Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey

While it is established that rural residents often seek care for mental health problems in primary care settings, or in some cases in a Community Mental Health Center, lack of providers and lack of insurance may lead those with mental illness to the hospital emergency room (ER). Critical Access Hospitals (CAHs) are, by definition, located in small, remote and underserved rural communities and must offer 24-hour emergency services. In such communities, access to local mental health services is more likely to be a problem, and the ER may be a key piece of the mental health ?safety net.? This study investigates the extent and types of cases that present with mental health problems in CAH ERs, as well as the resources available to ER staff for addressing such problems and what actually happens to such patients.
Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. In addition, 184 of these hospitals completed ER logs documenting all ER visits in two 24-hour periods, with details about presenting symptoms, treatment, and final disposition.