Emergency Linkage to Outpatient Psychiatric Services

Study Overview
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Brief Summary
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The purpose of this study is to compare two different kinds of follow-up care and their effects on psychiatric service use and psychological well-being. This randomized, controlled trial of subjects discharged from the psychiatric emergency services to outpatient care receive traditional hospital-based outpatient clinic referrals (treatment as usual) or appointments for community-based follow-up by a mobile crisis team.

Detailed Description
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There are subgroups of patients who only seek care in emergency settings. An effective strategy to link that group to ambulatory care involves extending contact with psychiatric emergency services beyond the initial hospital-based visit. The window of opportunity to promote successful treatment linkage is brief. This is a study of a novel treatment format that seeks to expand the concept of the emergency contact, the study patients method of entering the mental health system of care, and by doing this, enhance retention in prescribed outpatient care. The effects of the intervention on patient symptoms and mental health service use will be examined.

Official Title
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Emergency Linkage to Outpatient Psychiatric Services

Conditions
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Emergency Services, Psychiatric

Intervention / Treatment
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* Procedure: mobile crisis team


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: English and Spanish-speaking adult patients (18-and above) presenting to the psychiatric emergency service who rate a 1 or higher on the Spectrum of Suicidal Behavior of Pfeffer screening scale, and who have outpatient followup organized by Comprehensive Psychiatric Emergency Program staff through hospital outpatient psychiatric services are eligible for inclusion. Exclusion Criteria: Subjects less than 18 years old, those rated as not suicidal in the emergency department, subjects with mental retardation/developmental delay, and subjects who have community psychiatric treatment that they elect to continue in lieu of hospital outpatient psychiatric services referral are ineligible.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: mobile crisis team|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Subjects randomized to the experimental treatment will demonstrate significantly increased rates of linkage to first outpatient contact as compared with subjects randomized to control treatment. |  | 1 week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Subjects randomized to experimental treatment will demonstrate significantly reduced levels of psychiatric symptoms and significantly increased scores of overall functioning at 3 months after study enrollment, |  | 3 months | 
| and will demonstrate significantly higher use of outpatient mental health clinical services, lower use of ED contacts, and lower use of inpatient mental health services versus the control group during the six months after study enrollment. |  | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mental Health Services, Suicide, Suicide ideation