Youth Mobile Response and Stabilization Services: Factors Associated with Multiple Episodes of Care.

Mobile response and stabilization services (MRSS) provide short-term, community-based, care to individuals in crisis. Minimal studies have explored which factors are associated with multiple episodes of MRSS care. We used a retrospective cohort design of MRSS electronic health records to explore demographic and clinical characteristics associated with multiple episodes of care among 2,641 youth ages 5-21 years old in New York, USA. Youth with multiple episodes of care (n = 585; 22.2%) were more likely to be non-Hispanic, have treatment histories including presenting problems related to adjustment, conduct, mood, or suicidal thoughts and behaviors, have high-level mental health visits, and more follow-up visits. Future research should examine the unmet needs of non-Hispanic populations and whether characteristics associated with multiple MRSS episodes are consistent across populations to inform procedures targeting unmet needs that prevent or minimize repeated use during crises.

Increasing Emergency Department Visits for Mental Health Conditions in the United States.

OBJECTIVE: The Affordable Care Act (ACA) of 2010 was fully implemented in 2014, expanding access to outpatient mental health services and potentially reducing reliance on emergency (ED) services. This study examined trends and correlates of ED visits for mental health conditions from 2007 to 2016, with attention to changes in ED use after 2014. METHODS: Nationally representative samples of ED visits in the United States were assessed using a repeated cross-sectional analysis of National Hospital Ambulatory Medical Care Survey data. This study used diagnoses associated with each ED visit to identify changes in proportions in mental health diagnostic categories (psychiatric diagnoses only, substance use-related diagnoses only, or both, based on ICD-9-CM or ICD-10-CM criteria). These trends were further examined by age, sex, race/ethnicity, and insurance status. The statistical significance of temporal patterns was evaluated with multivariate logistic regression analyses. RESULTS: Between 2007 and 2016, about 8.4 million (8.3%) of 100.9 million ED visits nationwide were for psychiatric or substance use-related diagnoses. Over the 10-year study period, the proportion of ED visits for mental health diagnoses increased from 6.6% to 10.9% (P < .001). Visits for alcohol and "other" substance use and psychiatric diagnoses classified as "other" accounted for an increasing portion of mental health-related ED visits during this time (P < .001). ED visits in which Medicaid was the primary source of insurance coverage showed the largest increase, nearly doubling from 27.2% in 2007-2008 to 42.8% in 2015-2016 (adjusted odds ratio for linear trends = 1.71; 95% CI, 1.36-2.15). CONCLUSIONS: ED utilization for mental health conditions-and especially substance use conditions-significantly increased in the last decade. The increasing use of EDs by patients with mental health conditions may indicate suboptimal delivery of effective or acceptable outpatient mental health care, particularly for substance use-related conditions.