Who has incomplete emergency department care among mental health patients in Australia? Does it impact short and longer-term representations?

Background: Patients with mental health (MH) problems are at higher-than-average risk of leaving emergency departments (EDs) against medical advice and of re-presentations. For patients with a MH diagnosis in ED, we aimed to identify factors associated with patients who leave at own risk (LAOR) and the association between LAOR and 7- and 28-day re-presentations.

Methods: A retrospective analysis of all MH presentations to public hospital EDs in a Local Health District in Sydney, Australia between 2022 and 2023. GLIMMIX logistic regression models explored associations between patient and healthcare characteristics and risk of LAOR, and between LAOR and re-presentations.

Results: Patients more likely to LAOR were younger than 60, born in Australia, arrived at the ED between 4 pm and 8 am by private transport, were not triaged as resuscitation/emergency, had treatment initiated outside the triage benchmark time, and had an "Unspecified mental disorder" diagnosis. LAOR was inversely associated with time spent in the ED. LAOR was independently positively associated with a multi-fold risk of 7- and 28-day re-presentation.

Conclusion: Aspects of individual circumstances, healthcare, and patient's MH contribute to LAOR incidence. Future research should examine the potential long-term consequences of LAOR for MH patients and disentangle factors affecting the ED's care of MH presentations. (195 words).