The finding:
The investigators used a nationwide database of emergency department (ED) visits to describe correlates of ED visits with a psychiatric diagnosis. Studying one year of data (2018), the investigators identified 38.4 million encounters with either a primary or secondary psychiatric diagnosis. Among these, the most common primary diagnoses, by organ system, pertained to a primary mental health disorder (15%), injury or poisoning (15%), respiratory complaint (9%), or digestive complaint (8%). Encounters for a primary psychiatric diagnosis were more likely to occur in Southern regions with fewer psychiatrists per capita and among lower income patients or those with Medicaid. Nineteen percent of encounters for a primary psychiatric diagnosis resulted in hospital admission.

Strength and weaknesses:
By including both primary and secondary diagnoses, this brief paper provides helpful information as to the huge need for delivering behavioral health treatment in EDs. Descriptors of the patient, hospital, and encounters are combined to provide a helpful portrait of these visits. There are notable limitations however: all analyses are based on encounters, so many patients likely contribute multiple times to the dataset which may limit interpretation of correlations. The dataset is weighted to provide estimates, but little detail or consideration of the dataset’s strengths for these analyses is provided by the authors. No description of missing data is provided, and the analysis is based on diagnostic codes as part of routine practice. The data are somewhat older and pre-pandemic.

Relevance:
This paper highlights the extent of ED utilization for psychiatric care in the United States. Emergency psychiatrists must be aware that most ED patients with behavioral health needs are initially presenting for non-psychiatric care. These patients’ needs are likely different than those who present to the ED for a primary mental health diagnosis. The latter appear to be poorer and have less access to community psychiatry; the former have psychiatric diagnoses complicating their presentation and may benefit from strategies and staff training to improve the equitability of care provided for patients with mental health disorders in ED and crisis settings.