Understanding Psychological Distress and Therapeutic Environment in the Emergency Department

NCT ID: NCT06655467

Last Updated: 2024-12-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Total Enrollment

398 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-02-03

Study Completion Date

2025-03-18

Brief Summary

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This research aims to establish the number of patients coming to Emergency Departments (EDs) with issues relating to mental health, alcohol or drugs, or in some form of psychological distress, including those for whom this was not the main reason for attending ED. We will collect anonymous information on age, gender, ethnicity, when and how they came to the ED, where and how they are cared for whilst in the ED, and what happens to them afterwards. With this information we hope to build a better picture of these patients so we can go on to design and test ways to improve their care in the future.

Detailed Description

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Those presenting to the Emergency Department with mental ill health, substance misuse or in crisis have a worse patient journey than those presenting with physical issues alone. They wait twice as long to be seen1 and have poorer experiences. Recognising this, the RCEM/James Lind Alliance Priority Setting Partnership has placed mental health at the top of the Emergency Medicine research agenda. The question asked is: "How can care for mental health patients be optimised, whether presenting with either/both physical and mental health needs; including appropriate space to see patients, staff training, early recognition of symptoms, prioritisation, and patient experience?" An explicit research agenda has yet to emerge from this very broad question. At the most basic level, the patient population needs to be defined, the scale of the problem quantified, and current practice patterns and variation described in detail.

It has been estimated that the proportion of ED attendances related to "mental health disorders" is 4%. However these estimates are derived from retrospective data and are dependent on accurate diagnosis coding. There is a lack of data on dual diagnoses, which Scotland's Mental Health strategy has outlined as a key area for action, recommending opportunities to "pilot improved arrangements for dual diagnosis for people with problem substance use and mental health diagnosis". A literature review aiming to build a 'Typology' of psychiatric emergency services in the UK emphasised wide variation in provision and heterogeneity of models. No prospective study has yet quantified this variation in terms of waiting times, types of assessment offered, disposition and outcomes. The success of other large observational studies on ED presentations such as syncope, acute aortic syndromes and frailty suggests that a similar methodology could be applied to mental health and related presentations.

Conditions

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Mental Health Substance Use (Drugs, Alcohol) Psychological Distress

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Interventions

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Routine Care

This study involves no change in clinical care and no study specific interventions for participants.

Intervention Type BEHAVIORAL

Other Intervention Names

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Standard Care

Eligibility Criteria

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Inclusion Criteria

* Issues of mental health AND/OR
* Issues of substance use AND/OR
* Psychological distress (this refers to patients without an established mental health or substance use disorder who nonetheless present in a distressed state, where distress is not caused by a readily identifiable and treatable physical condition) AND/OR
* Where the treating ED team feel the patient would benefit from some form of mental health or addictions assessment or intervention, whether carried out by ED staff, specialist services or third sector agencies.

Exclusion Criteria

1. Patients aged 10 and under.
2. Patients with distress caused by a physical condition, relieved by appropriate treatment.
3. Delirium, unless caused by a mental health- or substance-related disorder.
4. Patients with alcohol intoxication alone, without other evidence of harmful use of alcohol and without evidence of psychological distress.
Minimum Eligible Age

11 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Royal College of Emergency Medicine

OTHER

Sponsor Role collaborator

NHS Fife

OTHER_GOV

Sponsor Role lead

Responsible Party

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Rajendra Raman

Chief Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Victoria Hospital

Kirkcaldy, Fife, United Kingdom

Site Status

Countries

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United Kingdom

Central Contacts

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Rajendra Raman, MBBChir

Role: CONTACT

Phone: +447803814111

Email: [email protected]

Facility Contacts

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Rajendra Raman, MBBChir

Role: primary

References

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European Taskforce on Geriatric Emergency Medicine (ETGEM) collaborators. Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study. Eur Geriatr Med. 2024 Apr;15(2):463-470. doi: 10.1007/s41999-023-00926-3. Epub 2024 Feb 10.

Reference Type BACKGROUND
PMID: 38340282 (View on PubMed)

McLatchie R, Reed MJ, Freeman N, Parker RA, Wilson S, Goodacre S, Cowan A, Boyle J, Clarke B, Clarke E; DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. Emerg Med J. 2024 Feb 20;41(3):136-144. doi: 10.1136/emermed-2023-213266.

Reference Type BACKGROUND
PMID: 37945311 (View on PubMed)

Reed MJ, Karuranga S, Kearns D, Alawiye S, Clarke B, Mockel M, Karamercan M, Janssens K, Riesgo LG, Torrecilla FM, Golea A, Fernandez Cejas JA, Lupan-Muresan EM, Zaimi E, Nuernberger A, Rennet O, Skjaerbaek C, Polyzogopoulou E, Imecz J, Groff P, Camilleri R, Cimpoesu D, Jovic M, Miro O, Anderson R, Laribi S; SEED investigators. Management of syncope in the Emergency Department: a European prospective cohort study (SEED). Eur J Emerg Med. 2024 Apr 1;31(2):136-146. doi: 10.1097/MEJ.0000000000001101. Epub 2023 Nov 27.

Reference Type BACKGROUND
PMID: 38015745 (View on PubMed)

Odejimi O, Bagchi D, Tadros G. Typology of psychiatric emergency services in the United Kingdom: a narrative literature review. BMC Psychiatry. 2020 Dec 10;20(1):587. doi: 10.1186/s12888-020-02983-5.

Reference Type BACKGROUND
PMID: 33302905 (View on PubMed)

Scottish Government (2017) Mental Health Strategy: 2017-2027. Crown Copyright. Available at: https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2017/03/mental-health-strategy-2017-2027/documents/00516047-pdf/00516047-pdf/govscot%3Adocument/00516047.pdf

Reference Type BACKGROUND

Barratt H, Rojas-Garcia A, Clarke K, Moore A, Whittington C, Stockton S, Thomas J, Pilling S, Raine R. Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis. PLoS One. 2016 Apr 27;11(4):e0154449. doi: 10.1371/journal.pone.0154449. eCollection 2016.

Reference Type BACKGROUND
PMID: 27120350 (View on PubMed)

Baracaia S, McNulty D, Baldwin S, Mytton J, Evison F, Raine R, Giacco D, Hutchings A, Barratt H. Mental health in hospital emergency departments: cross-sectional analysis of attendances in England 2013/2014. Emerg Med J. 2020 Dec;37(12):744-751. doi: 10.1136/emermed-2019-209105. Epub 2020 Nov 5.

Reference Type BACKGROUND
PMID: 33154100 (View on PubMed)

Royal College of Emergency Medicine (2022) James Lind Alliance Emergency Medicine Priority Setting Partnership Refresh 2022. Available at: https://rcem.ac.uk/research-priorities/

Reference Type BACKGROUND

Digel Vandyk A, Young L, MacPhee C, Gillis K. Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons. Qual Health Res. 2018 Mar;28(4):587-599. doi: 10.1177/1049732317746382. Epub 2017 Dec 12.

Reference Type BACKGROUND
PMID: 29231128 (View on PubMed)

Clarke DE, Dusome D, Hughes L. Emergency department from the mental health client's perspective. Int J Ment Health Nurs. 2007 Apr;16(2):126-31. doi: 10.1111/j.1447-0349.2007.00455.x.

Reference Type BACKGROUND
PMID: 17348963 (View on PubMed)

Royal College of Emergency Medicine (2022) RCEM Acute Insight Series: Mental Health Emergency Care. Available at: https://rcem.ac.uk/wp-content/uploads/2022/09/RCEM-Acute-Insight-Series-Mental-Health-Emergency-Care.pdf

Reference Type BACKGROUND

Other Identifiers

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24/EM/0245

Identifier Type: -

Identifier Source: org_study_id