Assessing Emergency Room (ER) Utilization for Acute Mental Health Care (MHC) Needs. Background and Outcome of Risk Evaluation, 10 Years after Mental Health Law 26657

Abstract

Introduction: An increased need for acute Mental Health care (MHC) in the Emergency Room (ER) is a world problem, taking place also at the General Hospitals Fernandez (GHF) of the City of Buenos Aires, Argentina, which has a public, universal and free national health system, and since 2008, a Mental Health Law (l. 26657). Methods: Descriptive analysis of the demand for acute MHC at the ER of GHF, between March 1 and May 31, 2018.Retrospective single center review of medical records of MHC. Results: 503 (n) ER medical records, the average age was 36 years, 272 women (54.07%) and 226 men (46.91%); 202 (40.15%) brought in by ambulance and 102 (20.27%) presented with police escort ; 403 (80.12%) were from Argentina and 35 (6.96%) from other countries; 418 (83.11%) depended of public health system; 173 (34.39%) anxiety disorder symptoms; 104 (20.67%) had substance disorder; 32 (18.49%) had anxiety disorder and substance disorder; 24 (4.77%) patients presented with depressive symptoms; 95 (18.88%) severe psychotic symptoms; 49 (9.14%) self-harm or suicidal attempt; 32 (3.36%) violent behavior, aggressive or agitated patients; 87 (16.89%) patients posing a risk for themselves or others, 51 of them, resulted in involuntary psychiatric hospitalization and 21 go to ambulatory treatment; 132 (26.24%) with medical complaints; 100 (19.88%) with vulnerable family support ; 48 (9.54%) homeless; in 48 (9.55%) of the patients, length of stay in the ER was longer than 24 hours; 45 (8.95%) abandoned treatment and 110 (21.86%) were not attended. Conclusion: The increased demand for acute MHC weighs down in our ER. Limited resources for the transfer to inpatient psychiatric units tend to prolong length of stay, recidivism and suboptimal care. Our results highlight the urgent need to develop inpatient psychiatric units, improve access to Mental Health Services with better MHC protocols and community services for MHC in order to reduce er overcrowding and to provide a higher standard for MHC, as was the prime purpose of our Mental Health Law 26657.