Reducing mental health emergency department visits through community-based assessment services. A controlled time-series analysis in the city of Lyon, France

Background

The mental health burden on Emergency Departments (EDs) is significant. Community-based mental health services are key to lowering ED visits by addressing mental health needs proactively.

Objective

To examine the impact of CAdEO, a community-based patient assessment and triage service launched in 2020 in Lyon, France, on psychiatric ED visits among new patients at a local psychiatric hospital.

Methods

We first used a quasi-experimental interrupted time series design to compare populations exposed (new patients) vs. non-exposed (patients currently under care) to CAdEO from 2015 to 2023. Second, we investigated how the quality of service functioning, measured by delays between referrals and consultations, affected ED visits.

Results

Exposure to the CadEO service was associated with a 0.5% daily decrease in mental health-related ED visits (Risk ratio (RR): 0.995; 95% Confidence Interval (CI): 0.991, 0.999). Reducing the waiting times for triage from 12 days to 4.7 days over a six-week period was associated with a 26.5% decrease in ED presentations (RR: 0.735; 95% CI=0.548, 0.986). Our sex-stratified analysis revealed that the ongoing effects of CAdEO resulted in males having lower ED visit rates than females. However, reducing waiting times for triage was associated with a lower rate of female ED visits. Finally, shorter CAdEO waits were linked to lower ED visits for mood and personality disorder patients.

Conclusions

This study suggests that a community-based patient assessment and triage service may help reduce the overall demand for mental health care in ED. Our findings also highlight the necessity for tailored approaches that consider gender and specific mental health conditions.