The suburban-city divide: an evaluation of emergency department mental health presentations across two centres

Objective To evaluate the characteristics of mental health presentations to the emergency department in two different hospital settings. Methods This was a retrospective cross-sectional study examining ED referrals to psychiatry in an inner-city and suburban centre. The authors collected data on gender, age, employment, housing, clinical presentation, time of assessment and admissions, over a 1-month period. Results The total number referred was 213: inner-city n = 109 and suburban n = 104. The inner-city saw a younger population; 47/109 (43%) were aged between 20 and 29 years, compared with 28/104 (27%) of suburban presenters ( P value 0.0134). A higher number of presenters were aged over 60 in the suburban centre n = 13/104 (12.5%) versus the inner-city centre 3/109 (2.8%) ( P value 0.0084). In the inner-city, the proportion of homeless presenters was significantly higher at 30/109 (28%) versus 5/104 (4.8%) in the suburban setting ( P < 0.0001). Presentations related to substances were highest, a total of 73 (34.3%) across both centres, with no significant difference in clinical presentations across the two centres. The majority were seen in the on-call period , 74/109 (67.9%) in the inner-city centre and 66/104 (63.5%) in the suburban centre. The psychiatric admission rate was significantly different between the two centres, with 33/109 (30.3%) patients admitted in the inner-city centre and 13/104 (12.5%) patients admitted in the suburban centre ( P value 0.002). Conclusions A large proportion of ED referrals to psychiatry constitute patients with unmet social and addiction needs, who are seen out of hours. This prompts consideration of expanding both ED and community services to comprise a more multidisciplinary-resourced, 24/7 care model.