Psychiatric Emergency or General Emergency: Evolution or Involution? A Qualitative Study With Mental Health and Emergency Professionals

Abstract

The treatment of individuals with psychiatric disorders who visit the Emergency Department (ED) remains a significant issue within healthcare organisations. Over the past decades, various organisational solutions have been proposed, ranging from dedicated Emergency Departments to liaison mechanisms involving mental health nurses within EDs or direct access to acute units. On one hand, there are clinical and organisational needs pushing towards the creation of dedicated pathways; on the other hand, there are concerns that such solutions may be counterproductive and dangerous in terms of health and social inclusion. The aim of this study is to assess the opinions of Mental Health and Emergency professionals on the advantages and disadvantages of clinical and organisational pathways dedicated to patients with psychiatric disorders who visit the general ED. The study was conducted using a qualitative research approach: semi-structured interviews were carried out through purposeful sampling composed of two cohorts: Emergency and Mental Health professionals. The data were analysed using content analysis with the software Atlas.ti. Forty-five interviews were collected, and six main themes/families were identified. A certain distance in opinions between the two cohorts emerged, especially regarding the adoption of dedicated pathways. In both cohorts, but particularly in the mental health cohort, there is a fear of stigmatisation and violation of patients' rights in dedicated pathways. Both groups believe that there is a need for more specific training and greater multidisciplinarity. This study adheres to the COREQ checklist for qualitative studies.