To characterise frequent use of psychiatric emergency outpatients services, this paper reports results from a prospective investigation of use of psychiatric services by new patients in two Nordic psychiatric services, Frederiksberg in Denmark and Oulu in Finland. One year treated incidence cohorts were used. Total number of patients included was 1,055. The repeat user was defined as a patient having at least three emergency outpatient contacts during a 1-year follow-up. The repeat users constituted 15.8% of the sample and 70.8% of all the emergency contacts in Frederiksberg. In Oulu the respective figures were 9.3% and 33.8%. The number of planned outpatient contacts or the number of hospital admissions of the repeat users did not differ from the non-repeaters. Repeaters in Frederiksberg were more likely to be self-referrals, male, divorced or unmarried, living with their parents, without their own housing, unemployed, aged between 25 and 44 years, and to have a diagnosis of dependency or personality disorder. In Oulu they did not differ from the other patients with regard to sociodemographic or diagnostic characteristics.

The emergency admissions to hospital care in six psychiatric services in four Nordic countries were explored as a part of a Nordic comparative study on sectorised psychiatry. One year treated incidence cohorts were used, with the total cohort comprising 2,454 patients. Of the 803 patients who were admitted to inpatient care during a 1-year follow-up, 82% had at least one emergency admission and 23% repeated emergency admissions. The definition for the repeated emergency admissions was at least two admissions during the follow-up. The mean length of stay in emergency inpatient care per treatment episode for this patient subgroup was 28 days. Their emergency inpatient episodes constituted 30% of all inpatient days during the follow-up. However, the variations between the services and diagnostic subgroups were large. The results of a logistic regression analysis indicated that the following variables predicted repeated emergency admissions: inpatient care at index contact, emergency outpatient contacts or no planned hospital admissions during the follow-up, psychiatric service, age under 45 years, and a diagnosis of psychosis, personality disorder or dependency. The repeated emergency admissions were related to the existence of a special service unit for abusers but not to the rates of outpatient staff or acute beds in the services, to geographical distances, referral practice or existence of emergency services.

While information for the medical aspects of disaster surge is increasingly available, there is little guidance for health care facilities on how to manage the psychological aspects of large-scale disasters that might involve a surge of psychological casualties. In addition, no models are available to guide the development of training curricula to address these needs. This article describes 2 conceptual frameworks to guide hospitals and clinics in managing such consequences. One framework was developed to understand the antecedents of psychological effects or “psychological triggers” (restricted movement, limited resources, limited information, trauma exposure, and perceived personal or family risk) that cause the emotional, behavioral, and cognitive reactions following large-scale disasters. Another framework, adapted from the Donabedian quality of care model, was developed to guide appropriate disaster response by health care facilities in addressing the consequences of reactions to psychological triggers. This framework specifies structural components (internal organizational structure and chain of command, resources and infrastructure, and knowledge and skills) that should be in place before an event to minimize consequences. The framework also specifies process components (coordination with external organizations, risk assessment and monitoring, psychological support, and communication and information sharing) to support evidence-informed interventions.

(Disaster Med Public Health Preparedness. 2011;5:73-80)

Objectives: To describe existing Scottish psychiatric emergency services, particularly the staffing levels and supervision of junior staff, to assess the level of recording of the urgency of referrals to such services and to determine the approximate rates of emergency presentations. Method: A postal questionnaire was sent to all 29 Scottish psychiatric hospitals, addressed to the physician superintendent or the consultant in charge of emergency services. Twenty-six were returned and further details on these and the other three services were clarified by telephone contact with medical records and medical staff. Description of services, number of presentations, staffing levels and degree of supervision were recorded. Rates of referral were estimated for Health Board populations. Results: Services varied from hospital based walk-in clinics through to community orientated domicillary assessment services. Emergency presentations are usually seen by junior staff in a psychiatric hospital outpatient department, a psychiatric ward or at an accident and emergency department. Out of hours supervision is typically by telephone advice from a consultant. Rates of emergency presentations based on collected and estimated figures were highest in urban areas. Conclusions: Scottish psychiatric emergency services are disparate in nature but all provide a 24 hour service. There is a lack of reliably collected data on the urgency of referrals but estimates suggest that there is a greater need for emergency psychiatric care in the large urban areas. Working definitions are proposed to assist in the classification of the urgency of referrals.