One in Eight Emergency Room Visits Related to Mental Illness or Substance Abuse
The available support services nationwide may be insufficient in managing the needs of the public’s health when it comes to mental illness and substance abuse disorders, as evidenced by the disparity between MHSA emergency room admission rates and prevalence of mental conditions. Throughout the past decade, the rate of emergency room admissions for MHSA conditions has been steadily rising. Emergency room visits in 2007 associated to MHSA were also two and half times more likely to result in hospitalization than emergency department admissions attributed to non-MHSA conditions—around 41% of all MHSA admissions.
The majority of MHSA admissions to hospital emergency departments were caused by a mental health condition alone, or 63.7% of all MHSA admissions. Most mental health conditions seen in the emergency department occurred in women (65.4%), but the majority of both substance abuse disorders and comorbid MHSA conditions occurred in men. Adults ages 18–44 accounted for the majority of all MHSA visits regardless of what type (mental health conditions alone, substance abuse conditions alone, and comorbid MHSA disorders); the majority of admissions for this age group were related to comorbid disorders (58.8% of these admissions). Older adults ages 65 years and older were much more likely to be admitted for a mental health condition alone (25.9% of these admissions) than their admissions for substance abuse conditions (9.1%) and comorbid disorders (5.2%). Overall, the majority of all MHSA admissions were female (53.9%) and younger adults (ages 18–44 years).
The most common MHSA condition seen in emergency departments were mood disorders (42.7% of all admissions), followed by anxiety disorders (26.1%), and alcohol-caused conditions (22.9%). Other common MHSA conditions that resulted in emergency department visits for adults were drug-related conditions, schizophrenia/psychoses, and intentional self harm.
The majority of emergency department visits was billed to Medicare (30.1% of admissions), followed by private insurance (25.7%), uninsured incidents (20.6%), and Medicaid (19.8%). However, those emergency visits that were uninsured were disproportionately more likely to result in the discharge of the patient than those conditions that were billed to any insurance plan. Uninsured patients admitted to emergency departments accounted for the majority of substance abuse conditions treated (35.6% of these admissions), but they were least likely to remain hospitalized after admission. This may indicate that those individuals suffering from a MHSA condition and have no insurance coverage are the least likely to get the necessary treatment they require.
The rise of emergency department admissions for MHSA conditions has caused much alarm within the healthcare community and public at large. Mental health professionals are concerned that the people who are most in need of long-term treatment are not receiving treatment. Also, large surges in MHSA cases, such as prescription drug intoxication, have become a national health epidemic and create the need of more intervention and prevention policies. Secondly, medical professionals in emergency healthcare are becoming inundated by overcrowding along with a lack of manpower to meet this demand. Without proper admission of patients to emergency care, these medical professionals are more vulnerable to commit medical errors and thin out the amount of medical resources—all of which result in a reduced quality of care for MHSA patients and all other emergency department patients.
The report, Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007, is based off data gathered on 26 million emergency department records from across the nation, and is available online in AHRQ’s database at www.ahrq.gov.