Research Article: Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis

Date Published: April 27, 2016

Publisher: Public Library of Science

Author(s): Helen Barratt, Antonio Rojas-García, Katherine Clarke, Anna Moore, Craig Whittington, Sarah Stockton, James Thomas, Stephen Pilling, Rosalind Raine, Takeru Abe.


The characteristics of Emergency Department (ED) attendances due to mental or behavioural health disorders need to be described to enable appropriate development of services. We aimed to describe the epidemiology of mental health-related ED attendances within health care systems free at the point of access, including clinical reason for presentation, previous service use, and patient sociodemographic characteristics.

Systematic review and meta-analysis of observational studies describing ED attendances by patients with common mental health conditions.

18 studies from seven countries met eligibility criteria. Patients attending due to mental or behavioural health disorders accounted for 4% of ED attendances; a third were due to self-harm or suicidal ideation. 58.1% of attendees had a history of psychiatric illness and up to 58% were admitted. The majority of studies were single site and of low quality so results must be interpreted cautiously.

Prevalence studies of mental health-related ED attendances are required to enable the development of services to meet specific needs.

Partial Text

In recent years, a number of initiatives have been developed to improve outcomes and experience for patients who attend hospital Emergency Departments (EDs) due to mental or behavioural health disorders. This is partly because of concerns about the quality of care for this patient group,[1] but also the need to ensure parity of response to mental and physical health emergencies.[2] In England, for example, the National Health Service (NHS) Mandate for 2014/15 stated that services for patients in mental health crisis should be as accessible, responsive and high quality as emergency services for other patients.[3] Yet a recent report by the Care Quality Commission demonstrated that there are clear variations in the help, care and support available to people in crisis and many patients still have a poor experience of care because services fail to meet their needs.[1] The first step towards improving health services requires high quality information about clinical need to ensure that services are designed to meet patients’ needs. However, recent commissioning guidance in the UK[4],[5] was based on a sample of Medicare patients in the United States who attended hospitals in 1999.[6] This study also looked only at the prevalence of depressive symptoms. To ensure generalisability, we needed to consider whether the use of these data was valid, given the differences between the US health care system and systems such as the NHS, where care is free to all at the point of use, independent of ability to pay. In order to inform service change and the development of new models of care, we undertook a systematic review and meta-analysis of the epidemiology of mental health-related Emergency Department (ED) attendances by adults within publically supported health care systems such as the English NHS and similar. We aimed to quantify the proportion of ED attendances that are due to mental or behavioural disorders and to identify patient clinical and sociodemographic characteristics associated with this type of attendance.

This analysis formed part of a series of linked reviews examining the epidemiology of mental or behavioural health disorders in EDs. Here, we present a systematic review of observational studies describing the overall population of patients attending hospital Emergency Departments because of a mental or behavioral health issue. Studies describing the epidemiology of specific mental health conditions will be examined elsewhere.

We identified 18 studies, which together suggest that 4% of ED attendances are made by patients attending because of a mental or behavioural health disorder. A third of these attendances are specifically due to self-harm or suicidal ideation. However, the majority of studies were single site and of low quality so data must be interpreted cautiously. Our estimate is similar to the Medicare figure quoted in current policy (5%).[6] Over half of patients had a past history of psychiatric illness in one study,[33] suggesting that they were ‘known’ to mental health services. In another, a third of patients were in current contact with services.[22] We estimate that half of attendances are made by females, and based on two studies the mean age of patients was 32–33.[22,33] Our findings suggest that a quarter were admitted to a mental health ward, but 6–8% left the ED without waiting to be seen.[21,22] A further third were discharged home from the ED, but it is unclear whether some in this category also received outpatient follow up.