Understanding Psychological Distress and Therapeutic Environment in the Emergency Department

Not yet recruiting

• Conditions: Mental Health; Substance Use (Drugs, Alcohol); Psychological Distress

• Registration Number: NCT06655467
• Lead Sponsor: NHS Fife

Brief Summary

This research aims to establish the number of patients coming to Emergency Departments (EDs) with issues relating to mental health, alcohol or drugs, or in some form of psychological distress, including those for whom this was not the main reason for attending ED. We will collect anonymous information on age, gender, ethnicity, when and how they came to the ED, where and how they are cared for whilst in the ED, and what happens to them afterwards. With this information we hope to build a better picture of these patients so we can go on to design and test ways to improve their care in the future.

Detailed Description

Those presenting to the Emergency Department with mental ill health, substance misuse or in crisis have a worse patient journey than those presenting with physical issues alone. They wait twice as long to be seen1 and have poorer experiences. Recognising this, the RCEM/James Lind Alliance Priority Setting Partnership has placed mental health at the top of the Emergency Medicine research agenda. The question asked is: "How can care for mental health patients be optimised, whether presenting with either/both physical and mental health needs; including appropriate space to see patients, staff training, early recognition of symptoms, prioritisation, and patient experience?" An explicit research agenda has yet to emerge from this very broad question. At the most basic level, the patient population needs to be defined, the scale of the problem quantified, and current practice patterns and variation described in detail.

It has been estimated that the proportion of ED attendances related to "mental health disorders" is 4%. However these estimates are derived from retrospective data and are dependent on accurate diagnosis coding. There is a lack of data on dual diagnoses, which Scotland's Mental Health strategy has outlined as a key area for action, recommending opportunities to "pilot improved arrangements for dual diagnosis for people with problem substance use and mental health diagnosis". A literature review aiming to build a 'Typology' of psychiatric emergency services in the UK emphasised wide variation in provision and heterogeneity of models. No prospective study has yet quantified this variation in terms of waiting times, types of assessment offered, disposition and outcomes. The success of other large observational studies on ED presentations such as syncope, acute aortic syndromes and frailty suggests that a similar methodology could be applied to mental health and related presentations.

Study Timeline

• Study First Submitted: 2024-10-21
• Study First Submitted QC: 2024-10-21
• Study First Posted: 2024-10-23
• Status Verified: 2024-12
• Last Update Submitted: 2024-12-08
• Last Update Posted: 2024-12-12
• Study Start: 2025-02-03
• Primary Completion: 2025-03-18
• Study Completion: 2025-03-18

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 398

Inclusion Criteria

• Issues of mental health AND/OR
• Issues of substance use AND/OR
• Psychological distress (this refers to patients without an established mental health or substance use disorder who nonetheless present in a distressed state, where distress is not caused by a readily identifiable and treatable physical condition) AND/OR
• Where the treating ED team feel the patient would benefit from some form of mental health or addictions assessment or intervention, whether carried out by ED staff, specialist services or third sector agencies.

Exclusion Criteria

1. Patients aged 10 and under.
2. Patients with distress caused by a physical condition, relieved by appropriate treatment.
3. Delirium, unless caused by a mental health- or substance-related disorder.
4. Patients with alcohol intoxication alone, without other evidence of harmful use of alcohol and without evidence of psychological distress.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Proportion fo ED attendance related to issues of mental health, substance use or psychological distress	7 days	Number of patients meeting eligibility criteria, expressed as a proportion of all ED attendances at each site during the study period.

Secondary Outcome Measures

Name	Time	Method
Resource Availability Scale	7 days	Perception of resource availability (self-reported by ED clinicians on a Visual Analog Scale) for managing an individual patient presenting with issues of mental health, substance use or psychological distress. Values may range from 0 (complete lack of resources) to 10 (all resources available).
Proportion of patients physically in ED who meet inclusion criteria at any one time	7 days	Proportion of patients physically in the ED who meet inclusion criteria at any given time over the 7-day study period.
Comparison with coding data	7 days	Proportion of total ED patients meeting inclusion criteria during the study period compared with coding data from a recent historical cohort at one site (NHS Fife).
Admission rate	7 days	Proportion of patients meeting inclusion criteria who are admitted to hospital on an informal basis, and proportion admitted under detention.
Length of stay	30 days	Mean, standard deviation (or nonparametric equivalents) and range of lengths of ED and hospital stay for patients meeting inclusion criteria.
Specialist mental health or addictions input in ED	7 days	Proportion of patients meeting inclusion criteria who receive specialist mental health or addictions input whilst in ED.
Specialist referrals from ED	7 days	Proportion of patients meeting inclusion criteria who are referred by the ED team for specialist mental health or addictions input after ED discharge.
7-day and 30-day follow-up	30 days	Proportion of patients meeting inclusion criteria who return to ED, are admitted to hospital or die within 7 and 30 days of index ED visit.
Clinician Confidence Scale	7 days	Self-reported confidence of ED clinicians (Visual Analog Scale) in managing an individual patient presenting with issues of mental health, substance use or psychological distress. Values may range from 0 (no confidence at all) to 10 (complete confidence).

Trial Locations

Locations (1)

Victoria Hospital; 🇬🇧 Kirkcaldy, Fife, United Kingdom