The Psychiatric Emergency Service Patient

Dear Editor: For most patients, the psychiatric emergency service (PES) is the major point of entry into the mental health system (1). Several functionally and structurally dissimilar PES models are in use today (2-A); consistent epidemiologic data supporting any particular model are lacking. Presently, data obtained from one PES cannot be easily compared with data obtained from another. Differing observation periods, patient volumes, and data-acquisition strategies, as well as the lack of a standardized PES classification scheme, have likely all contributed to the inability to obtain the stable and reproducible patient profiles crucial for assessing PES efficacy.

Using a rigorous PC-based data acquisition strategy, we aimed to more definitively assess the clinical and demographic characteristics of a local PES population and the presence of clinically significant subpopulations. Over a period of 4 � years, we acquired up to 70 variables prospectively from patients visiting the PES of a large metropolitan general hospital (5). We subsequently added a preexisting 10 �-year, prospectively acquired patient log of 8 variables to the database. We compared these results with those derived from a 72-journal review of the PES literature (from 1965 to 2003).

Overall, 14 826 patients made 29 577 PES visits throughout the 15 �-year observation period. There was only a moderate degree of agreement between the present data and data obtained from the literature review. Demographic and socioeconomic variables were partially consistent with those of previous reports, whereas more complex clinical data were poorly correlated. We could not derive a single, all-inclusive typical local PES user profile from our data. Rather, we observed several different profiles, varying according to the age and sex of the patients. We also identified clinically significant subpopulations, for example, frequent users and patients with a primary diagnosis of substance abuse, and quantified their overall impact on PES functioning.

The present report benefited from the longest observation period of any published PES study. Gold standards for several variables, such as sex and age, were obtained and, by corollary, more definitive and precise local PES user profiles than were previously available. Using the same methodology, we are currently undertaking a 2-year multicentre study collecting data in 4 structurally and functionally dissimilar PES's to determine whether the above local data can be generalized, as well as the effects of different PES models on PES efficacy. Useful information will be obtained regarding the type of model possessing a greater potential for future development.

[Reference]

References

1. Oldham JM, Lin A, Breslin L. Comprehensive psychiatric emergency services. Psychiatr Q 1990;61:57-66.

2. Allen MH. Level 1 psychiatric emergency services. The tools of the crisis sector. Psychiatr CHn North Am 1999;22:713-34.

3. Wellin E, Slesinger DP, Hollister CD. Psychiatric emergency services: evolution, adaptation and proliferation. Soc Sci Med 1987;24:475-82.

4. Alien MH. Definitive treatment in the psychiatric emergency service. Psychiatr Q 1996;67:247-63.

5. Moreau J, Couture M, Chaput Y, Tremblay M, Lacroix D. L'informatique � l'urgence psychiatrique. Revue Fran�aise psychiatr psychol m�dicale 2000;35:81-3.

[Author Affiliation]

Yves Chaput, MD, FRCPC, PhD

Marie Jos�e Lebel, RN

Montreal, Quebec

Edith Labont�, MD, FRCPC

Quebec, Quebec

Lucie Beaulieu, MD, FRCPC

Saint-Jean-sur-Richelieu, Quebec