Many Emergency Department Visits for Mental Health and Addiction-Related Issues May Be Prevented With More Outpatient Psychiatric Services

The study researchers examined what proportion of individuals seeking care at an emergency department for mental health or addiction-related reasons have had no access to outpatient services in the preceding 2 years.

Nearly half of all incident psychiatric emergency department (ED) visits in a province in Canada were first-contact visits, indicating a needed for better outpatient access to psychiatric care. These findings, from a retrospective cohort study, were published in JAMA Network Open.

Health care administrative data from Ontario, Canada collected between 2010 and 2018 was analyzed for this study. All ED visits for first time mental health and addiction-related issue from a patient aged ³16 years were assessed for clinical and demographic features.

A total of 659,084 individuals had an incident ED visit. These patients were 51.6% women aged mean 39.1 (standard deviation [SD], 18.5) years. Nearly half (45.4%; n=298,924) were first-contact visits. Fewer first-time visits resulted in hospital admission (11.7% vs 18.8%).

Patients seeking care at the ED for a first-contact visit were younger (median 33 vs 37 years), more male (53.7% vs 43.9%), had no primary care physician (11.4% vs 1.3%), and lived in a rural area (17.4% vs 11.7%) compared with patients who had previous mental health contacts.

First-contact visits differed on the basis of diagnosis, in which patients were more likely to have a substance-related disorder and less likely to have a mood disorder.

The first-contact visits were more likely among patients who were men (adjusted odds ratio [aOR], 1.10 (95% CI, 1.09-1.10), older (³85 years: aOR, 1.40; 95% CI, 1.37-1.42; 65-84 years: aOR, 1.13; 95% CI, 1.12-1.14), an immigrant (aOR, 1.25; 95% CI, 1.19-1.31), had no primary care provider (aOR, 1.68; 95% CI, 1.67-1.69), lived in a rural area (aOR, 1.21; 95% CI, 1.67-1.69), and were seeking treatment for a substance-related disorder (aOR, 1.66; 95% CI, 1.65-1.68), anxiety and adjustment disorder (aOR 1.51; 95% CI, 1.49-1.52), or schizophrenia or non-organic psychotic disorders (aOR, 1.13; 95% CI, 1.12-1.15).

This study may have been limited by not having access to data about contacts with privately insured physicians or mental health professionals.

These data indicated nearly half of all ED visits were first-contact consultations which may have been prevented with easier access to outpatient psychiatric care.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Kurdyak P, Gandhi S, Holder L, et al. Incidence of access to ambulatory mental health care prior to a psychiatric emergency department visit among adults in Ontario, 2010-2018. JAMA Netw Open. Published online April 14, 2021. doi:10.1001/jamanetworkopen.2021.5902