigned to the visit and the rate of MHD-DC-related ED visits increased seven times as much as the overall rate of ED visits in North Carolina during the study period. Those with an MHD-DC were admitted to the hospital from the ED more than twice as often as those without MHD-DCs. Stress, anxiety, and depression were diagnosed in 61% of MHD-DC-related ED visits. The annual rate of MHD-DC-related ED visits for those aged ≥65 years was nearly twice the rate of those aged 25-64 years; half of those aged ≥65 years with MHD-DCs were admitted to the hospital from the ED. Mental health is an important component of public health (4). Surveillance is needed to describe trends in ED use for MHDs to develop strategies to prevent hospitalization, improve access to ambulatory care, and develop new ways to provide ED care for the elderly with MHDs.