Patient Perspectives of Emergency Mental Health Care in a Rural State.

Rural mental health Pub Date : 2025-01-01 Epub Date: 2024-10-17 DOI:10.1037/rmh0000279
Kelly Knight, Callan Gravel-Pucillo, Miles Lamberson, Roz King, Christian Pulcini
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Abstract

Increases in emergency department (ED) presentations for mental health conditions continue to challenge the national mental healthcare infrastructure, often resulting in ED boarding. However, limited prior studies capture the perspectives on mental healthcare of those experiencing prolonged boarding in the ED (≥ 24 hours stay) for mental health conditions. We aimed to assess patient perspectives on acute mental healthcare among individuals boarding in a general ED in a rural state. We performed semi-structured interviews of adults (≥18 years old) presenting with a primary mental health condition boarding in a general ED for at least 24 hours. An interview guide was developed a priori, and a trained study team performed the interviews. A thematic analysis was conducted by two independent coders. A coding tree was developed through an iterative process that included double-coding transcripts and monitoring of inter-rater reliability. Fifteen patients were interviewed to reach saturation. Ages ranged from 22 to 65. Analysis revealed several key themes including the environment of the ED, interactions with family members and staff, communication regarding the plan of care, patient perceptions of autonomy and respect, and mental healthcare services provided outside the ED. Our study revealed that adults encounter significant challenges to access timely acute mental healthcare in the ED in a rural state. Participant recommendations for improvement included increasing the availability of therapy while in the ED and providing a physical environment that is more welcoming. Community, hospital-based, and statewide quality improvement and public policy strategies should be considered to address the identified challenges.

农村地区紧急精神卫生保健的患者视角
急诊科(ED)心理健康状况报告的增加继续挑战着国家精神卫生保健基础设施,往往导致急诊科登牌。然而,有限的先前研究捕获了那些因精神健康状况而在急诊科长时间登机(≥24小时)的人的精神保健观点。我们的目的是评估在农村州普通急诊科登机的患者对急性精神保健的看法。我们对在普通急诊科住院至少24小时且有初级心理健康问题的成年人(≥18岁)进行了半结构化访谈。事先制定了一份访谈指南,由训练有素的研究小组进行访谈。两位独立编码员进行了专题分析。一个编码树是通过一个迭代的过程,包括双编码转录本和监测之间的可靠性。15例患者访谈达到饱和。年龄从22岁到65岁不等。分析揭示了几个关键主题,包括急诊科的环境,与家庭成员和工作人员的互动,关于护理计划的沟通,患者对自主权和尊重的看法,以及急诊科外提供的精神卫生保健服务。我们的研究显示,在农村州的急诊科,成年人在获得及时的急性精神卫生保健方面遇到了重大挑战。参与者提出的改善建议包括在急诊科增加治疗的可用性,并提供一个更受欢迎的物理环境。应考虑社区、医院和全州范围的质量改进和公共政策战略,以应对已确定的挑战。
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