Psychiatric Emergencies in the Community: Characteristics and Outcome in Switzerland

• Published in: Administration and policy in mental health and mental health services research Vol. 48; no. 6; pp. 1055 - 1064
• Main Authors: Moetteli, Sonja, Heinrich, Raphael, Jaeger, Matthias, Amodio, Camillo, Roehmer, Jan, Maatz, Anke, Seifritz, Erich, Theodoridou, Anastasia, Hotzy, Florian
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2021; Springer Nature B.V
• Subjects: Clinical Psychology; Community; Crisis intervention; Emergencies; Health Administration; Health Informatics; Hospitals; Humans; Inpatient care; Involuntary; Medical records; Medicine; Medicine & Public Health; Mental disorders; Mental health care; Original; Original Article; Patient admissions; Patients; Police stations; Psychiatric symptoms; Psychiatry; Psychosis; Psychotic Disorders; Public Health; Public spaces; Referral and Consultation; Refusal; Retrospective Studies; Risk factors; Situational factors; Sociodemographics; Suicide; Switzerland; Switzerland; Psychiatric emergencies; Crisis intervention; Involuntary admission; Community services; Hospital admission; Coercion
• ISSN: 0894-587X; 1573-3289
• DOI: 10.1007/s10488-021-01117-7

Psychiatric emergencies occur frequently in the community setting, e.g. the patient’s home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical records of consultations classified as psychiatric emergencies of a 24/7 service of community-based emergency physicians. Information on sociodemographic, clinical and situational factors was extracted. The observation period was 6 months in 2017. Binary logistic regression was used to examine predictors for involuntary admissions. Most emergency consultations (64.5%) took place at the patient’s home, followed by police stations (31.0%), public places (3.2%), and somatic hospitals (1.3%). Patient characteristics and reasons for consultation varied considerably between the locations. The first involved person was commonly a relative. Of all consultations, 38.4% resulted in involuntary admissions, mainly in patients with psychosis, suicidality, aggression, refusal of necessary treatment and previous involuntary admissions. Situation-related factors and the involvement of relatives were no significant predictors of the outcome. Psychiatric emergencies occur in different places and in patients with a variety of psychiatric symptoms. Although half of the emergency situations were resolved in the community, the rate of involuntary admissions was still high. For additional reduction, the further development of quickly available alternatives to psychiatric inpatient treatment is required. These should be specifically geared towards acute situations in patients with the described risk factors. Additionally, the role of relatives during psychiatric emergencies should be further studied.