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The European Journal of Public Health Advance Access published online on October 25, 2006
The European Journal of Public Health, doi:10.1093/eurpub/ckl248
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© The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received August 28, 2006
Accepted September 22, 2006

Article

Are mental health problems associated with use of Accident and Emergency and health-related harm?

J. Keene 1 * and J. Rodriguez 1

1 University of Reading, Reading, UK

* To whom correspondence should be addressed.
J. Keene, E-mail: j.keene{at}reading.ac.uk


  Abstract

Background: Previous findings indicate that mental health problems are common in Emergency departments; however, there are few studies of the extent of health-related problems and emergency service use in mental health populations as a whole. Methods: Record linkage methods were used to map the association between mental health, age, gender, and health-related harm across total health and mental health care populations in one geographical area, over three years. By examining patterns of health-related harm, an accurate profile of mentally ill Emergency patients was generated enabling identification of factors that increased vulnerability to harm. Results: Of the total population of 625 964 individuals, 10.7% contacted Accident and Emergency (A&E) over three years, this proportion rose to 28.6% among the total secondary care mental health population. Young men and older women were more likely to contact A&E, both overall and within mental health populations and were also more likely to be frequent attendees at A&E. Four distinct groups (typologies) of mental health patients attending A&E emerged: young, male frequent attendees with self-inflicted and other traumatic injuries; young females also presenting with self-harm; older patients with multiple medical conditions; and very old patients with cardiac conditions and fractures. Conclusion: The study indicates increased A+E service use and unmet health-related need within a total mental health population. It identifies specific ‘care populations’ particularly vulnerable to accidents and self-harm and highlights the need for targeted services for mentally ill groups who may not access traditional health and social care services effectively.

Keywords: Accident and Emergency; health-related harm; mentally ill; populations.
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