Community Mental Health Services for Frequent Emergency Department Users: A Qualitative Study of Outcomes Perceived by Program Clients and Case Managers

Jonathan Samosh; Ayda Agha; Donna Pettey; John Sylvestre; Tim Aubry

doi:10.1097/NCM.0000000000000692

Community Mental Health Services for Frequent Emergency Department Users: A Qualitative Study of Outcomes Perceived by Program Clients and Case Managers

Prof Case Manag. 2023 Dec 1. doi: 10.1097/NCM.0000000000000692. Online ahead of print.

Authors

Jonathan Samosh^{1

2

3

4

5}, Ayda Agha^{1

2

3

4

5}, Donna Pettey^{1

2

3

4

5}, John Sylvestre^{1

2

3

4

5}, Tim Aubry^{1

2

3

4

5}

Affiliations

¹ Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness.
² Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness.
³ Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services.
⁴ John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness.
⁵ Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness.

PMID: 38037223
DOI: 10.1097/NCM.0000000000000692

Abstract

Purpose of study: This study aimed to investigate the perceived outcomes and mechanisms of change of a community mental health service combining system navigation and intensive case management supports for frequent emergency department users presenting with mental illness or addiction.

Primary practice setting: The study setting was a community mental health agency receiving automated referrals directly from hospitals in a midsize Canadian city for all individuals attending an emergency department two or more times within 30 days for mental illness or addiction.

Methodology and sample: Qualitative interviews with 15 program clients. Focus groups with six program case managers. Data were analyzed using pragmatic qualitative thematic analysis.

Results: Participants generally reported perceiving that the program contributed to reduced emergency department use, reduced mental illness symptom severity, and improved quality of life. Perceived outcomes were more mixed for outcomes related to addiction. Reported mechanisms of change emphasized the importance of positive working relationships between program clients and case managers, as well as focused efforts to develop practical skills.

Implications for case management practice: Community mental health services including intensive case management for frequent emergency department users presenting with mental illness or addiction were perceived to effectively address client needs while reducing emergency department resource burden. Similar programs should emphasize the development of consistent and warm working relationships between program clients and case managers, as well as practical skills development to support client health and well-being.